Agency Information Collection Activities: Proposed Collection; Comment Request, 25671-25674 [2018-11927]
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Federal Register / Vol. 83, No. 107 / Monday, June 4, 2018 / Notices
Federal Advisory Committee Act (5
U.S.C. App. 2), announcement is made
of an Agency for Healthcare Research
and Quality (AHRQ) Special Emphasis
Panel (SEP) meeting on AHRQ–HS–18–
001, ‘‘Patient Safety Learning
Laboratories: Pursuing Safety in
Diagnosis and Treatment at the
Intersection of Design, Systems
Engineering, and Health Services
Research (R18).’’
A Special Emphasis Panel is a group
of experts in fields related to health care
research who are invited by the Agency
for Healthcare Research and Quality
(AHRQ), and agree to be available, to
conduct on an as needed basis,
scientific reviews of applications for
AHRQ support. Individual members of
the Panel do not attend regularlyscheduled meetings and do not serve for
fixed terms or a long period of time.
Rather, they are asked to participate in
particular review meetings which
require their type of expertise.
Each SEP meeting will commence in
open session before closing to the public
for the duration of the meeting. The SEP
meeting referenced above will be closed
to the public in accordance with the
provisions set forth in 5 U.S.C. App. 2,
section 10(d), 5 U.S.C. 552b(c)(4), and 5
U.S.C. 552b(c)(6). Grant applications for
the ‘‘AHRQ–HS–18–001’’, ‘‘Patient
Safety Learning Laboratories: Pursuing
Safety in Diagnosis and Treatment at the
Intersection of Design, Systems
Engineering, and Health Services
Research (R18)’’ is to be reviewed and
discussed at this meeting. The grant
applications and the discussions could
disclose confidential trade secrets or
commercial property such as patentable
material, and personal information
concerning individuals associated with
the grant applications, the disclosure of
which would constitute a clearly
unwarranted invasion of personal
privacy.
Francis D. Chesley, Jr.,
Acting Deputy Director.
[FR Doc. 2018–11925 Filed 6–1–18; 8:45 am]
BILLING CODE 4160–90–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
sradovich on DSK3GMQ082PROD with NOTICES
Agency for Healthcare Research and
Quality
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, HHS.
ACTION: Notice.
AGENCY:
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This notice announces the
intention of the Agency for Healthcare
Research and Quality (AHRQ) to request
that the Office of Management and
Budget (OMB) approve the proposed
information collection project ‘‘Medical
Expenditure Panel Survey (MEPS)
Household Component and the MEPS
Medical Provider Component.’’
DATES: Comments on this notice must be
received by August 3, 2018.
ADDRESSES: Written comments should
be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by
email at doris.lefkowitz@AHRQ.hhs.gov.
Copies of the proposed collection
plans, data collection instruments, and
specific details on the estimated burden
can be obtained from the AHRQ Reports
Clearance Officer.
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
emails at doris.lefkowitz@
AHRQ.hhs.gov.
SUMMARY:
SUPPLEMENTARY INFORMATION:
Proposed Project
Medical Expenditure Panel Survey
(MEPS) Household Component (HC)
In accordance with the Paperwork
Reduction Act, 44 U.S.C. 3501–3521,
AHRQ invites the public to comment on
this proposed information collection.
For over thirty years, results from the
MEPS and its predecessor surveys (the
1977 National Medical Care
Expenditure Survey, the 1980 National
Medical Care Utilization and
Expenditure Survey and the 1987
National Medical Expenditure Survey)
have been used by OMB, DHHS,
Congress and a wide number of health
services researchers to analyze health
care use, expenses and health policy.
Major changes continue to take place
in the health care delivery system. The
MEPS is needed to provide information
about the current state of the health care
system as well as to track changes over
time. The MEPS permits annual
estimates of use of health care and
expenditures and sources of payment
for that health care. It also permits
tracking individual change in
employment, income, health insurance
and health status over two years. The
use of the NHIS as a sampling frame
expands the MEPS analytic capacity by
providing another data point for
comparisons over time.
Households selected for participation
in the MEPS–HC are interviewed five
times in person. These rounds of
interviewing are spaced about 5 months
apart. The interview will take place
with a family respondent who will
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25671
report for him/herself and for other
family members.
The MEPS–HC has the following goal:
D To provide nationally representative
estimates for the U.S. civilian
noninstitutionalized population for:
D health care use, expenditures, sources
of payment
D health insurance coverage
To achieve the goals of the MEPS–HC
the following data collections are
implemented:
1. Household Component Core Instrument.
The core instrument collects data about
persons in sample households. Topical areas
asked in each round of interviewing include
priority condition enumeration, health status,
health care utilization including prescribed
medicines, expenses and payments,
employment, and health insurance. Other
topical areas that are asked only once a year
include access to care, income, assets,
satisfaction with providers, and children’s
health. While many of the questions are
asked about the entire reporting unit (RU),
which is typically a family, only one person
normally provides this information. All
sections of the current core instrument are
available on the AHRQ website at https://
meps.ahrq.gov/mepsweb/survey_comp/
survey_questionnaires.jsp.
2. Adult Self-Administered Questionnaire.
A brief self-administered questionnaire
(SAQ) will be used to collect self-reported
data (rather than through household proxy)
on health opinions and satisfaction with
health care, and information on health status,
preventive care and health care quality
measures for adults 18 and older. This
questionnaire is revised from the previous
OMB clearance and received clearance on
May 9, 2018.
