Agency Information Collection Activities: Proposed Collection; Comment Request, 44877-44881 [2018-19027]
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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:
This notice announces the
intention of the Agency for Healthcare
SUMMARY:
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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.’’
This proposed information collection
was previously published in the Federal
Register on June 4, 2018 and allowed 60
days for public comment. AHRQ did not
receive substantive comments from
members of the public. The purpose of
this notice is to allow an additional 30
days for public comment.
DATES: Comments on this notice must be
received by October 4, 2018.
ADDRESSES: Written comments should
be submitted to: AHRQ’s OMB Desk
Officer by fax at (202) 395–6974
(attention: AHRQ’s desk officer) or by
email at OIRA_submission@
omb.eop.gov (attention: AHRQ’s desk
officer).
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
email at doris.lefkowitz@AHRQ.hhs.gov.
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 the 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
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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:
D To provide nationally
representative estimates for the U.S.
civilian noninstitutionalized population
for:
Æ Health care use, expenditures,
sources of payment
Æ health insurance coverage
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
• 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,
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payments, and sources of payment
associated with specific health care
encounters.
This study is being conducted by
AHRQ through its 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.
Method of Collection
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 (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. The
satisfaction with health care items are a
subset of items from the Consumer
Assessment of Healthcare Providers and
Systems (CAHPS®). The health status
items are from the Veterans Rand 12
item health survey (VR–12), a generic
instrument developed with the support
of the Department of Veterans Affairs
and the Centers for Medicare and
Medicaid Services. Additionally, there
are questions addressing adult
preventive care for both males and
females. This questionnaire is revised
from the previous OMB clearance.
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
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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 serviceconnected 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 Veteran Health
Administration to develop the
questionnaire content.
4. Diabetes Care SAQ. A brief selfadministered 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 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. 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. 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
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collected in the CAPI interview is
generated and used by the validator to
guide the validation interview.
To achieve the goal of the MEPS–MPC
the following data collections are
implemented:
1. MPC Contact Guide/Screening Call.
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. 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. 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. 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. 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. This
questionnaire is used to collect
information about hospital events,
including inpatient stays, outpatient
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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.
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. 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.
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 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 1—ESTIMATED ANNUALIZED BURDEN HOURS
Number of
respondents
Form name
Number of
responses per
respondent
Hours
per response
Total burden
hours
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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 .......................................................................
Subtotal for the MEPS–HC ..............................................................................
* 13,338
12,984
11,985
2,072
1,350
12,804
12,804
4,225
71,562
2.5
1
1
1
1
5.4
3.1
1
na
92/60
7/60
7/60
3/60
15/60
3/60
3/60
5/60
na
51,129
1,515
1,398
104
338
3,457
1,985
352
60,278
36,598
635
11
11,210
1
1.53
1
1.65
2/60
9/60
11/60
10/60
1,220
146
2
3,083
MEPS–MPC
MPC Contact Guide/Screening Call ** .............................................................
Home care for health care providers questionnaire ........................................
Home care for non-health care providers questionnaire .................................
Office-based providers questionnaire ..............................................................
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Federal Register / Vol. 83, No. 171 / Tuesday, September 4, 2018 / Notices
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS—Continued
Number of
respondents
Form name
Number of
responses per
respondent
Hours
per response
Total burden
hours
Separately billing doctors questionnaire ..........................................................
Hospitals questionnaire ...................................................................................
Institutions (non-hospital) questionnaire ..........................................................
Pharmacies questionnaire ...............................................................................
12,397
5,310
116
6,919
3.46
3.26
2.05
2.92
13/60
9/60
9/60
3/60
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
* 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).
** 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 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 $1,467,167; the annual cost burden
for the MEPS–MPC is estimated to be
$298,580. The total annual cost burden
for the MEPS–HC and MPC is estimated
to be $1,765,746.
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
* $24.34
* 24.34
* 24.34
* 24.34
* 24.34
* 24.34
* 24.34
* 24.34
$1,244,480
36,875
34,027
2,531
8,227
84,143
48,315
8,568
Subtotal for the MEPS–HC .......................................................................
71,562
60,278
na
1,467,167
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
** 17.25
** 17.25
** 17.25
** 17.25
** 17.25
** 17.25
** 17.25
*** 15.90
21,045
2,519
35
53,182
160,322
44,798
621
16,059
Subtotal for the MEPS–MPC ....................................................................
73,196
17,388
na
298,580
Grand Total .......................................................................................
144,758
77,666
na
1,765,746
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 2017 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.
sradovich on DSK3GMQ082PROD with NOTICES
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
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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
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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
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Federal Register / Vol. 83, No. 171 / Tuesday, September 4, 2018 / Notices
comments will become a matter of
public record.
Francis D. Chesley, Jr.,
Acting Deputy Director.
[FR Doc. 2018–19027 Filed 8–31–18; 8:45 am]
BILLING CODE 4160–90–P
DEPARTMENT OF HEALTH AND
HUMAN SERVICES
Agency for Healthcare Research and
Quality
Agency Information Collection
Activities: Proposed Collection;
Comment Request
Agency for Healthcare Research
and Quality, HHS.
