[Federal Register Volume 60, Number 119 (Wednesday, June 21, 1995)]
[Notices]
[Pages 32384-32386]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 95-15115]
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PHYSICIAN PAYMENT REVIEW COMMISSION
Request for Proposals
Agency: Physician Payment Review Commission.
Action: Notice.
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The Physician Payment Review Commission is soliciting proposals to
conduct a telephone interview of Medicare beneficiaries who are either
enrolled in or disenrolled from a Medicare managed care plan. The
survey's purpose is to gather information about these beneficiaries'
experiences with Medicare managed care, particularly on beneficiary
access to care. This notice describes the application procedures,
general policy considerations, and criteria to be used in reviewing
applications for prospective grants and contracts submitted to the
Commission.
Background on the Commission
The Physician Payment Review Commission was established in 1986
(P.L. 99-272) to advise the U.S. Congress on physician payment policy
under Part B of the Medicare program, and its mandate was later
expanded to include consideration of a broader set of interrelated
policies affecting the financing, quality, and delivery of health
services. The 13-member Commission brings together the perspectives of
physicians and other health professionals, consumers and the elderly,
purchasers, managed care organizations, and experts in health services
and health economics research. The Commission maintains a
multidisciplinary staff that conducts and manages all the analytical
work that supports its recommendations to the Congress.
The Commission submits an annual report to the Congress on March
31. It also submits a series of reports in May of each year concerning
Medicare expenditures and fee updates, access to care, the financial
liability of Medicare [[Page 32385]] beneficiaries, and comments on the
President's budget. The Commission has published analyses and
recommendations relevant to this solicitation on topics such as
ensuring access to care for vulnerable populations, approaches to
health plan quality assurance, and improving Medicare risk program
payment policy.
Description of Proposal Topic
Although beneficiary enrollment currently remains low, managed care
is expected to play an increasingly large role in the future of the
Medicare program. In response to this expectation, the Commission has
begun to develop an approach for evaluating Medicare managed care
enrollees' access to care as a component of its ongoing work in
monitoring access for beneficiaries generally. Sources of information
for use in monitoring Medicare managed care enrollees' access to care
are currently limited, however. Encounter data are unavailable, for
example. Also, the Medicare Current Beneficiary Survey (MCBS), which
provides information about beneficiary experience in obtaining care, is
not a useful source of information on beneficiaries enrolled in managed
care plans because the number of enrollees in its sample is small and
geographically clustered.
Because existing data for monitoring access for this population are
insufficient, the Commission seeks to develop, test, and field a
questionnaire for use in surveying Medicare beneficiaries who are
either enrolled in or disenrolled from Medicare managed care plans.
This survey would be used to obtain information about Medicare
beneficiaries' experiences with managed care plans, and how those
experiences affect their access to care. The managed care experiences
of certain vulnerable subgroups of the beneficiary population may be
analyzed and compared to those of the general beneficiary population.
The survey instrument would use some questions from the MCBS to permit
comparisons with beneficiaries in the fee-for-service sector, and would
also adapt or develop other questions more appropriate to managed care.
The survey results would provide information about beneficiary
experience with managed care plans that could potentially be used as a
baseline for comparison with the results of future studies. The
information is expected to be used by the Commission to help assess the
effects of potential health policy initiatives and to formulate policy
recommendations. Also, the Commission expects that the survey will
yield experience relevant to the design of future Medicare beneficiary
surveys for the collection of information specific to Medicare managed
care enrollees.
In particular, the Commission seeks to gain insight into Medicare
managed care enrollee and disenrollee experiences with or perception of
the following:
access to care, including the timely availability of
needed services, experience in obtaining a primary care physician upon
enrollment and in cases where a physician leaves the plan, ability to
find a physician, waiting times for appointments, travel distance to
provider, barriers to care, and adequacy of access to specialists, as
well as the perceived impact of supplemental benefits provided by the
plan and of case management or disease management programs provided;
utilization of services, including preventive care, acute
care, home health care, rehabilitation care, reasons for and experience
with out-of-plan service utilization, and experience in obtaining
costly or experimental services in circumstances in which they might be
indicated;
level of satisfaction with various aspects of managed care
experiences, including access to care, quality of care, care management
or coordination efforts, choice of providers, and financial liability;
degree of awareness and understanding of managed care plan
arrangements, including incentives, service arrangements, restrictions
on or consequences of out-of-plan service use, and enrollees' rights
and responsibilities;
aspects of managed care plan enrollment that bear on
access to care, such as sources of beneficiary information on
enrollment and options, and experience with the enrollment process;
primary and contributing reasons for continuing enrollment
and, where applicable, disenrollment; and
nature and extent of any problems with discontinuity of
care when switching to or from a managed care plan, including
experiences with obtaining or retaining supplemental insurance and with
changing providers.