3. Veteran SAQ. MEPS includes a new selfadministered questionnaire for spring of 2019
data collection targeting the veteran
population. The questionnaire asks questions
in the following domains of interest: if a
veteran is eligible for VA health care; if a
Veteran is enrolled in VA health care;
coordination of care in and out of the VA
health care system, services provided to
Veterans in and out of the VA health care
system, and VA eligibility priority groups, for
Veterans enrolled in VA health care and for
Veterans eligible for VA health care. To assist
in the correct identification of priority
groups, the questionnaire may also include
items assessing the following: presence of
service-connected disability; serviceconnected disability rating; presence of
presumptive-conditions; timing and era of
active duty; and VA receipt of disability
compensation benefits. AHRQ worked with
the Veterans Health Administration to
develop the questionnaire content.
4. Diabetes Care SAQ. There is no change
in this instrument. A brief self-administered
paper-and-pencil questionnaire on the
quality of diabetes care is administered once
a year (during rounds 3 and 5) to persons
identified as having diabetes. Included are
questions about the number of times the
respondent reported having a hemoglobin
A1c blood test, whether the respondent
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reported having his or her feet checked for
sores or irritations, whether the respondent
reported having an eye exam in which the
pupils were dilated, the last time the
respondent had his or her blood cholesterol
checked and whether the diabetes has caused
kidney or eye problems. Respondents are also
asked if their diabetes is being treated with
diet, oral medications or insulin. This
questionnaire is unchanged from the
previous OMB clearance.
5. Authorization forms for the MEPS–MPC
Provider and Pharmacy Survey. There is no
change in this instrument. As in previous
panels of the MEPS, we will ask respondents
for authorization to obtain supplemental
information from their medical providers
(hospitals, physicians, home health agencies
and institutions) and pharmacies.
6. MEPS Validation Interview. There is no
change in this instrument. Each interviewer
is required to have at least 15 percent of his/
her caseload validated to insure that the
computer assisted personal interview (CAPI)
questionnaire content was asked
appropriately and procedures followed, for
example the use of show cards. Validation
flags are set programmatically for cases preselected by data processing staff before each
round of interviewing. Home office and field
management may also request that other
cases be validated throughout the field
period. When an interviewer fails a
validation their work is subject to 100
percent validation. Additionally, any case
completed in less than 30 minutes is
validated. A validation abstract form
containing selected data collected in the
CAPI interview is generated and used by the
validator to guide the validation interview.
Medical Expenditure Panel Survey
(MEPS) Medical Provider Component
(MPC)
The MEPS–MPC will contact medical
providers (hospitals, physicians, home
health agencies and institutions)
identified by household respondents in
the MEPS-HC as sources of medical care
for the time period covered by the
interview, and all pharmacies providing
prescription drugs to household
members during the covered time
period. The MEPS–MPC is not designed
to yield national estimates as a standalone survey. The sample is designed to
target the types of individuals and
providers for whom household reported
expenditure data was expected to be
insufficient. For example, Medicaid
enrollees are targeted for inclusion in
the MEPS–MPC because this group is
expected to have limited information
about payments for their medical care.
The MEPS–MPC collects event level
data about medical care received by
sampled persons during the relevant
time period. The data collected from
medical providers include:
• Dates on which medical encounters during
the reference period occurred
• Data on the medical content of each
encounter, including ICD-10 codes
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• Data on the charges associated with each
encounter, the sources paying for the
medical care-including the patient/family,
public sources, and private insurance, and
amounts paid by each source
Data collected from pharmacies
include:
• Date of prescription fill
• National drug code (NDC) or prescription
name, strength and form
• Quantity
• Payments, by source
The MEPS–MPC has the following
goal:
• To serve as an imputation source for and
to supplement/replace household reported
expenditure and source of payment
information. This data will supplement,
replace and verify information provided by
household respondents about the charges,
payments, and sources of payment
associated with specific health care
encounters.
To achieve the goal of the MEPS–MPC
the following data collections are
implemented:
1. MPC Contact Guide/Screening Call.
There is no change in this instrument. An
initial screening call is placed to determine
the type of facility, whether the practice or
facility is in scope for the MEPS–MPC, the
appropriate MEPS–MPC respondent and
some details about the organization and
availability of medical records and billing at
the practice/facility. All hospitals, physician
offices, home health agencies, institutions
and pharmacies are screened by telephone. A
unique screening instrument is used for each
of these seven provider types in the MEPS–
MPC, except for the two home care provider
types which use the same screening form.
2. Home Care Provider Questionnaire for
Health Care Providers. There is no change in
this instrument. This questionnaire is used to
collect data from home health care agencies
which provide medical care services to
household respondents. Information
collected includes type of personnel
providing care, hours or visits provided per
month, and the charges and payments for
services received. Some HMOs may be
included in this provider type.
3. Home Care Provider Questionnaire for
Non-Health Care Providers. There is no
change in this instrument. This questionnaire
is used to collect information about services
provided in the home by non-health care
workers to household respondents because of
a medical condition; for example, cleaning or
yard work, transportation, shopping, or child
care.
4. Medical Event Questionnaire for
Office-Based Providers. There is no change
in this instrument. This questionnaire is for
office-based physicians, including doctors of
medicine (MDs) and osteopathy (DOs), as
well as providers practicing under the
direction or supervision of an MD or DO (e.g.,
physician assistants and nurse practitioners
working in clinics). Providers of care in
private offices as well as staff model HMOs
are included.
