[Federal Register Volume 81, Number 119 (Tuesday, June 21, 2016)]
[Notices]
[Pages 40306-40308]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-14614]


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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: ``AHRQ ACTION III--Measurement for Performance Improvement in 
Physician Practices.'' In accordance with the Paperwork Reduction Act, 
44 U.S.C. 3501-3521, AHRQ invites the public to comment on this 
proposed information collection.
    This proposed information collection was previously published in 
the Federal Register on April 13, 2016 and allowed 60 days for public 
comment. AHRQ did not receive any substantive comments. The purpose of 
this notice is to allow an additional 30 days for public comment.

DATES: Comments on this notice must be received by July 21, 2016.

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

FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports 
Clearance Officer, (301) 427-1477, or by email at 
[email protected].

SUPPLEMENTARY INFORMATION: 

Proposed Project

AHRQ ACTION III--Measurement for Performance Improvement in Physician 
Practices

    This two-year project is an important first step to understanding 
fully measurement for performance improvement in medical groups. This 
exploratory research is expected to set the stage for informing future 
research and policy discussions, both of which could ultimately have a 
more direct impact on providers, payers, and patients. As a critical 
first step this research breaks new ground in an important area of 
health care research by looking at the current landscape to understand 
better how medical groups are using measurement internally to improve 
performance and what that means to them, and how internal measurement 
relates to external measurement obligations and identifying where the 
gaps are.
    Project success for this exploratory work will be more relevant 
given the complete context of the current landscape of performance 
measurement, gleaned through an environmental scan, expert input, and 
qualitative data

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collection. Ultimately, success will be measured by our ability to 
answer the research questions that are guiding this research project 
(see below).
    The overall goal of AHRQ's Measurement for Performance Improvement 
in Physician Practices project is to identify the current gaps in our 
knowledge about how practices are using data, if at all, for 
performance improvement. AHRQ has developed this project to address the 
lack of current evidence on internal performance measurement in medical 
groups, identifying the following research questions:
     What gaps exist in the research literature regarding 
management for performance improvement in medical groups?
     What factors, both internal and external, drive efforts to 
use measurement to improve medical group performance?
     How are measures used to support internal management and 
improvement processes?
     What additional activities support use of internal 
performance measures?
     How are internal performance measures derived and 
reported? What specific measures, benchmarks, and comparisons are used?
     How have physicians responded to these measurement 
processes?
     What are the perceived benefits of internal measurement 
activities? What types of costs and other burdens are directly 
associated with internal measurement? How feasible is it to specify 
actual costs of reporting?
     What implications does evidence on internal measurement 
for performance improvement have for payers, policy makers, executives 
in delivery systems, and clinical leaders?
Specific Project Objectives
     Identify specific measures/metrics used internally by 
medical groups to assess performance and support improvement 
activities.
     Describe how internal measurement activities/measures are 
used in medical groups to support improvement in individual, team, or 
organizational performance including, but not limited to, how these 
activities are tied to ``internal'' financial incentives.
     Identify types of costs and other types of burdens (e.g. 
staff resources, IT resources, etc.), directly related to internal 
measurement and reporting activities. Assess the feasibility of 
capturing information on costs and burdens of internal and external 
performance measurement, and, if feasible, collect data on the actual 
costs and other associated burdens of internal and external performance 
measurement.
     Based on the findings, identify implications, potential 
impacts, and future research opportunities for payers, regulators, and 
medical groups regarding internal measurements for performance 
improvement.
    Efforts to improve performance among health care providers through 
measurement and reporting have evolved over time and have taken many 
forms and many names. For example, Triple Aim, Public Reporting, 
Performance Measurement, Quality Improvement, Pay for Performance are 
all common concepts today. And, most health care providers, including 
medical groups, are monitoring their performance using a wide array of 
quality measures that reflect care processes, clinical outcomes, and 
patient experiences. Increasing numbers of providers are required to 
report their performance on quality measures by payers such as the 
Centers for Medicare and Medicaid Services and external regulatory 
bodies such as the National Committee for Quality Assurance or the 
Joint Commission on Accreditation of Healthcare Organizations.
    Little is known, however, about how providers make use internally 
of measures that are required by external bodies for payment or 
reporting. Nor is it known what other measures providers collect and 
use to improve performance. This project aims to fill this knowledge 
gap. In doing so, it may also inform payment and reporting initiatives 
by providing indications of the degree to which providers view 
externally mandated measures as valuable for their internal quality 
assessment and reporting efforts.
    As an initial step in understanding the landscape of measurement 
for performance improvement, this research will look to understand how 
medical groups define and measure performance improvement.
    This work is being conducted by AHRQ through its contractor, 
Westat, pursuant to AHRQ's statutory authority to conduct and support 
research on health care and on systems for the delivery of such care, 
including activities with respect to the quality, effectiveness, 
efficiency, appropriateness and value of healthcare services and with 
respect to quality measurement and improvement. 42 U.S.C. 299a(a)(1) 
and (2).

