[Federal Register: May 6, 2009 (Volume 74, Number 86)]
[Notices]
[Page 20952-20955]
From the Federal Register Online via GPO Access [wais.access.gpo.gov]
[DOCID:fr06my09-68]
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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.
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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
[[Page 20953]]
Expenditure Panel Survey (MEPS) Household Component and the MEPS
Medical Provider Component Through 2012.'' In accordance with the
Paperwork Reduction Act of 1995, Public Law 104-13 (44 U.S.C.
3506(c)(2)(A)), AHRQ invites the public to comment on this proposed
information collection.
DATES: Comments on this notice must be received by July 6, 2009.
ADDRESSES: Written comments should be submitted to: Doris Lefkowitz,
Reports Clearance Officer, AHRQ, by e-mail 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 e-mail at
doris.lefkowitz@ahrq.hhs.gov.
SUPPLEMENTARY INFORMATION:
Proposed Project
''Medical Expenditure Panel Survey (MEPS) Household Component and the
MEPS Medical Provider Component Through 2012''
AHRQ seeks to renew the Medical Expenditure Panel Survey Household
Component (MEPS-HC) and the MEPS Medical Provider Component (MEPS-MPC)
through the year 2012. For over thirty years, the results of 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. AHRQ is
authorized to conduct the MEPS pursuant to 42 U.S.C. 299b-2.
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 current MEPS design, unlike the previous periodic surveys, 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 National Health Interview Survey (NHIS) as a
sampling frame expands the surveys' analytic capacity by providing
another data point for comparisons over time.
The MEPS-HC and MEPS-MPC are two of three components of the MEPS:
MEPS-HC is a sample of households participating in the National
Health Interview Survey (NHIS) in the prior calendar year that are
interviewed 5 times over a 2\1/2\ year period. These 5 interviews yield
two years of information on use of and expenditures for health care,
sources of payment for that health care, insurance status, employment,
health status and health care quality.
MEPS-MPC collects information from medical and financial records
maintained by hospitals, physicians, pharmacies, health care
institutions, and home health agencies named as sources of care by
household respondents.
Insurance Component (MEPS-IC): The MEPS-IC collects information on
establishment characteristics, insurance offerings and premiums from
employers. The MEPS-IC is conducted by the Census Bureau for AHRQ and
is cleared separately.
This request is for the MEPS-HC and MEPS-MPC only.
Method of Collection
The MEPS is designed to meet the need for information to estimate
health expenses, insurance coverage, access, use and quality.
Households selected for participation in the MEPS 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.
After a preliminary mail contact containing an advance letter,
households will be mailed MEPS record keeping materials (a calendar)
and a DVD and brochure. After the advance contact, households will be
contacted for the first of five in-person interviews. The interviews
are conducted as a computer assisted personal interview (CAPI). The
CAPI instrument is organized as a core instrument that will repeat
unchanged in each of the rounds. Additional sections are asked only
once a year and provide greater depth. Dependent interviewing methods
in which respondents are asked to confirm or revise data provided in
earlier interviews will be used to update information such as
employment and health insurance data after the round in which such data
are usually collected. The main data collection modules for the MEPS-HC
are as follows:
Household Component Core Instrument. The core instrument collects
data about persons in sample households. Topical areas asked in each
round of interviewing include condition enumeration, health status,
health care utilization including prescribed medicines, expense and
payment, employment, and health insurance. Other topical areas that are
asked only once a year include access to care, priority conditions,
income, assets, satisfaction with health plans and providers, childrens
health, adult preventive care. 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.
Adult Self Administered Questionnaire. A brief self-administered
questionnaire (SAQ), administered once a year in rounds 2 and 4, will
be used to collect self-reported (rather than through household proxy)
information on health status, health opinions and satisfaction with
health care for adults 18 and older.
Diabetes Care SAQ. A brief self administered questionnaire on the
quality of diabetes care is administered once a year in rounds 3 and 5
to persons identified as having diabetes.
Permission forms for the MEPS-MPC. As in previous panels of the
MEPS, we will ask respondents for permission to obtain supplemental
information from their medical providers (hospitals, physicians, health
care institutions, home health agencies and pharmacies).
MEPS-MPC Instruments
The main objective of the MEPS-MPC is a collection of data from
medical providers that will serve as an imputation source of medical
expenditure and source of payment data reported by household
respondents. 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. The
questionnaires used in the MEPS-MPC vary according to type of provider.
The data collection instruments are as follows:
Home Care for Health Care Providers Questionnaire. 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.
Home Care Provider Questionnaire for Non-Health Care Providers.
This 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.
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Office-based Providers Questionnaire. This questionnaire is for the
office-based physician sample, including doctors of medicine (MD5) and
osteopathy (DOs), as well as providers practicing under the direction
or supervision of an MO 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.
Separately Billing Doctors Questionnaire. Information from
physicians identified by hospitals as providing care to sampled persons
during the course of inpatient stays, outpatient department or
emergency room care, but who bill separately from the hospital, is
collected in this questionnaire.
Hospitals Questionnaire. 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 itself.
Institutions Questionnaire. This questionnaire is used to collect
data from health care institutions providing care to sampled persons
and includes nursing homes, assisted living facilities, rehabilitation
facilities, as well as any other health care facilities providing
health care to a sampled person.