5. Medical Event Questionnaire for
Separately Billing Doctors. There is no
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change in this instrument. This questionnaire
collects information from physicians
identified by hospitals (during the Hospital
Event data collection) as providing care to
sampled persons during the course of
inpatient, outpatient department or
emergency room care, but who bill separately
from the hospital.
6. Hospital Event Questionnaire. There is
no change in this instrument. This
questionnaire is used to collect information
about hospital events, including inpatient
stays, outpatient department, and emergency
room visits. Hospital data are collected not
only from the billing department, but from
medical records and administrative records
departments as well. Medical records
departments are contacted to determine the
names of all the doctors who treated the
patient during a stay or visit. In many cases,
the hospital administrative office also has to
be contacted to determine whether the
doctors identified by medical records billed
separately from the hospital; doctors that do
bill separately from the hospital will be
contacted as part of the Medical Event
Questionnaire for Separately Billing Doctors.
HMOs are included in this provider type.
7. Institutions Event Questionnaire. There
is no change in this instrument. This
questionnaire is used to collect information
about institution events, including nursing
homes, rehabilitation facilities and skilled
nursing facilities. Institution data are
collected not only from the billing
department, but from medical records and
administrative records departments as well.
Medical records departments are contacted to
determine the names of all the doctors who
treated the patient during a stay. In many
cases, the institution’s administrative office
also has to be contacted to determine
whether the doctors identified by medical
records billed separately from the institution
itself. Some HMOs may be included in this
provider type.
8. Pharmacy Data Collection
Questionnaire. There is no change in this
instrument. This questionnaire requests the
NDC and when that is not available the
prescription name, strength and form as well
as the date prescription was filled, payments
by source, the quantity, and person for whom
the prescription was filled. When the NDC is
available, we do not ask for prescription
name, strength or form because that
information is embedded in the NDC; this
reduces burden on the respondent. Most
pharmacies have the requested information
available in electronic format and respond by
providing a computer generated printout of
the patient’s prescription information. If the
computerized form is unavailable, the
pharmacy can report their data to a telephone
interviewer. Pharmacies are also able to
provide a CD–ROM with the requested
information if that is preferred. HMOs are
included in this provider type.
Dentists, optometrists, psychologists,
podiatrists, chiropractors, and others
not providing care under the
supervision of a MD or DO are
considered out of scope for the MEPS–
MPC.
The MEPS–HC and MEPS–MPC are
being conducted by AHRQ through its
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contractors, Westat and RTI
International, pursuant to AHRQ’s
statutory authority to conduct and
support research on health care and on
systems for the delivery of such care,
including activities with respect to the
cost and use of health care services and
with respect to health statistics and
surveys. 42 U.S.C. 299a(a)(3) and (8); 42
U.S.C. 299b–2.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated
annualized burden hours for the
respondents’ time to participate in the
MEPS–HC and the MEPS–MPC
The MEPS–HC Core Interview will be
completed by 13,338 * (see note below
Exhibit 1) ‘‘family level’’ respondents,
also referred to as RU respondents.
Since the MEPS–HC consists of 5
rounds of interviewing covering a full
two years of data, the annual average
number of responses per respondent is
2.5 responses per year. The MEPS–HC
core requires an average response time
of 92 minutes to administer. The Adult
Female SAQ will be completed once a
year by each female person in the RU
that is 18 years old and older, an
estimated 12,984 persons. The Adult
Male SAQ will be completed once a
year by each male person in the RU that
is 18 years old and older, an estimated
11,985 persons. The Adult SAQs each
require an average of 7 minutes to
complete. The Diabetes care SAQ will
be completed once a year by each
person in the RU identified as having
diabetes, an estimated 2,072 persons,
and takes about 3 minutes to complete.
The Veteran SAQ will be completed
once by each in-scope person who is a
veteran of the U.S. military identified in
the Round 1, Panel 23 interview, an
estimated 1,350 persons. The Veteran
SAQ requires an average of 15 minutes
to complete. The authorization form for
the MEPS–MPC Provider Survey will be
completed once for each medical
provider seen by any RU member. The
12,804 RUs in the MEPS–HC will
complete an average of 5.4 authorization
forms, which require about 3 minutes
each to complete. The authorization
form for the MEPS–MPC Pharmacy
Survey will be completed once for each
pharmacy for any RU member who has
obtained a prescription medication. RUs
will complete an average of 3.1 forms,
which take about 3 minutes to complete.
About one third of all interviewed RUs
will complete a validation interview as
part of the MEPS–HC quality control,
which takes an average of 5 minutes to
complete. The total annual burden
hours for the MEPS–HC are estimated to
be 60,278 hours.
All medical providers and pharmacies
included in the MEPS–MPC will receive
a screening call and the MEPS–MPC
uses 7 different questionnaires; 6 for
medical providers and 1 for pharmacies.
Each questionnaire is relatively short
and requires 2 to 19 minutes to
complete. The total annual burden
hours for the MEPS–MPC are estimated
to be 17,388 hours. The total annual
burden for the MEPS–HC and MPC is
estimated to be 77,666 hours.
Exhibit 2 shows the estimated annual
cost burden associated with the
respondents’ time to participate in this
information collection. The annual cost
burden for the MEPS–HC is estimated to
be $1,438,233; the annual cost burden
for the MEPS–MPC is estimated to be
$291,595. The total annual cost burden
for the MEPS–HC and MPC is estimated
to be $1,729,828.