Method of Collection

    For this study, AHRQ will conduct field data collection through 
semi-structured in-depth interviews. The unit of analysis for this work 
is the medical group. To understand measurement for performance 
improvement in each medical group, AHRQ will interview up to 5 
administrators and frontline clinicians per medical group. Interviews 
with both administrators and clinicians will be facilitated using the 
same protocol. As discussed below, given the different levels of 
involvement and experience with internal performance measurement, 
interviews will vary in detail and thus length. But, as AHRQ works to 
uncover the story of each medical group involved in the study, the same 
guiding protocol will apply. AHRQ will audio-record and professionally 
transcribe each interview conducted. And, all interviews will be loaded 
into Dedoose for coding and analysis.
    The information collected in the data collection effort will be 
used for one main purpose:
    Identify the current gaps in internal measurement in physician 
practices. The results from the data collection will give AHRQ a 
snapshot on the current practices being undertaken for internal 
performance measurement and inform best next steps to move beyond this 
exploratory research phase.
    The intended target audiences expected to benefit most from the 
project include the medical groups using this information to improve 
performance, the health care professionals who work in these medical 
groups working to improve how they care for patients, and the patients 
who benefit from improved care. One way this research could benefit 
these audiences is by informing payment and reporting initiatives by 
providing indications of the degree to which providers view externally 
mandated measures as valuable for their internal quality assessment and 
reporting efforts.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
participants' time to take part in this research. To recruit medical 
groups to participate, AHRQ will engage groups in a short call to 
assess interest and obtain a commitment to participate. AHRQ expects 
the need to reach out to approximately 100 medical groups to obtain a 
sample of 45 groups that are conducting some type of measurement for 
internal performance improvement, are interested in taking part, and 
are able to take part during the data collection window. In-depth, 
semi-structured qualitative interviews will then be conducted with up 
to 5 staff members at 45 medical groups using a single protocol. AHRQ 
will target small (2-9 eligible professionals (EP)),

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medium (10-24 EPs), and large (25+ EPs) medical groups from across the 
Unites States. The goal is to recruit approximately 3 administrators 
and 2 frontline clinicians in each Group, understanding that depending 
on the size and organization of the medical group staff members may 
operate in multiple roles.
    Based on the pilot study conducted for this project, AHRQ estimates 
that the recruitment call will average 15 minutes, and that the longest 
interviews will be 1.5 hours. These longest interviews will be with the 
highest level administrators working on internal performance 
measurement at the most complex medical groups. AHRQ believes these 
will be the largest medical groups that are part of complex systems and 
payment relationships. These complex organizational relationships will 
require more time to understand in order to understand the place, role, 
and operation of internal measurement for performance improvement 
within the group. For equivalent administrators from medium and small 
groups, AHRQ estimates the longest interviews will be 1.25 hours. For 
all other administrators and frontline clinicians, AHRQ estimates the 
interviews will be 1 hour.
    The total annualized burden is estimated to be 295 hours. Again, 
interviews with both frontline clinicians and all medical group 
administrators will use the same protocol. The screening call will be 
an informal conversation in which AHRQ looks to learn if the medical 
group self-identifies as using measurement for performance improvement 
and provides consent to take part. AHRQ will answer any questions the 
medical group has about the study on this call and confirm some basic, 
publicly available background information about the group that AHRQ has 
obtained is accurate and up to date. This background information will 
help put the information learned during the interview in better 
context. The types of background information AHRQ is looking at 
includes medical group size, organizational structure, specialty mix, 
and payment relationships.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                                     Number of       Hours per     Total burden
                            Form name                               respondents      response          hours
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Frontline clinicians............................................              90               1              90
Medical group administrators....................................             235  ..............  ..............
Medical group administrators: Administrator with authority to                100            0.25              25
 agree to participate in the study..............................
Medical group administrators:Initial, highest level                           45             1.5            67.5
 administrators.................................................
Medical group administrators: All other administrators..........              90            1.25           112.5
                                                                 -----------------------------------------------
    Total.......................................................             325              NA             295
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    Exhibit 2 shows the estimated annualized cost burden associated 
with the participants' time to take part in this research. The total 
cost burden is estimated to be $27,270.45.

                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                                                      Average
                        Interviewee type                           Total burden     hourly wage     Total cost
                                                                       hours          rate *          burden
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Frontline clinicians............................................              90     \a\ $103.54       $9,318.60
Medical group administrators....................................             205       \b\ 87.57       17,951.85
                                                                 -----------------------------------------------
    Total.......................................................             295              NA       27,270.45
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\a\ Based on the average hourly wage for one physician (29-1060; $103.54).
\b\ Based on the average hourly wage for one Chief Executive (11-1011; $87.57).
* National Industry-Specific Occupational Employment and Wage Estimates, May 2014, from the Bureau of Labor
  Statistics (available at http://www.bls.gov/oes/current/naics4_621100.htm [for Offices of Physicians, NAICS
  622100]).

Request for Comments

    In accordance with the Paperwork Reduction Act, 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.

Sharon B. Arnold,
Deputy Director.
[FR Doc. 2016-14614 Filed 6-20-16; 8:45 am]
 BILLING CODE 4160-90-P