[Federal Register Volume 74, Number 133 (Tuesday, July 14, 2009)]
[Notices]
[Pages 34016-34019]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: E9-16567]


=======================================================================
-----------------------------------------------------------------------

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 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.
    This proposed information collection was previously published in 
the Federal Register on May 6th 2009 and allowed 60 days for public 
comment. No comments were received. The purpose of this notice is to 
allow an additional 30 days for public comment.

DATES: Comments on this notice must be received by August 13, 2009.

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 
e-mail at [email protected] (attention: AHRQ's desk officer).
    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 
[email protected].

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:
    [squ] MEPS-HC is a sample of households participating in the 
National Health Interview Survey (NHIS) in the prior calendar year and 
are interviewed 5 times over a 2 and 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.
    [squ] 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.
    [squ] 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 
CAPT 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

[[Page 34017]]

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, 
children's 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.
    Office-based Providers Questionnaire. This questionnaire is for the 
office-based physician sample, 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.
    Separately Billing Doctors Questionnaire. Information from 
physicians identified by hospitals as providing care to sampled persons 
during the course of inpatient, 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 I 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 2 
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-MPC is estimated to be 
20,077 hours. 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.

[[Page 34018]]



                                  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..........................          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
                                                 ---------------------------------------------------------------
    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
                                                 ---------------------------------------------------------------
    Subtotal for the MEPS-MPC...................          39,813              na              na          20,077
                                                 ---------------------------------------------------------------
        Grand Total.............................          92,613              na              na          82,767
----------------------------------------------------------------------------------------------------------------


                                   Exhibit 2--Estimated Annualized Cost Burden
----------------------------------------------------------------------------------------------------------------
                                                                                      Average
                    Form name                        Number of     Total burden    hourly  wage     Total cost
                                                    respondents        hours           rate*          burden
----------------------------------------------------------------------------------------------------------------
                                                    MEPS-IIC
----------------------------------------------------------------------------------------------------------------
MEPS-HC Core Interview..........................          15,000          56,250          $19.56      $1,100,250
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
                                                 ---------------------------------------------------------------
    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
                                                 ---------------------------------------------------------------
        Grand Total.............................          92,613          82,767              na       1,512,181
----------------------------------------------------------------------------------------------------------------
* Based upon the mean of the average wages for Healthcare Support Workers, All Other (319099) 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
------------------------------------------------------------------------
                                        Total cost      Annualized cost
          Cost component                (millions)         (millions)
------------------------------------------------------------------------
Sampling Activities...............              $2.79              $0.93
Interviewer Recruitment and                      8.52               2.84
 Training.........................

[[Page 34019]]

 
Data Collection Activities........               86.7               28.9
Data Processing...................              21.39               7.13
Production of Public Use Data                   19.53               6.51
 Files............................
Project Management................               3.93               1.31
                                   -------------------------------------
    Total.........................              142.8               47.6
------------------------------------------------------------------------

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: July 1, 2009.
Carolyn M. Clancy,
Director.
[FR Doc. E9-16567 Filed 7-13-09; 8:45 am]
BILLING CODE 4160-90-M