As a component of the survey analysis, the Commission seeks to
identify characteristics of beneficiaries and of managed care plans
that affect beneficiary experience with access to care. To that end,
the survey questionnaire should include background questions on
relevant characteristics of beneficiaries who have experience in a
managed care plan and relevant characteristics of the plans they have
enrolled in or disenrolled from.
The sample size will be determined by technical feasibility and
resource constraints. Projects should be bid at the sample size that
the Offeror believes to be appropriate. For comparability purposes, a
budget based on a simple size of 2,000 should be included in the
Offeror's business proposal. The Commission is exempt from Office of
Management and Budget regulations regarding the clearance of forms and
survey instruments.
The contractor will perform the following tasks:
1. Conduct a review of relevant survey or other research findings.
2. Refine survey topics, including suggesting additional survey
topics to meet the Commission's needs, develop the survey instrument in
consultation with Commission staff, and pilot test the full instrument.
3. Determine the appropriate sampling design and sample size, and
select a random sample of Medicare beneficiaries who are either
enrolled in or disenrolled from a Medicare managed care plan.
4. Conduct the telephone interviews.
5. Deliver to the Commission a documented, cleaned, computer data
file of the responses by July 15, 1996.
6. Deliver a draft report of the methodology and results of the
survey to the Commission by August 5, 1996.
7. Deliver to the Commission the final written report of the
survey's methodology and results by September 2, 1996.
The Commission plans to award a contract in September 1995.
Formal Proposals
Proposals must conform to the requirements specified in the
Commission's formal Request for Proposals, which will be made available
to applicants on June 29, 1995. The following provides an outline of
what should be contained in the formal proposal:
1. Suggestions for additional topic areas to meet the Commission's
needs (described more fully in the Request for Proposals) and examples
of questions to address specific topics of interest.
2. Plans for developing and testing the survey instrument,
including the use and adaptation of previously validated questions
where applicable, and discussion of the types of questions from the
MCBS that would be most appropriate and useful in obtaining
comparability of relevant survey results.
3. Plans for determining the appropriate sampling design and sample
size, and for obtaining a random sample of beneficiaries who are either
enrolled or disenrolled from a Medicare managed [[Page 32386]] care
plan. Plans for oversampling certain groups thought to be vulnerable to
access problems should be included. The Commission will provide a data
set of beneficiaries and relevant characteristics for sample
generation.
4. Methods to be used to obtain an adequate response rate.
5. Detailed description of how the interviews will be carried out,
including the training of interviewers, and method to achieve reliable
results.
6. Analysis plan.
7. Discussion of problems that may be encountered and strategies
for resolving them.
8. Work plan including description of tasks, time schedule, level
of effort for key individuals, and the number of days devoted to each
task.
9. Description of the organizational experience and resources and
the qualifications of key project staff, demonstrating their
understanding of the Medicare program and managed care, experience with
the design and conduct of telephone interview surveys of Medicare
beneficiaries or the elderly, and the ability to complete successfully
the preceding tasks.
10. Detailed budget providing justifications and explanations for
amounts required for each task of the project.
Review of Proposals
Proposals will be reviewed by a panel composed of at least three
individuals, at least one of whom will not be affiliated with the
Commission. Reviewers will score applications and make recommendations
based on the criteria published in the Commission's Request for
Proposals, Part IV, Section M, ``Technical Evaluation and Criteria for
Award.''
General Information
Authority
The Commission's authority for making these awards is based on
Section 1845(c)(2)(B) of the Social Security Act (42 U.S.C. Section
1359w-1).
Regulations
General policies and procedures that govern the administration of
contracts and grants are located in Title 45 of the CFR parts 74 and
92. Applicants are urged to review the requirements contained in those
regulations.
Submission Address
Physician Payment Review Commission,2120 L Street NW, Suite
200,Washington, DC 205037.
Submission Deadline
In order to be considered under this Request for Proposals,
complete proposals must be received in the Commission's office no later
than close of business, Friday, July 28, 1995.
Obligation
Ths solicitation in no way obligates the Commission to fund any
applicant.
Date:
June 15, 1995.
Contact:
Elizabeth Docteur, Analyst, Physician Payment Review Commission,
2120 L Street NW., Suite 200, Washington, DC 20037, (202) 653-7220.
Lauren B. LeRoy,
Acting Executive Director.
[FR Doc. 95-15115 Filed 6-20-95; 8:45 am]
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