[Federal Register Volume 78, Number 17 (Friday, January 25, 2013)]
[Pages 5459-5461]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2013-01300]



Centers for Medicare & Medicaid Services


Medicare Program; Request for Information To Aid in the Design 
and Development of a Survey Regarding Patient Experiences With Hospital 
Outpatient Surgery Departments/Ambulatory Surgery Centers and Patient-
Reported Outcomes From Surgeries and Procedures Performed in These 

AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.

ACTION: Request for information.


SUMMARY: This document is a request for information regarding hospital 
outpatient surgery departments (HOSDs) and ambulatory surgery centers 
(ASCs), as well as patient-reported outcomes from surgeries or other 
procedures performed in these settings.

DATES: The information solicited in this notice must be received at the 
address provided below by March 26, 2013.

ADDRESSES: In responding to this solicitation, please reply via email 
to AmbSurgSurvey@cms.hhs.gov or by postal mail at Centers for Medicare 
and Medicaid Services, Attention: Memuna Ifederah, Mailstop C1-25-05, 
7500 Security Boulevard, Baltimore, MD 21244-1850.

FOR FURTHER INFORMATION CONTACT: Memuna Ifederah, (410) 768-6849 or 
Caren Ginsberg (410) 786-0713.


I. Background

    In accordance with section 3011 of the Affordable Care Act, the 
Department of Health and Human Services (HHS) developed the National 
Quality Strategy to create national aims and priorities to guide local, 
state, and national efforts to improve the quality of health care. The 
National Quality Strategy established three aims supported by six 
    The 3 aims are as follows:
     Better Care: Improve the overall quality, by making health 
care more patient-centered, reliable, accessible, and safe.
     Healthy People/Healthy Communities: Improve the health of 
the U.S. population by supporting proven interventions to address 
behavioral, social, and environmental determinants of health in 
addition to delivering higher quality care.
     Affordable Care: Reduce the cost of quality health care 
for individuals, families, employers, and government.\1\

    \1\ Please see U.S. Department of Health and Human Services, 
Report to Congress, National Strategy for Quality Improvement in 
Health Care, (March 2011), available at http://www.healthcare.gov/law/resources/reports/nationalqualitystrategy032011.pdf.

    The six priorities are: ``(1) Making care safer by reducing harm 
caused by the delivery of care; (2) ensuring that each person and 
family are engaged as partners in their care; (3) promoting effective 
communication and coordination of care; (4) promoting the most 
effective prevention and treatment practices for the leading causes of 
mortality, starting with cardiovascular disease; (5) working with 
communities to promote wide use of best practices to enable health 
living; and (6) making quality care more affordable for individuals, 
families, employers and governments by developing and spreading new 
health care delivery models''.
    Surveys focusing on the patient experience as well as the Hospital 
Outpatient Surgery Department/

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Ambulatory Surgery Patient Experience of Care Survey now under 
development support the National Quality Strategy of better care and 
the priorities of--
     Ensuring that each person and family are engaged as 
partners in their care (priority 2); and
     Promoting effective communication and coordination of care 
(priority 3).
    Since 1995, the Agency for Healthcare Research and Quality (AHRQ) 
and its Consumer Assessment of Healthcare Providers and Systems 
(CAHPS[supreg]) Consortium, in partnership with the Centers for 
Medicare & Medicaid Services (CMS), has developed standardized 
CAHPS[supreg] Surveys and tools for a variety of populations to collect 
data on patient's experiences with and ratings of care. CMS and AHRQ 
have developed CAHPS[supreg] surveys for in-center hemodialysis 
facilities, nursing homes, and clinician and group practices. CMS has 
already implemented CAHPS[supreg] surveys for health and drug plans, 
hospitals, and home health agencies.
    We are developing a standardized Hospital Outpatient Surgical 
Department/Ambulatory Surgical Center (HOSD/ASC) Experience of Care 
Survey to evaluate the care received in these facilities from the 
patient's perspective. Two related CAHPS[supreg] surveys exist; 
however, they do not collect information specific to the patient 
experience of care in HOSD/ASC facilities. In 2006, CMS began 
implementing the Hospital CAHPS[supreg] (HCAHPS) Survey, which collects 
data on hospital inpatients experiences with and ratings of hospital 
inpatient care. The HCAHPS Survey includes neither patients who receive 
outpatient surgical care from hospital-based outpatient surgical 
departments, nor patients who received such care from freestanding 
ASCs. The Surgical Care CAHPS[supreg] Survey, developed by the American 
College of Surgeons (ACS) and the Surgical Quality Alliance (SQA) 
focuses on both inpatient and outpatient surgeries and includes 
questions related to the patient's experience before, during, and after 
surgery. However, this survey focuses on the care provided by the 
physician rather than the facility. Hospital outpatient surgery 
departments and ASCs will be the unit of analysis for this HOSD/ASC 
survey instrument. The Hospital Outpatient Surgery Department/
Ambulatory Surgery Center Patient Experience of Care Survey will be 
used to help consumers make informed choices about providers as well as 
improving the quality of care.

