[Federal Register Volume 68, Number 124 (Friday, June 27, 2003)]
[Notices]
[Pages 38346-38359]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 03-16057]


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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: [email protected].
    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 [email protected].

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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