ACTION: Notice.
AGENCY:
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 ‘‘Nursing
Home Survey on Patient Safety Culture
Database.’’
This proposed information collection
was previously published in the Federal
Register on May 31, 2018, and allowed
60 days for public comment. AHRQ
received no substantive comments
during this period. The purpose of this
notice is to allow an additional 30 days
for public comment.
DATES: Comments on this notice must be
received by October 4, 2018.
ADDRESSES: Written comments should
be submitted to: AHRQ’s OMB Desk
Officer by fax at (202) 395–6974
(attention: AHRQ’s desk officer) or by
email at OIRA_submission@
omb.eop.gov (attention: AHRQ’s desk
officer).
FOR FURTHER INFORMATION CONTACT:
Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427–1477, or by
email at doris.lefkowitz@AHRQ.hhs.gov.
SUPPLEMENTARY INFORMATION:
SUMMARY:
sradovich on DSK3GMQ082PROD with NOTICES
Proposed Project
Nursing Home Survey on Patient Safety
Culture Database
In accordance with the Paperwork
Reduction Act, 44 U.S.C. 3501–3521,
AHRQ invites the public the comment
on this proposed information collection.
In 1999, the Institute of Medicine called
for health care organizations to develop
a ‘‘culture of safety’’ such that their
workforce and processes focus on
improving the reliability and safety of
care for patients (IOM, 1999; To Err is
Human: Building a Safer Health
System). To respond to the need for
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tools to assess patient safety culture in
health care, AHRQ developed and pilot
tested the Nursing Home Survey on
Patient Safety Culture with OMB
approval (OMB NO. 0935–0132;
Approved July 5, 2007).
The survey is designed to enable
nursing homes to assess provider and
staff perspectives about patient safety
issues, medical error, and error
reporting and includes 42 items that
measure 12 composites of patient safety
culture. AHRQ made the survey
publicly available along with a Survey
User’s Guide and other toolkit materials
in November 2008 on the AHRQ
website.
The AHRQ Nursing Home SOPS
Database consists of data from the
AHRQ Nursing Home Survey on Patient
Safety Culture. Nursing homes in the
U.S. can voluntarily submit data from
the survey to AHRQ through its
contractor, Westat. The Nursing Home
SOPS Database (OMB NO. 0935–0195,
last approved on September 30, 2015)
was developed by AHRQ in 2011 in
response to requests from nursing
homes interested in viewing their
organizations’ patient safety culture
survey results. Those organizations
submitting data receive a feedback
report, as well as a report on the
aggregated de-identified findings of the
other nursing homes submitting data.
These reports are used to assist nursing
home staff in their efforts to improve
patient safety culture in their
organizations.
Rationale for the information
collection. The Nursing Home SOPS
and Nursing Home SOPS Database
support AHRQ’s goals of promoting
improvements in the quality and safety
of health care in nursing home settings.
The survey, toolkit materials, and
database results are all made publicly
available on AHRQ’s website. Technical
assistance is provided by AHRQ through
its contractor at no charge to nursing
homes, to facilitate the use of these
materials for nursing home patient
safety and quality improvement.
This database will:
(1) Present results from nursing
homes that voluntarily submit their
data,
(2) Provide data to nursing homes to
facilitate internal assessment and
learning in the patient safety
improvement process, and
(3) Provide supplemental information
to help nursing homes identify their
strengths and areas with potential for
improvement in patient safety culture.
This study is being conducted by
AHRQ through its contractor, Westat,
pursuant to AHRQ’s statutory authority
to conduct and support research on
PO 00000
Frm 00025
Fmt 4703
Sfmt 4703
44881
health care and on systems for the
delivery of such care, including
activities with respect to the quality,
effectiveness, efficiency,
appropriateness and value of health care
services and with respect to quality
measurement and improvement. 42
U.S.C 299a(a)(1) and (2)
Method of Collection
To achieve the goal of this project the
following activities and data collections
will be implemented:
(1) Eligibility and Registration Form—
The nursing home (or parent
organization) point-of-contact (POC)
completes a number of data submission
steps and forms, beginning with the
completion of an online Eligibility and
Registration Form. The purpose of this
form is to collect basic demographic
information about the nursing home and
initiate the registration process.
(2) Data Use Agreement—The purpose
of the data use agreement, completed by
the nursing home POC, is to state how
data submitted by nursing homes will
be used and provides privacy
assurances.
(3) Nursing Home Site Information
Form—The purpose of the site
information form, completed by the
nursing home POC, is to collect
background characteristics of the
nursing home. This information will be
used to analyze data collected with the
Nursing Home SOPS survey.
(4) Data File(s) Submission—POCs
upload their data file(s) using the data
file specifications, to ensure that users
submit standardized and consistent data
in the way variables are named, coded
and formatted. The number of
submissions to the database is likely to
vary each year because nursing homes
do not administer the survey and submit
data every year. Data submission is
typically handled by one POC who is
either a corporate level health care
manager for a Quality Improvement
Organization (QIO), a survey vendor
who contracts with a nursing home to
collect their data, or a nursing home
Director of Nursing or nurse manager.