The MEPS–MPC interviewer will be
authorized to offer remuneration to
providers who present cost as a salient
objection to responding or if a flat fee
is applied to any request for medical or
billing records. Based on the past cycle
of data collection fewer than one third
of providers will request remuneration.
Exhibit 3 shows the total and average
per record remuneration by provider
type, based on the 2016 data collection,
the most recent year for which data is
available. For those providers that
required remuneration the average
payment per medical record was $37.80,
this compares to $32.98 in 2010.
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents
Form name
Number of
responses per
respondent
Hours per
response
Total burden
hours
MEPS–HC
MEPS–HC Core Interview ...............................................................................
Adult Female SAQ ...........................................................................................
Adult Male SAQ ...............................................................................................
Diabetes care SAQ ..........................................................................................
Veteran SAQ ....................................................................................................
Authorization form for the MEPS–MPC Provider Survey ................................
Authorization form for the MEPS–MPC Pharmacy Survey .............................
MEPS–HC Validation Interview .......................................................................
* 13,338
12,984
11,985
2,072
1,350
12,804
12,804
4,225
2.5
1
1
1
1
5.4
3.1
1
92/60
7/60
7/60
3/60
15/60
3/60
3/60
5/60
51,129
1,515
1,398
104
338
3,457
1,985
352
Subtotal for the MEPS–HC .......................................................................
71,562
na
na
60,278
MPC Contact Guide/Screening Call ** .............................................................
Home care for health care providers questionnaire ........................................
Home care for non-health care providers questionnaire .................................
Office-based providers questionnaire ..............................................................
Separately billing doctors questionnaire ..........................................................
Hospitals questionnaire ...................................................................................
Institutions (non-hospital) questionnaire ..........................................................
Pharmacies questionnaire ...............................................................................
36,598
635
11
11,210
12,397
5,310
116
6,919
1
1.53
1
1.65
3.46
3.26
2.05
2.92
2/60
9/60
11/60
10/60
13/60
9/60
9/60
3/60
1,220
146
2
3,083
9,294
2,597
36
1,010
Subtotal for the MEPS–MPC ....................................................................
73,196
na
na
17,388
Grand Total .......................................................................................
144,758
na
na
77,666
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MEPS–MPC
* While the expected number of responding units for the annual estimates is 12,804, it is necessary to adjust for survey attrition of initial respondents by a factor of 0.96 (13,338 = 12,804/0.96).
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** There are 6 different contact guides; one for office based, separately billing doctor, hospital, institution, and pharmacy provider types, and
the two home care provider types use the same contact guide.
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Number of
respondents
Form name
Total burden
hours
Average
hourly
wage rate
Total cost
burden
MEPS–HC
MEPS–HC Core Interview ...............................................................................
Adult Female SAQ ...........................................................................................
Adult Male SAQ ...............................................................................................
Diabetes care SAQ ..........................................................................................
Veteran SAQ ....................................................................................................
Authorization forms for the MEPS–MPC Provider Survey ..............................
Authorization form for the MEPS–MPC Pharmacy Survey .............................
MEPS–HC Validation Interview .......................................................................
13,338
12,984
11,985
2,072
1,350
12,804
12,804
4,225
51,129
1,515
1,398
104
338
3,457
1,985
352
* $23.86
* 23.86
* 23.86
* 23.86
* 23.86
* 23.86
* 23.86
* 23.86
$1,219,938
36,148
33,356
2,481
8,065
82,484
47,362
8,399
Subtotal for the MEPS–HC .......................................................................
71,562
60,278
na
1,438,233
MPC Contact Guide/Screening Call ................................................................
Home care for health care providers questionnaire ........................................
Home care for non-health care providers questionnaire .................................
Office-based providers questionnaire ..............................................................
Separately billing doctors questionnaire ..........................................................
Hospitals questionnaire ...................................................................................
Institutions (non-hospital) questionnaire ..........................................................
Pharmacies questionnaire ...............................................................................
36,598
635
11
11,210
12,397
5,310
116
6,919
1,220
146
2
3,083
9,294
2,597
36
1,010
** 16.85
** 16.85
** 16.85
** 16.85
** 16.85
** 16.85
** 16.85
*** 15.47
20,557
2,460
34
51,949
156,604
43,759
607
15,625
Subtotal for the MEPS–MPC ....................................................................
73,196
17,388
na
291,595
Grand Total .......................................................................................
144,758
77,666
na
1,729,828
MEPS–MPC
* Mean hourly wage for All Occupations (00–0000).
** Mean hourly wage for Medical Secretaries (43–6013).
*** Mean hourly wage for Pharmacy Technicians (29–2052).
Occupational Employment Statistics,
May 2016 National Occupational
Employment and Wage Estimates
United States, U.S. Department of Labor,
Bureau of Labor Statistics. https://
www.bls.gov/oes/current/oes_
nat.htm#b29-0000.
EXHIBIT 3—TOTAL AND AVERAGE REMUNERATION BY PROVIDER TYPE FOR THE MEPS–MPC
Number of
records with
payment
Provider type
Average
payment
Total
remuneration
Hospital ........................................................................................................................................
Office Based Providers ................................................................................................................
Institutions ....................................................................................................................................
Home Care Provider (Health Care Providers) ............................................................................
Home Care Provider (Non-Health Care Providers) .....................................................................
Pharmacy .....................................................................................................................................
Separately Billing Doctors ...........................................................................................................
1,718
678
1
4
0
10,305
412
$43.99
33.88
63.71
78.50
0
35.69
70.60
$75,575
22,971
64
314
0
367,785
29,087
Total MPC .............................................................................................................................