Pharmacies Questionnaire. This questionnaire requests the
prescription name, NDC code, date prescription was filled, payments by
source, prescription strength, form and quantity, and person for whom
the prescription was filled. 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.
Estimated Annual Respondent Burden
Exhibit 1 shows the estimated annualized burden hours for the
respondents' time to participate in the MEPS-HC and MEPS-MPC. The MEPS-
HC Core Interview will be completed by 15,000 ``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 1 and
Y2 hours to administer. The Adult SAQ will be completed once a year by
each person in the RU that is 18 years old and older, an estimated
21,000 persons. The Adult SAQ requires 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 1,800
persons and takes about 3 minutes to complete. Permission forms for the
MEPS-MPC will be completed once for each medical provider seen by any
RU member. Each of the 15,000 RUs in the MEPS-HC will complete an
average of 5.2 forms, which require about 3 minutes each to complete.
The total annual burden hours for the MEPS-HC is estimated to be 62,690
hours.
The MEPS-MPC uses 7 different questionnaires; 6 for medical
providers and 1 for pharmacies. Each questionnaire is relatively short
and requires 3 to 5 minutes to complete. The total annual burden hours
for the MEPS-HC and MPC is estimated to be 82,767 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 $1,226,216;
the annual cost burden for the MEPS-MPC is estimated to be $285,965.
Exhibit 1--Estimated Annualized Burden Hours
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Number of
Form name Number of responses per Hours per Total burden
respondents respondent response hours
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MEPS-HC:
MEPS-HC Core Interview...................... 15,000 2.5 1.5 56,250
Adult SAQ................................... 21,000 1 7/60 2,450
Diabetes care SAQ........................... 1,800 1 3/60 90
Permission forms for the MEPS-MPC........... 15,000 5.2 3/60 3,900
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Subtotal for the MEPS-HC................ 52,800 na na 62,690
MEPS-MPC:
Home care for health care providers 441 6.5 5/60 239
questionnaire..............................
Home care for non-health care providers 23 6.6 5/60 13
questionnaire..............................
Office-based providers questionnaire........ 13,665 5.8 5/60 6,605
Separately billing doctors questionnaire.... 12,450 2 3/60 1,245
Hospitals questionnaire..................... 5,402 6.5 5/60 2,926
Institutions (non-hospital) questionnaire... 72 1.5 5/60 9
Pharmacies questionnaire.................... 7,760 23.3 3/60 9,040
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Subtotal for the MEPS-MPC............... 39,813 na ia 20,077
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Grand Total......................... 92,613 na ia 82,767
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Exhibit 2--Estimated Annualized Cost Burden
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Number of Total burden Average hourly Total cost
Form mode respondents hours wage rate * burden
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MEPS-HC:
MEPS-HC Core Interview...................... 15,000 56,250 $19.56 $1,100,250
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Adult SAQ................................... 21,000 2,450 19.56 47,922
Diabetes care SAQ........................... 1,800 90 19.56 1,760
Permission forms for the MEPS-MPC........... 15,000 3,900 19.56 76,284
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Subtotal for the MEPS-HC................ 52,800 62,690 na 1,226,216
MEPS-MPC:
Home care for health care providers 441 239 14.24 3,403
questionnaire..............................
Home care for non-health care providers 23 13 19.56 254
questionnaire..............................
Office-based providers questionnaire........ 13,665 6,605 14.24 94,055
Separately billing doctors questionnaire.... 12,450 1,245 14.24 17,729
Hospitals questionnaire..................... 5,402 2,926 14.24 41,666
Institutions (non-hospital) questionnaire... 72 9 14.24 128
Pharmacies questionnaire.................... 7,760 9,040 14.24 128,730
Subtotal for the MEPS-MPC............... 39,813 20,077 na 285,965
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Grand Total......................... 92,613 82,767 na 1,512,181
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* Based upon the mean of the average wages for Healthcare Support Workers, All Other (31-9099) and All
Occupations (00-0000), Occupational Employment Statistics, May 2007 National Occupational Employment and Wage
Estimates United States, U.S. Department of Labor, Bureau of Labor Statistics. http://www.bls.gov/oes/current/
oes_nat.htm#b29-0000.
Estimated Annual Costs to the Federal Government
Exhibit 3 shows the total and annualized cost of this information
collection. The cost associated with the design and data collection of
the MEPS-HC and MEPS-MPC is estimated to be $47.6 million in each of
the next three fiscal years.
Exhibit 3--Estimated Total and Annualized Cost
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Annualized
Cost component Total cost (in cost (in
million) million)
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Sampling Activities..................... $2.79 $0.93
Interviewer Recruitment and Training.... 8.52 2.84
Data Collection Activities.............. 86.7 28.9
Data Processing......................... 21.39 7.13
Production of Public Use Data Files..... 19.53 6.51
Project Management...................... 3.93 1.31
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Total............................... 142.8 47.6
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Request for Comments
In accordance with the above-cited Paperwork Reduction Act
legislation, 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 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.
Dated: April 27, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-10406 Filed 5-5-09; 8:45 am]
BILLING CODE 4160-90-M