[Federal Register: June 27, 2003 (Volume 68, Number 124)]
[Notices]
[Page 38346-38359]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr27jn03-88]
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DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Medicare & Medicaid Services
[CMS-4062-N]
Medicare and Medicaid Programs; Solicitation for Information on
the Hospital CAHPS
AGENCY: Centers for Medicare & Medicaid Services (CMS), HHS.
ACTION: Notice.
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SUMMARY: This notice seeks input and recommendations regarding an
initiative that the Department of Health and Human Services (DHHS)
plans to use to create a standard instrument, sampling, and data
collection protocol that hospitals can use to collect comparable data
for use in publicly reporting hospital patients' perspectives on the
care they received. This survey is being developed and tested by the
Agency for Healthcare Research and Quality (AHRQ) in conjunction with
the CAHPS [reg] (formerly known as the Consumer Assessment of Health
Plans Survey). The initiative is being called ``Hospital CAHPS'' or
``HCAHPS.'' In this notice, we are soliciting public input on the draft
HCAHPS survey instrument and recommendations for the survey
administration.
DATES: We will consider comments on the draft HCAPHS survey instrument
and recommendations for the survey administration if we receive them at
the appropriate address, as provided below, no later than 5 p.m. on
July 28, 2003.
ADDRESSES: Comments should be mailed to the following address:
Department of Health and Human Services, Centers for Medicare &
Medicaid Services, Attention: Elizabeth Goldstein, Director for the
Division of Beneficiary Analysis, Mail Stop: S1-13-05, 7500 Security
Boulevard, Baltimore, Maryland 21244-1850. E-mail comments should be
sent to the following address: egoldstein@cms.hhs.gov. General Information: Comments may be in the form of a letter or e-
mail. Please refer to file code CMS-4062-N when submitting comments and
include name, title, organization, mailing address, telephone number,
fax number, and e-mail address.
Because of staffing and resource limitations, we cannot accept
comments by facsimile (FAX) transmissions. Comments postmarked after
the closing date, or postmarked on or before the closing date but not
received in time for the review, will be considered late comments.
FOR FURTHER INFORMATION CONTACT: Elizabeth Goldstein, (410) 786-6665 or
by e-mail at egoldstein@cms.hhs.gov.
SUPPLEMENTARY INFORMATION:
I. Background
A key priority for the Secretary of HHS and our Administrator is
hospital public reporting. Therefore, we are currently working with the
AHRQ to develop the HCAHPS standard instrument and data collection
protocol to collect comparable data to support public reporting of
hospital patients' perspectives on inpatient hospital care they
received.
AHRQ has initiated a rigorous process to develop a draft of the
HCAHPS survey instrument. On July 24, 2002, AHRQ published a ``Notice
of Request for Measures'' in the Federal Register (67 FR 48477)
soliciting the submission of existing instruments measuring patients'
perspectives on care. In addition, AHRQ conducted an exhaustive review
of existing literature, conducted cognitive testing with sample survey
respondents, and obtained stakeholder input on the process of
developing the draft HCAPHS survey instrument.
On February 5, 2003, we published a collection of information
requirement notice in the Federal Register (68 FR 5889), soliciting
input on a draft HCAHPS survey instrument. In this notice, we are
soliciting input on the same draft HCAHPS survey instrument that was
published on February 5, 2003, in the Federal Register and are
providing a 30 day comment period to allow interested parties another
opportunity to comment on the draft HCAHPS survey instrument. We will
consider both sets of comments when revising the HCAHPS survey
instrument.
In addition, we are currently testing the same draft HCAHPS survey
instrument as part of CMS's 3-State hospital pilot project in Maryland,
New York, and Arizona. (See our Web site at http://www.cms.hhs.gov/quality/hospital
for more information on the 3-State hospital pilot
project and the draft HCAHPS survey instrument).
Through the 3-State hospital pilot we will also assess the draft
HCAHPS survey instrument. Results will be used to examine the
reliability and validity of the draft HCAHPS items, and identify the
items that are most useful for public reporting. Based on the results
of the 3-State hospital pilot and public input received regarding the
draft items, AHRQ will revise the HCAHPS survey instrument. We
anticipate that the revised HCAHPS survey instrument would be
significantly shorter than the current version.
At the end of the 3-State hospital pilot process and revisions
pursuant to public comments, DHHS should have a standard, well-tested
instrument for measuring patients' perspectives on hospital care that
can be used for comparative public reporting. The 3-State hospital
pilot and draft HCAHPS survey instrument is currently designed for all
hospital patients 18 years old and over, excluding psychiatric
patients. We expect that the final HCAHPS survey instrument would be
put in the public domain for use by hospitals or other interested
parties.
HCAHPS can be seen as a core set of questions to which individual
hospitals can add their own specific questions. HCAHPS is designed to
produce data for comparative public reporting to support consumer
choice. The HCAHPS survey instrument will complement, not replace data
currently collected that support improvement in internal hospital
customer services and related activities.
It is our intent to create a process for data collection that can
generate data useful for comparative public reporting and that can be
used in conjunction with existing survey processes used for quality
improvement. We are reviewing options that would allow us to meet our
public reporting goals while allowing flexibility in survey
administration. As we consider various options, we expect, at a
minimum, to be able to
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accommodate administration by mail or telephone.
II. Provisions of this Notice
A. Purpose
The purpose of this notice is to solicit comments and
recommendations on the draft HCAHPS survey instrument and
implementation options.