13,118
........................
495,796
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Request for Comments
In accordance with the Paperwork
Reduction Act, comments on AHRQ’s
information collection are requested
with regard to any of the following: (a)
Whether the proposed collection of
information is necessary for the proper
performance of AHRQ’s health care
research and health care information
dissemination functions, including
whether the information will have
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practical utility; (b) the accuracy of
AHRQ’s estimate of burden (including
hours and costs) of the proposed
collection(s) of information; (c) ways to
enhance the quality, utility and clarity
of the information to be collected; and
(d) ways to minimize the burden of the
collection of information upon the
respondents, including the use of
automated collection techniques or
other forms of information technology.
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Comments submitted in response to
this notice will be summarized and
included in the Agency’s subsequent
request for OMB approval of the
proposed information collection. All
comments will become a matter of
public record.
Francis D. Chesley, Jr.,
Acting Deputy Director.
[FR Doc. 2018–11927 Filed 6–1–18; 8:45 am]
BILLING CODE 4160–90–P
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]]>Agencies
[Federal Register Volume 83, Number 107 (Monday, June 4, 2018)]
[Notices]
[Pages 25671-25674]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-11927]
-----------------------------------------------------------------------
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality
Agency Information Collection Activities: Proposed Collection;
Comment Request
AGENCY: Agency for Healthcare Research and Quality, HHS.
ACTION: Notice.
-----------------------------------------------------------------------
SUMMARY: This notice announces the intention of the Agency for
Healthcare Research and Quality (AHRQ) to request that the Office of
Management and Budget (OMB) approve the proposed information collection
project ``Medical Expenditure Panel Survey (MEPS) Household Component
and the MEPS Medical Provider Component.''
DATES: Comments on this notice must be received by August 3, 2018.
ADDRESSES: Written comments should be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by email at
[email protected].
Copies of the proposed collection plans, data collection
instruments, and specific details on the estimated burden can be
obtained from the AHRQ Reports Clearance Officer.
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427-1477, or by emails at
[email protected].
SUPPLEMENTARY INFORMATION:
Proposed Project
Medical Expenditure Panel Survey (MEPS) Household Component (HC)
In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3521, AHRQ invites the public to comment on this proposed information
collection. For over thirty years, results from the MEPS and its
predecessor surveys (the 1977 National Medical Care Expenditure Survey,
the 1980 National Medical Care Utilization and Expenditure Survey and
the 1987 National Medical Expenditure Survey) have been used by OMB,
DHHS, Congress and a wide number of health services researchers to
analyze health care use, expenses and health policy.
Major changes continue to take place in the health care delivery
system. The MEPS is needed to provide information about the current
state of the health care system as well as to track changes over time.
The MEPS permits annual estimates of use of health care and
expenditures and sources of payment for that health care. It also
permits tracking individual change in employment, income, health
insurance and health status over two years. The use of the NHIS as a
sampling frame expands the MEPS analytic capacity by providing another
data point for comparisons over time.
Households selected for participation in the MEPS-HC are
interviewed five times in person. These rounds of interviewing are
spaced about 5 months apart. The interview will take place with a
family respondent who will report for him/herself and for other family
members.
The MEPS-HC has the following goal:
[ssquf] To provide nationally representative estimates for the U.S.
civilian noninstitutionalized population for:
[ssquf] health care use, expenditures, sources of payment
[ssquf] health insurance coverage
To achieve the goals of the MEPS-HC the following data collections
are implemented:
1. Household Component Core Instrument. The core instrument
collects data about persons in sample households. Topical areas
asked in each round of interviewing include priority condition
enumeration, health status, health care utilization including
prescribed medicines, expenses and payments, employment, and health
insurance. Other topical areas that are asked only once a year
include access to care, income, assets, satisfaction with providers,
and children's health. While many of the questions are asked about
the entire reporting unit (RU), which is typically a family, only
one person normally provides this information. All sections of the
current core instrument are available on the AHRQ website at https://meps.ahrq.gov/mepsweb/survey_comp/survey_questionnaires.jsp.
2. Adult Self-Administered Questionnaire. A brief self-
administered questionnaire (SAQ) will be used to collect self-
reported data (rather than through household proxy) on health
opinions and satisfaction with health care, and information on
health status, preventive care and health care quality measures for
adults 18 and older. This questionnaire is revised from the previous
OMB clearance and received clearance on May 9, 2018.
3. Veteran SAQ. MEPS includes a new self-administered
questionnaire for spring of 2019 data collection targeting the
veteran population. The questionnaire asks questions in the
following domains of interest: if a veteran is eligible for VA
health care; if a Veteran is enrolled in VA health care;
coordination of care in and out of the VA health care system,
services provided to Veterans in and out of the VA health care
system, and VA eligibility priority groups, for Veterans enrolled in
VA health care and for Veterans eligible for VA health care. To
assist in the correct identification of priority groups, the
questionnaire may also include items assessing the following:
presence of service-connected disability; service-connected
disability rating; presence of presumptive-conditions; timing and
era of active duty; and VA receipt of disability compensation
benefits. AHRQ worked with the Veterans Health Administration to
develop the questionnaire content.
