[Federal Register Volume 81, Number 226 (Wednesday, November 23, 2016)]
[Notices]
[Pages 84581-84583]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2016-28155]


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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: ``The Consumer Assessment of Healthcare Providers and Systems 
(CAHPS) Patient-Centered Medical Home (PCMH) Items Demonstration 
Study.'' In accordance with the Paperwork Reduction Act, AHRQ invites 
the public to comment on this proposed information collection.
    This proposed information collection was previously published in 
the Federal Register on August 3rd, 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 December 23, 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: 

[[Page 84582]]

Proposed Project

``The Consumer Assessment of Healthcare Providers and Systems (CAHPS) 
Patient-Centered Medical Home (PCMH) Items Demonstration Study.''

    This study is being conducted by AHRQ through its contractor, RAND, 
pursuant to AHRQ's statutory authority to conduct and support research 
on healthcare 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

    The patient-centered medical home (PCMH) is a model for delivering 
primary care that is patient-centered, comprehensive, coordinated, 
accessible, and continuously improved through a systems-based approach 
to quality and safety.
    As primary care practices across the United States seek National 
Committee for Quality Assurance (NCQA) recognition as patient-centered 
medical homes (PCMH), they can choose to administer the Consumer 
Assessment of Healthcare Providers and Systems (CAHPS[supreg]) 
Clinician and Group (CG-CAHPS) survey with or without the PCMH 
supplemental item set (AHRQ, 2010; Hays et al., 2014; Ng et al., 2016; 
Scholle et al., 2012). NCQA offers a special patient experience 
distinction to practices that opt to use the CAHPS PCMH items set in 
their CG-CAHPS survey tool. While over 11,000 practices, representing 
an estimated 15-18% of primary care physicians, are currently 
recognized for PCMH by NCQA (NCQA, 2015), fewer than 3% of them submit 
patient experience surveys to NCQA when applying for recognition under 
NCQA's PCMH recognition program.
    Despite the rapid movement toward PCMH primary care transformation 
and the increasing use of CAHPS PCMH items, little is known about the 
ways in which practices are using these CAHPS data and the PCMH 
supplemental item information (about access, comprehensiveness, self-
management, shared decision making, coordination of care, and 
information about care and appointments) to understand and improve 
their patients' experiences during PCMH transformation. The PCMH Items 
Demonstration Study will investigate:
     How practices across the U.S. use CAHPS and the PCMH item 
set during PCMH transformation,
     How practices assemble and select items for inclusion in 
their patient experience surveys (e.g. core, PCMH, supplemental, and 
custom items),
     Primary care practice leaders' perspectives on NCQA PCMH 
Recognition and CAHPS Patient Experience Distinction,
     Effects of changes made during PCMH transformation on 
patient experiences reported on CAHPS surveys and any PCMH items, and
     Associations between PCMH transformation and patient 
experience scores.
    To achieve the goals of this project the following data collections 
will be implemented:
    (1) Office Manager Questions administered via phone about the 
participating practice's characteristics to describe the type of 
practices in the study and to understand how practice characteristics 
influence PCMH transformation and patient experience.
    (2) Physician Interviews administered via phone with the lead PCMH 
clinical expert about the details, decisions and processes of PCMH 
transformation, NCQA PCMH Recognition and CAHPS Patient Experience 
Distinction and their use of patient experience data during the 
transformation process.
    (3) PCMH-A Assessment Tool to be completed by the lead PCMH 
clinical expert (before or after the interview on the standardized form 
via fax or email) to collect validated metrics on the ``PCMH-ness'' of 
the practice.
    (4) CAHPS Patient Experience Data Files, which are patient-level 
de-identified CAHPS patient experience data covering the period of PCMH 
transformation for the participating practice. These data are collected 
independently of this study by the practice (or network) via their 
current vendor. We will work with the PCMH clinical expert (or a person 
they designate who handles their data) in each of the participating 
practices to submit these CAHPS data files securely to RAND to 
understand practices' CAHPS patient experience trends and associations 
with PCMH implementation during practices' PCMH journey.
    Characterizing primary care practices' use of CAHPS and PCMH items 
will provide important insight into the activities practices conduct 
during PCMH transformation to improve patient experience scores. This 
information may be useful in supporting practices that lag behind their 
peers, learning from practices with outstanding records of patient 
experience, and providing recommendations that may be used to refine 
the content of the CAHPS survey items.