B. Solicitation Regarding HCAHPS
As previously mentioned, the draft HCAHPS survey instrument was
published for public comment on February 5, 2003, in the Federal
Register and is currently being tested as part of CMS's 3-State
hospital pilot project in Maryland, New York, and Arizona. In this
notice, we are soliciting input on the same draft HCAHPS survey
instrument and are providing a 30 day comment period to allow
interested parties another opportunity to submit comments to be used in
revising the HCAHPS survey instrument. We are also soliciting input on
the number of questions that should be in the revised HCAHPS survey
instrument. (See addendum).
C. Input on Implementation Options
We are soliciting input and recommendations for the survey
administration, including sampling and data collection methods. We
request that those providing comments discuss any survey biases that
may be present in the approach they suggest (for example, differential
mode effects) and how such biases might be addressed to allow fair and
meaningful comparisons between hospitals. Some of the specific areas
that we are interested in receiving input on are discussed below. In
addition to the areas specified below, we are also seeking input on any
issues that would affect the implementation of HCAHPS. For example, we
are interested in any best practices in case-mix adjustments to control
for differences in hospital patient populations.
1. Mode of Administration
Currently, there is wide variation in administration protocols
including: (1) Mail, telephone, and other modes (such as interactive
voice recognition); (2) number of follow-up surveys sent or telephone
calls made; (3) Computer Assisted Telephone Interviewing (CATI)
scripts; (4) refusal conversion protocols; (5) pre-notification and
cover letter language; and (6) quality control procedures.
We are soliciting input regarding best practices in mail,
telephone, or other modes of administration. We would appreciate
comments regarding how we can provide flexibility in survey
administration, but at the same time ensure objective comparisons
between hospitals. We would also appreciate suggestions regarding ways
to adjust for any biases that may be present in the approaches
suggested.
2. Frequency of Data Collection
There is currently variation in terms of how often hospitals survey
their patients. Some hospitals continuously survey their patients,
while others do it periodically. As part of our data collection options
for hospitals, we would like to ensure that we accurately reflect the
mix of patients served by a hospital, capture sufficient samples, and
provide the least disruption to current survey operations. Therefore,
we are soliciting input on whether data collection should be ongoing or
provided at a specific time (for example, at one point of time in a
given year) and the pros and cons of the approach suggested.
3. Sampling
Currently, there are differences across hospitals in terms of how
the sampling frame is developed and who is included in the sample.
Therefore, we are soliciting input regarding what issues need to be
considered as a sampling design is developed and the appropriate
exclusions from the sample. We are soliciting this input to develop a
sampling approach that would allow for a meaningful comparison across
hospitals.
4. Time After Discharge
Survey vendors and hospitals currently differ on how quickly
patients are surveyed following discharge. We are soliciting input
regarding how quickly discharge lists are available; how soon after
discharge is it feasible to survey patients; and what is the quality of
data contained on the discharge lists.
For the national implementation of HCAHPS, there will be distinct
roles for hospitals, survey vendors, and the government. Hospitals and
vendors will be responsible for data collection, including: (1)
Developing a sampling frame of relevant discharges; (2) drawing the
sample of discharges to be surveyed; (3) collecting survey data from
sampled discharges; and (4) submitting HCAHPS data to CMS in a standard
format. We anticipate that there will be multiple survey vendors,
including current survey vendors, who would be able to administer
HCAHPS. As will be discussed in a separate document, hospitals will not
be required to use a vendor for administration of HCAHPS. However, we
anticipate hospitals that choose to administer HCAHPS without the use
of a vendor to be able to follow all HCAHPS standards and
specifications related to administration of the HCAHPS survey
instrument. We will make the HCAHPS survey instrument freely available
in the public domain.
The government will be responsible for support of the HCAHPS
initiative and public reporting. The government responsibility would
include: (1) Providing technical assistance; (2) ensuring the integrity
of data collection; (3) accumulating HCAHPS data from individual
hospitals; (4) producing risk-adjusted hospital-level estimates; (5)
conducting research on the presentation of data for public reporting;
and (6) reporting publicly the comparative hospital data.
D. Submission Process
We note, that we will not respond individually to all comments, but
will consider all suggestions submitted. To facilitate handling of
submissions, the commenter must submit the following information; (1)
Name; (2) title; (3) organization; (4) mail address; (5) telephone
number; (6) fax number; and (7) e-mail address.
For each of the implementation issues described above or any other
issues related to survey implementation, we request that the commenter
provide in their response any comments and evidence regarding the
effectiveness of the proposed implementation approach.
E. Evaluation Process
Based on the comments and input we receive on the 3-State hospital
pilot, the draft HCAHPS survey instrument, and the implementation
options, we will develop a draft survey administration strategy. Our
intent is that the strategy will support our public reporting goals and
allow some level of flexibility in survey administration. All final
HCAHPS materials will be put in the public domain for use by hospitals
nationally.
Authority: Section 1138 of the Social Security Act (42 U.S.C.
1320b-8).
(Catalog of Federal Domestic Assistance Program No. 93.773,
Medicare-Hospital Insurance; Program No. 93.774, Medicare-
Supplementary Medical Insurance, and Program No. 93.778, Medical
Assistance Program)
Dated: June 17, 2003.
Thomas A. Scully,
Administrator, Centers for Medicare & Medicaid Services.
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[FR Doc. 03-16057 Filed 6-26-03; 8:45 am]
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