POCs submit data on behalf of 5 nursing
homes, on average, because many
nursing homes are part of a QIO or
larger nursing home or health system
that includes many nursing home sites,
or the POC is a vendor that is submitting
data for multiple nursing homes.
Survey data from the AHRQ Nursing
Home Survey on Patient Safety Culture
are used to produce three types of
products:
(1) A Nursing Home SOPS User
Database Report that is made publicly
available on the AHRQ website;
E:\FR\FM\04SEN1.SGM
04SEN1
]]>Agencies
[Federal Register Volume 83, Number 171 (Tuesday, September 4, 2018)]
[Notices]
[Pages 44877-44881]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-19027]
=======================================================================
-----------------------------------------------------------------------
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.''
This proposed information collection was previously published in
the Federal Register on June 4, 2018 and allowed 60 days for public
comment. AHRQ did not receive substantive comments from members of the
public. The purpose of this notice is to allow an additional 30 days
for public comment.
DATES: Comments on this notice must be received by October 4, 2018.
ADDRESSES: Written comments should be submitted to: AHRQ's OMB Desk
Officer by fax at (202) 395-6974 (attention: AHRQ's desk officer) or by
email at [email protected] (attention: AHRQ's desk officer).
FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports
Clearance Officer, (301) 427-1477, or by email 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 the 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:
[cir] Health care use, expenditures, sources of payment
[cir] health insurance coverage
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 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-
10 codes
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,
[[Page 44878]]
payments, and sources of payment associated with specific health care
encounters.
This study is being conducted by AHRQ through its 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.
Method of Collection
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 (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. The satisfaction with
health care items are a subset of items from the Consumer Assessment of
Healthcare Providers and Systems (CAHPS[supreg]). The health status
items are from the Veterans Rand 12 item health survey (VR-12), a
generic instrument developed with the support of the Department of
Veterans Affairs and the Centers for Medicare and Medicaid Services.
Additionally, there are questions addressing adult preventive care for
both males and females. This questionnaire is revised from the previous
OMB clearance.
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
Veteran Health Administration to develop the questionnaire content.
4. Diabetes Care SAQ. 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
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. 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. 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.
To achieve the goal of the MEPS-MPC the following data collections
are implemented:
1. MPC Contact Guide/Screening Call. 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. 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.
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. 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. 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. This questionnaire is used to
collect information about hospital events, including inpatient stays,
outpatient
[[Page 44879]]
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. 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. 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.
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 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 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
[[Page 44880]]
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).
** 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 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 $1,467,167;
the annual cost burden for the MEPS-MPC is estimated to be $298,580.
The total annual cost burden for the MEPS-HC and MPC is estimated to be
$1,765,746.
Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
Number of Total burden Average hourly Total cost
Form name respondents hours wage rate burden
----------------------------------------------------------------------------------------------------------------
MEPS-HC
----------------------------------------------------------------------------------------------------------------
MEPS-HC Core Interview.......................... 13,338 51,129 * $24.34 $1,244,480
Adult Female SAQ................................ 12,984 1,515 * 24.34 36,875
Adult Male SAQ.................................. 11,985 1,398 * 24.34 34,027
Diabetes care SAQ............................... 2,072 104 * 24.34 2,531
Veteran SAQ..................................... 1,350 338 * 24.34 8,227
Authorization forms for the MEPS-MPC Provider 12,804 3,457 * 24.34 84,143
Survey.........................................
Authorization form for the MEPS-MPC Pharmacy 12,804 1,985 * 24.34 48,315
Survey.........................................
MEPS-HC Validation Interview.................... 4,225 352 * 24.34 8,568
---------------------------------------------------------------
Subtotal for the MEPS-HC.................... 71,562 60,278 na 1,467,167
----------------------------------------------------------------------------------------------------------------
MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call................ 36,598 1,220 ** 17.25 21,045
Home care for health care providers 635 146 ** 17.25 2,519
questionnaire..................................
Home care for non[dash]health care providers 11 2 ** 17.25 35
questionnaire..................................
Office[dash]based providers questionnaire....... 11,210 3,083 ** 17.25 53,182
Separately billing doctors questionnaire........ 12,397 9,294 ** 17.25 160,322
Hospitals questionnaire......................... 5,310 2,597 ** 17.25 44,798
Institutions (non-hospital) questionnaire....... 116 36 ** 17.25 621
Pharmacies questionnaire........................ 6,919 1,010 *** 15.90 16,059
---------------------------------------------------------------
Subtotal for the MEPS-MPC................... 73,196 17,388 na 298,580
---------------------------------------------------------------
Grand Total............................. 144,758 77,666 na 1,765,746
----------------------------------------------------------------------------------------------------------------
* 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 2017 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.
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
[[Page 44881]]
comments will become a matter of public record.
Francis D. Chesley, Jr.,
Acting Deputy Director.
[FR Doc. 2018-19027 Filed 8-31-18; 8:45 am]
BILLING CODE 4160-90-P