4. Diabetes Care SAQ. There is no change in this instrument. A
brief self-administered paper-and-pencil questionnaire on the
quality of diabetes care is administered once a year (during rounds
3 and 5) to persons identified as having diabetes. Included are
questions about the number of times the respondent reported having a
hemoglobin A1c blood test, whether the respondent
[[Page 25672]]
reported having his or her feet checked for sores or irritations,
whether the respondent reported having an eye exam in which the
pupils were dilated, the last time the respondent had his or her
blood cholesterol checked and whether the diabetes has caused kidney
or eye problems. Respondents are also asked if their diabetes is
being treated with diet, oral medications or insulin. This
questionnaire is unchanged from the previous OMB clearance.
5. Authorization forms for the MEPS-MPC Provider and Pharmacy
Survey. There is no change in this instrument. As in previous panels
of the MEPS, we will ask respondents for authorization to obtain
supplemental information from their medical providers (hospitals,
physicians, home health agencies and institutions) and pharmacies.
6. MEPS Validation Interview. There is no change in this
instrument. Each interviewer is required to have at least 15 percent
of his/her caseload validated to insure that the computer assisted
personal interview (CAPI) questionnaire content was asked
appropriately and procedures followed, for example the use of show
cards. Validation flags are set programmatically for cases pre-
selected by data processing staff before each round of interviewing.
Home office and field management may also request that other cases
be validated throughout the field period. When an interviewer fails
a validation their work is subject to 100 percent validation.
Additionally, any case completed in less than 30 minutes is
validated. A validation abstract form containing selected data
collected in the CAPI interview is generated and used by the
validator to guide the validation interview.
Medical Expenditure Panel Survey (MEPS) Medical Provider Component
(MPC)
The MEPS-MPC will contact medical providers (hospitals, physicians,
home health agencies and institutions) identified by household
respondents in the MEPS[dash]HC as sources of medical care for the time
period covered by the interview, and all pharmacies providing
prescription drugs to household members during the covered time period.
The MEPS-MPC is not designed to yield national estimates as a stand-
alone survey. The sample is designed to target the types of individuals
and providers for whom household reported expenditure data was expected
to be insufficient. For example, Medicaid enrollees are targeted for
inclusion in the MEPS-MPC because this group is expected to have
limited information about payments for their medical care.
The MEPS-MPC collects event level data about medical care received
by sampled persons during the relevant time period. The data collected
from medical providers include:
Dates on which medical encounters during the reference
period occurred
Data on the medical content of each encounter, including
ICD[dash]10 codes
Data on the charges associated with each encounter, the
sources paying for the medical care[dash]including the patient/
family, public sources, and private insurance, and amounts paid by
each source
Data collected from pharmacies include:
Date of prescription fill
National drug code (NDC) or prescription name, strength and
form
Quantity
Payments, by source
The MEPS-MPC has the following goal:
To serve as an imputation source for and to supplement/
replace household reported expenditure and source of payment
information. This data will supplement, replace and verify
information provided by household respondents about the charges,
payments, and sources of payment associated with specific health
care encounters.
To achieve the goal of the MEPS-MPC the following data collections
are implemented:
1. MPC Contact Guide/Screening Call. There is no change in this
instrument. An initial screening call is placed to determine the
type of facility, whether the practice or facility is in scope for
the MEPS-MPC, the appropriate MEPS-MPC respondent and some details
about the organization and availability of medical records and
billing at the practice/facility. All hospitals, physician offices,
home health agencies, institutions and pharmacies are screened by
telephone. A unique screening instrument is used for each of these
seven provider types in the MEPS-MPC, except for the two home care
provider types which use the same screening form.
2. Home Care Provider Questionnaire for Health Care Providers.
There is no change in this instrument. This questionnaire is used to
collect data from home health care agencies which provide medical
care services to household respondents. Information collected
includes type of personnel providing care, hours or visits provided
per month, and the charges and payments for services received. Some
HMOs may be included in this provider type.
3. Home Care Provider Questionnaire for Non[dash]Health Care
Providers. There is no change in this instrument. This questionnaire
is used to collect information about services provided in the home
by non[dash]health care workers to household respondents because of
a medical condition; for example, cleaning or yard work,
transportation, shopping, or child care.
4. Medical Event Questionnaire for Office[dash]Based Providers.
There is no change in this instrument. This questionnaire is for
office[dash]based physicians, including doctors of medicine (MDs)
and osteopathy (DOs), as well as providers practicing under the
direction or supervision of an MD or DO (e.g., physician assistants
and nurse practitioners working in clinics). Providers of care in
private offices as well as staff model HMOs are included.
5. Medical Event Questionnaire for Separately Billing Doctors.
There is no change in this instrument. This questionnaire collects
information from physicians identified by hospitals (during the
Hospital Event data collection) as providing care to sampled persons
during the course of inpatient, outpatient department or emergency
room care, but who bill separately from the hospital.
6. Hospital Event Questionnaire. There is no change in this
instrument. This questionnaire is used to collect information about
hospital events, including inpatient stays, outpatient department,
and emergency room visits. Hospital data are collected not only from
the billing department, but from medical records and administrative
records departments as well. Medical records departments are
contacted to determine the names of all the doctors who treated the
patient during a stay or visit. In many cases, the hospital
administrative office also has to be contacted to determine whether
the doctors identified by medical records billed separately from the
hospital; doctors that do bill separately from the hospital will be
contacted as part of the Medical Event Questionnaire for Separately
Billing Doctors. HMOs are included in this provider type.