Estimated Annual Respondent Burden

    Table 1 shows the estimated annualized burden and cost for the 
respondents' time to participate in this data collection. These burden 
estimates are based on tests of data collection conducted on nine or 
fewer entities. As indicated below, the annual total burden hours are 
estimated to be 179 hours. The annual total cost associated with the 
annual total burden hours is estimated to be $16,899.
    Table 1 shows the estimated annualized burden for the respondents' 
time to participate in this data collection. The PCMH Items 
Demonstration Study will recruit 150 practices including the 
participating practices' office managers and one physician/lead PCMH 
clinical expert. We will recruit and administer the Office Manager 
Questions by phone to 150 office managers, recruit all sampled 
physicians by sending them a recruitment packet that includes a cover 
letter, an AHRQ endorsement letter and an info sheet, and then 
administer the Physician Interview protocol questions by phone to 150 
physicians, and 150 physicians will self-administer the PCMH-A 
Assessment Tool.
    We have calculated our burden estimate for Office Manager Questions 
asked during physician recruitment using an estimate of 3-5 questions a 
minute as the Office Manager Questions are closed-ended survey 
questions. The Office Manager Questions contains 17 questions and is 
estimated to require an average of 5 minutes; this estimate is 
supported by the information gathered during a pilot of these 
questions. For the Physician Interview, we have calculated the burden 
estimate to require an average of 40 minutes per interview. For the 
PCMH-A Assessment Tool, we calculated our burden using a conservative 
estimate of 4.5 items per minute. Prior work suggests that 3-5 items on 
an assessment tool can typically be completed per minute, depending on 
item complexity and respondent characteristics (Berry, 2009; Hays & 
Reeve, 2010). The PCMH-A Assessment tool contains 36 items and is 
estimated to require an average completion time of 8-10 minutes.
    Participating practices will be asked to submit any available CAHPS 
Patient Experience data files (e.g. submission of de-identified data 
including a data dictionary via encrypted transfer) for the period of 
time covering their NCQA

[[Page 84583]]

PCMH Recognition history. Each practice will have an average estimate 
of 3 CAHPS Patient Experience data files to submit per one submission, 
which we based on the average number of years of PCMH history of the 
sample. In addition, we conservatively estimate that half of the 
control practices (25/50) administer CG-CAHPS data, as this percentage 
is unknown; while 90% of the participating current and past CAHPS 
practices (90/100) will submit CAHPS data, yielding 115 submissions of 
CAHPS patient experience data files. As indicated below, the annual 
total burden is estimated to be 179 hours.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                            Number of responses      Hours per     Total burden
       Data collection task         Number of respondents      per respondent        response          hours
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Office Manager Questions..........  150..................  1....................            5/60            12.5
Physician Interview...............  150..................  1....................           40/60             100
PCMH-A Assessment Tool............  150 (Same Physicians   1 (same person as               15/60            37.5
                                     as above).             above).
CAHPS Patient Experience Data       115..................  1 per practice.......           15/60           28.75
 Files.
        Total.....................  415..................  1....................           75/60          178.75
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+ The same respondent completes the Physician Interview and PCMH-A Assessment Tool and submits the CAHPS Patient
  Experience Data Files.


                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                   Number of     Total burden    Average hourly     Total cost
             Data collection task                  requests          hours         wage rate *        burden
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Office Manager Questions......................             150            12.5        $57.44 \a\         $718.00
Physician Interview...........................             150             100         97.33 \b\        9,733.00
PCMH-A Assessment Tool........................             150            37.5         97.33 \b\        3,649.88
CAHPS Patient Experience Data Files...........             115           28.75         97.33 \b\        2,798.24
Total.........................................             300          178.75             55.48       16,899.12
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+ The same respondent completes the Physician Interview and PCMH-A Assessment Tool and submits the CAHPS Patient
  Experience Data Files.
* Occupational Employment Statistics, May 2015 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
\a\Based on the mean wages for General and Operations Managers, 11-1021 within Healthcare Support Occupations,
  the occupational group most likely tasked with completing the Office Manager Questions.
\a\Based on the mean wages for Physicians and Surgeons, 29-1060, the occupational group most likely tasked with
  completing the Physician Interview, PCMH-A Assessment Tool, and submitting the CAHPS Patient Experience Data
  Files.

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. 2016-28155 Filed 11-22-16; 8:45 am]
 BILLING CODE 4160-90-P