II. Solicitation of Information

    This document solicits input for developing this new patient 
experience survey, including the following:
     Relevant topic areas such as communication between 
patients and health care providers; access to care; customer service; 
provision of pre- and post-surgical care information; access to follow-
up care; care coordination; patient preferences; environment; and 
     Publicly available surveys, survey questions, and measures 
indicating-- (1) patient experience and/or level of patient 
satisfaction with experience in HOSDs/ASCs; and (2) patient-reported 
outcomes from surgeries or other procedures (for example, 
colonoscopies, endoscopies) performed in HOSDs and ASCs. These surveys, 
survey questions, and measures should measure and assess quality of 
care and patient-reported outcomes from the patient's perspective, and 
track changes over time.
    We are interested in suggestions for topic areas, and publicly 
available surveys, questions or measures that address the following 
specifically for outpatient surgery:
     Issues that are that are highly relevant to DHHS and CMS, 
because they support DHHS's and CMS's efforts for improved quality and 
efficiency of care and are included in or facilitate alignment with 
other CMS programs.
     Identification of gaps in the quality of care delivered in 
outpatient surgical departments.
     Measures of surgical care coordination and related care 
coordination activities.
     Identification and assessment of patient-reported 
outcomes, such as pain, nausea and vomiting, deep vein thrombosis, 
infection, pneumonia, and urinary retention.
    We are looking for suggested topic areas, as well as any publicly 
available surveys, questions and measures in which--(1) the source of 
information is from patients who directly received care at HOSDs or 
ASCs; and (2) patients identified the topic areas such as those listed 
above as important to them in evaluating HOSD or ASC care (for example, 
wait time and medical staff and physician communication). We are 
seeking topic areas, surveys, questions and measures that are 
applicable across outpatient surgical settings (for example, 
freestanding settings, hospital based settings, for-profit settings; 
not-for-profit settings; rural settings; urban settings; multi-
specialty and single-specialty surgery departments/centers). We prefer 
existing surveys, questions, and measures that have been tested and 
have a high degree of reliability and validity, and for which there is 
evidence of wide use.
    This request for information solicits input from consumers, 
researchers, vendors, health plans, HOSDs, ASCs, surgeons, advocacy 
organizations, community-based providers, and other stakeholders and 
interested parties. This call for topic areas, publicly available 
surveys, questions, and measures is occurring now because of the multi-
phased survey development and testing process necessary to produce a 
standardized instrument. The target population for the survey is adults 
(defined in CAHPS surveys as 18 years old and older) who recently have 
had surgery or other procedures, such as a colonoscopy or endoscopy, in 
a surgical outpatient setting.
    CMS is developing this survey and plans to submit it to AHRQ for 
recognition as a CAHPS[supreg] survey. The survey will be developed in 
accordance with CAHPS[supreg] Survey Design Principles and 
implementation instructions will be based on those for CAHPS[supreg] 
instruments (https://www.cahps.AHRQ.gov/About-CAHPS/Principles.aspx).
    We are asking respondents to include the following in their 
     A brief cover letter summarizing the information requested 
above for submitted topic areas, surveys, questions, and measures, and 
how the submission will help fulfill the intent of the patient 
experiences survey.
     (Optional) Information about the person submitting the 
material for purposes of follow-up questions about the submission, 
including the following:

++ Name.
++ Title.
++ Organization.
++ Mailing address.
++ Telephone number.
++ Email address.
++ Indication that the topic area or instrument is publicly available.

     When submitting topic areas, respondents should include to 
the extent available the following information:

++ Detailed descriptions of the suggested topic area(s) and specific 
++ Sample questions, in all available languages.
++ Relevant peer-reviewed journal articles or full citations.
++ Name of the instrument.
++ Copies of the full instrument in all available languages.
++ Topic areas included in the survey.
++ Measures derived from the survey.
++ Survey reliability (internal consistency, test-retest, etc.) and

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validity (content, construct, criterion-related).
++ Results of cognitive testing (one-on-one testing with a small number 
of respondents to ensure that they understand the questionnaire).
++ Results of field testing.
++ Current use of the instrument (who is using it, what it is being 
used for, what population it is being used with, how instrument 
findings are reported, and by whom the findings are used).
++ Relevant peer-review journal articles or full citations.
++ CAHPS[supreg] trademark status.
++ Survey administration instructions.
++ Data analysis instructions.
++ Guidelines for reporting survey data.

(Catalog of Federal Domestic Assistance Program No. 93.773, 
Medicare--Hospital Insurance; and Program No. 93.774, Medicare--
Supplementary Medical Insurance Program)

    Dated: December 13, 2012.
Marilyn Tavenner,
Acting Administrator, Centers for Medicare & Medicaid Services.
[FR Doc. 2013-01300 Filed 1-24-13; 8:45 am]