7. Institutions Event Questionnaire. There is no change in this
instrument. This questionnaire is used to collect information about
institution events, including nursing homes, rehabilitation
facilities and skilled nursing facilities. Institution data are
collected not only from the billing department, but from medical
records and administrative records departments as well. Medical
records departments are contacted to determine the names of all the
doctors who treated the patient during a stay. In many cases, the
institution's administrative office also has to be contacted to
determine whether the doctors identified by medical records billed
separately from the institution itself. Some HMOs may be included in
this provider type.
8. Pharmacy Data Collection Questionnaire. There is no change in
this instrument. This questionnaire requests the NDC and when that
is not available the prescription name, strength and form as well as
the date prescription was filled, payments by source, the quantity,
and person for whom the prescription was filled. When the NDC is
available, we do not ask for prescription name, strength or form
because that information is embedded in the NDC; this reduces burden
on the respondent. Most pharmacies have the requested information
available in electronic format and respond by providing a computer
generated printout of the patient's prescription information. If the
computerized form is unavailable, the pharmacy can report their data
to a telephone interviewer. Pharmacies are also able to provide a
CD-ROM with the requested information if that is preferred. HMOs are
included in this provider type.
Dentists, optometrists, psychologists, podiatrists, chiropractors,
and others not providing care under the supervision of a MD or DO are
considered out of scope for the MEPS-MPC.
The MEPS-HC and MEPS-MPC are being conducted by AHRQ through its
[[Page 25673]]
contractors, Westat and RTI International, pursuant to AHRQ's statutory
authority to conduct and support research on health care and on systems
for the delivery of such care, including activities with respect to the
cost and use of health care services and with respect to health
statistics and surveys. 42 U.S.C. 299a(a)(3) and (8); 42 U.S.C. 299b-2.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in the MEPS-HC and the MEPS-MPC
The MEPS-HC Core Interview will be completed by 13,338 \*\ (see
note below Exhibit 1) ``family level'' respondents, also referred to as
RU respondents. Since the MEPS-HC consists of 5 rounds of interviewing
covering a full two years of data, the annual average number of
responses per respondent is 2.5 responses per year. The MEPS-HC core
requires an average response time of 92 minutes to administer. The
Adult Female SAQ will be completed once a year by each female person in
the RU that is 18 years old and older, an estimated 12,984 persons. The
Adult Male SAQ will be completed once a year by each male person in the
RU that is 18 years old and older, an estimated 11,985 persons. The
Adult SAQs each require an average of 7 minutes to complete. The
Diabetes care SAQ will be completed once a year by each person in the
RU identified as having diabetes, an estimated 2,072 persons, and takes
about 3 minutes to complete. The Veteran SAQ will be completed once by
each in-scope person who is a veteran of the U.S. military identified
in the Round 1, Panel 23 interview, an estimated 1,350 persons. The
Veteran SAQ requires an average of 15 minutes to complete. The
authorization form for the MEPS-MPC Provider Survey will be completed
once for each medical provider seen by any RU member. The 12,804 RUs in
the MEPS-HC will complete an average of 5.4 authorization forms, which
require about 3 minutes each to complete. The authorization form for
the MEPS-MPC Pharmacy Survey will be completed once for each pharmacy
for any RU member who has obtained a prescription medication. RUs will
complete an average of 3.1 forms, which take about 3 minutes to
complete. About one third of all interviewed RUs will complete a
validation interview as part of the MEPS-HC quality control, which
takes an average of 5 minutes to complete. The total annual burden
hours for the MEPS-HC are estimated to be 60,278 hours.
All medical providers and pharmacies included in the MEPS-MPC will
receive a screening call and the MEPS-MPC uses 7 different
questionnaires; 6 for medical providers and 1 for pharmacies. Each
questionnaire is relatively short and requires 2 to 19 minutes to
complete. The total annual burden hours for the MEPS-MPC are estimated
to be 17,388 hours. The total annual burden for the MEPS-HC and MPC is
estimated to be 77,666 hours.
Exhibit 2 shows the estimated annual cost burden associated with
the respondents' time to participate in this information collection.
The annual cost burden for the MEPS-HC is estimated to be $1,438,233;
the annual cost burden for the MEPS-MPC is estimated to be $291,595.
The total annual cost burden for the MEPS-HC and MPC is estimated to be
$1,729,828.
The MEPS-MPC interviewer will be authorized to offer remuneration
to providers who present cost as a salient objection to responding or
if a flat fee is applied to any request for medical or billing records.
Based on the past cycle of data collection fewer than one third of
providers will request remuneration. Exhibit 3 shows the total and
average per record remuneration by provider type, based on the 2016
data collection, the most recent year for which data is available. For
those providers that required remuneration the average payment per
medical record was $37.80, this compares to $32.98 in 2010.
Exhibit 1--Estimated Annualized Burden Hours
----------------------------------------------------------------------------------------------------------------
Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
----------------------------------------------------------------------------------------------------------------
MEPS-HC
----------------------------------------------------------------------------------------------------------------
MEPS-HC Core Interview.......................... * 13,338 2.5 92/60 51,129
Adult Female SAQ................................ 12,984 1 7/60 1,515
Adult Male SAQ.................................. 11,985 1 7/60 1,398
Diabetes care SAQ............................... 2,072 1 3/60 104
Veteran SAQ..................................... 1,350 1 15/60 338
Authorization form for the MEPS-MPC Provider 12,804 5.4 3/60 3,457
Survey.........................................
Authorization form for the MEPS-MPC Pharmacy 12,804 3.1 3/60 1,985
Survey.........................................
MEPS-HC Validation Interview.................... 4,225 1 5/60 352
---------------------------------------------------------------
Subtotal for the MEPS-HC.................... 71,562 na na 60,278
----------------------------------------------------------------------------------------------------------------
MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call **............. 36,598 1 2/60 1,220
Home care for health care providers 635 1.53 9/60 146
questionnaire..................................
Home care for non[dash]health care providers 11 1 11/60 2
questionnaire..................................
Office[dash]based providers questionnaire....... 11,210 1.65 10/60 3,083
Separately billing doctors questionnaire........ 12,397 3.46 13/60 9,294
Hospitals questionnaire......................... 5,310 3.26 9/60 2,597
Institutions (non-hospital) questionnaire....... 116 2.05 9/60 36
Pharmacies questionnaire........................ 6,919 2.92 3/60 1,010
---------------------------------------------------------------
Subtotal for the MEPS-MPC................... 73,196 na na 17,388
---------------------------------------------------------------
Grand Total............................. 144,758 na na 77,666
----------------------------------------------------------------------------------------------------------------
* While the expected number of responding units for the annual estimates is 12,804, it is necessary to adjust
for survey attrition of initial respondents by a factor of 0.96 (13,338 = 12,804/0.96).
[[Page 25674]]
** There are 6 different contact guides; one for office based, separately billing doctor, hospital, institution,
and pharmacy provider types, and the two home care provider types use the same contact guide.
Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
Average
Form name Number of Total burden hourly wage Total cost
respondents hours rate burden
----------------------------------------------------------------------------------------------------------------
MEPS-HC
----------------------------------------------------------------------------------------------------------------
MEPS-HC Core Interview.......................... 13,338 51,129 * $23.86 $1,219,938
Adult Female SAQ................................ 12,984 1,515 * 23.86 36,148
Adult Male SAQ.................................. 11,985 1,398 * 23.86 33,356
Diabetes care SAQ............................... 2,072 104 * 23.86 2,481
Veteran SAQ..................................... 1,350 338 * 23.86 8,065
Authorization forms for the MEPS-MPC Provider 12,804 3,457 * 23.86 82,484
Survey.........................................
Authorization form for the MEPS-MPC Pharmacy 12,804 1,985 * 23.86 47,362
Survey.........................................
MEPS-HC Validation Interview.................... 4,225 352 * 23.86 8,399
---------------------------------------------------------------
Subtotal for the MEPS-HC.................... 71,562 60,278 na 1,438,233
----------------------------------------------------------------------------------------------------------------
MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call................ 36,598 1,220 ** 16.85 20,557
Home care for health care providers 635 146 ** 16.85 2,460
questionnaire..................................
Home care for non[dash]health care providers 11 2 ** 16.85 34
questionnaire..................................
Office[dash]based providers questionnaire....... 11,210 3,083 ** 16.85 51,949
Separately billing doctors questionnaire........ 12,397 9,294 ** 16.85 156,604
Hospitals questionnaire......................... 5,310 2,597 ** 16.85 43,759
Institutions (non-hospital) questionnaire....... 116 36 ** 16.85 607
Pharmacies questionnaire........................ 6,919 1,010 *** 15.47 15,625
---------------------------------------------------------------
Subtotal for the MEPS-MPC................... 73,196 17,388 na 291,595
----------------------------------------------------------------------------------------------------------------
Grand Total............................. 144,758 77,666 na 1,729,828
----------------------------------------------------------------------------------------------------------------
* Mean hourly wage for All Occupations (00-0000).
** Mean hourly wage for Medical Secretaries (43-6013).
*** Mean hourly wage for Pharmacy Technicians (29-2052).
Occupational Employment Statistics, May 2016 National Occupational
Employment and Wage Estimates United States, U.S. Department of Labor,
Bureau of Labor Statistics. https://www.bls.gov/oes/current/oes_nat.htm#b29-0000.
Exhibit 3--Total and Average Remuneration by Provider Type for the MEPS-MPC
----------------------------------------------------------------------------------------------------------------
Number of
Provider type records with Average Total
payment payment remuneration
----------------------------------------------------------------------------------------------------------------
Hospital........................................................ 1,718 $43.99 $75,575
Office Based Providers.......................................... 678 33.88 22,971
Institutions.................................................... 1 63.71 64
Home Care Provider (Health Care Providers)...................... 4 78.50 314
Home Care Provider (Non-Health Care Providers).................. 0 0 0
Pharmacy........................................................ 10,305 35.69 367,785
Separately Billing Doctors...................................... 412 70.60 29,087
-----------------------------------------------
Total MPC................................................... 13,118 .............. 495,796
----------------------------------------------------------------------------------------------------------------
Request for Comments
In accordance with the Paperwork Reduction Act, comments on AHRQ's
information collection are requested with regard to any of the
following: (a) Whether the proposed collection of information is
necessary for the proper performance of AHRQ's health care research and
health care information dissemination functions, including whether the
information will have practical utility; (b) the accuracy of AHRQ's
estimate of burden (including hours and costs) of the proposed
collection(s) of information; (c) ways to enhance the quality, utility
and clarity of the information to be collected; and (d) ways to
minimize the burden of the collection of information upon the
respondents, including the use of automated collection techniques or
other forms of information technology.
Comments submitted in response to this notice will be summarized
and included in the Agency's subsequent request for OMB approval of the
proposed information collection. All comments will become a matter of
public record.
Francis D. Chesley, Jr.,
Acting Deputy Director.
[FR Doc. 2018-11927 Filed 6-1-18; 8:45 am]
BILLING CODE 4160-90-P
