[Federal Register Volume 83, Number 107 (Monday, June 4, 2018)]
[Notices]
[Pages 25671-25674]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-11927]


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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 ``Medical Expenditure Panel Survey (MEPS) Household Component 
and the MEPS Medical Provider Component.''

DATES: Comments on this notice must be received by August 3, 2018.

ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, 
Reports Clearance Officer, AHRQ, by email at 
[email protected].
    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 emails at 
[email protected].

SUPPLEMENTARY INFORMATION:

Proposed Project

Medical Expenditure Panel Survey (MEPS) Household Component (HC)

    In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3521, AHRQ invites the public to comment on this proposed information 
collection. For over thirty years, results from 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.
    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 MEPS 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 NHIS as a 
sampling frame expands the MEPS analytic capacity by providing another 
data point for comparisons over time.
    Households selected for participation in the MEPS-HC 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.
    The MEPS-HC has the following goal:
[ssquf] To provide nationally representative estimates for the U.S. 
civilian noninstitutionalized population for:
[ssquf] health care use, expenditures, sources of payment
[ssquf] health insurance coverage
    To achieve the goals of the MEPS-HC the following data collections 
are implemented:

    1. Household Component Core Instrument. The core instrument 
collects data about persons in sample households. Topical areas 
asked in each round of interviewing include priority condition 
enumeration, health status, health care utilization including 
prescribed medicines, expenses and payments, employment, and health 
insurance. Other topical areas that are asked only once a year 
include access to care, income, assets, satisfaction with providers, 
and children's health. 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. All sections of the 
current core instrument are available on the AHRQ website at http://meps.ahrq.gov/mepsweb/survey_comp/survey_questionnaires.jsp.
    2. Adult Self-Administered Questionnaire. A brief self-
administered questionnaire (SAQ) will be used to collect self-
reported data (rather than through household proxy) on health 
opinions and satisfaction with health care, and information on 
health status, preventive care and health care quality measures for 
adults 18 and older. This questionnaire is revised from the previous 
OMB clearance and received clearance on May 9, 2018.
    3. Veteran SAQ. MEPS includes a new self-administered 
questionnaire for spring of 2019 data collection targeting the 
veteran population. The questionnaire asks questions in the 
following domains of interest: if a veteran is eligible for VA 
health care; if a Veteran is enrolled in VA health care; 
coordination of care in and out of the VA health care system, 
services provided to Veterans in and out of the VA health care 
system, and VA eligibility priority groups, for Veterans enrolled in 
VA health care and for Veterans eligible for VA health care. To 
assist in the correct identification of priority groups, the 
questionnaire may also include items assessing the following: 
presence of service-connected disability; service-connected 
disability rating; presence of presumptive-conditions; timing and 
era of active duty; and VA receipt of disability compensation 
benefits. AHRQ worked with the Veterans Health Administration to 
develop the questionnaire content.
    4. Diabetes Care SAQ. There is no change in this instrument. A 
brief self-administered paper-and-pencil questionnaire on the 
quality of diabetes care is administered once a year (during rounds 
3 and 5) to persons identified as having diabetes. Included are 
questions about the number of times the respondent reported having a 
hemoglobin A1c blood test, whether the respondent

[[Page 25672]]

reported having his or her feet checked for sores or irritations, 
whether the respondent reported having an eye exam in which the 
pupils were dilated, the last time the respondent had his or her 
blood cholesterol checked and whether the diabetes has caused kidney 
or eye problems. Respondents are also asked if their diabetes is 
being treated with diet, oral medications or insulin. This 
questionnaire is unchanged from the previous OMB clearance.
    5. Authorization forms for the MEPS-MPC Provider and Pharmacy 
Survey. There is no change in this instrument. As in previous panels 
of the MEPS, we will ask respondents for authorization to obtain 
supplemental information from their medical providers (hospitals, 
physicians, home health agencies and institutions) and pharmacies.
    6. MEPS Validation Interview. There is no change in this 
instrument. Each interviewer is required to have at least 15 percent 
of his/her caseload validated to insure that the computer assisted 
personal interview (CAPI) questionnaire content was asked 
appropriately and procedures followed, for example the use of show 
cards. Validation flags are set programmatically for cases pre-
selected by data processing staff before each round of interviewing. 
Home office and field management may also request that other cases 
be validated throughout the field period. When an interviewer fails 
a validation their work is subject to 100 percent validation. 
Additionally, any case completed in less than 30 minutes is 
validated. A validation abstract form containing selected data 
collected in the CAPI interview is generated and used by the 
validator to guide the validation interview.

Medical Expenditure Panel Survey (MEPS) Medical Provider Component 
(MPC)

    The MEPS-MPC will contact medical providers (hospitals, physicians, 
home health agencies and institutions) identified by household 
respondents in the MEPS[dash]HC as sources of medical care for the time 
period covered by the interview, and all pharmacies providing 
prescription drugs to household members during the covered time period. 
The MEPS-MPC is not designed to yield national estimates as a stand-
alone survey. The sample is designed to target the types of individuals 
and providers for whom household reported expenditure data was expected 
to be insufficient. For example, Medicaid enrollees are targeted for 
inclusion in the MEPS-MPC because this group is expected to have 
limited information about payments for their medical care.
    The MEPS-MPC collects event level data about medical care received 
by sampled persons during the relevant time period. The data collected 
from medical providers include:

 Dates on which medical encounters during the reference 
period occurred
 Data on the medical content of each encounter, including 
ICD[dash]10 codes
 Data on the charges associated with each encounter, the 
sources paying for the medical care[dash]including the patient/
family, public sources, and private insurance, and amounts paid by 
each source

    Data collected from pharmacies include:

 Date of prescription fill
 National drug code (NDC) or prescription name, strength and 
form
 Quantity
 Payments, by source

    The MEPS-MPC has the following goal:

 To serve as an imputation source for and to supplement/
replace household reported expenditure and source of payment 
information. 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.

    To achieve the goal of the MEPS-MPC the following data collections 
are implemented:

    1. MPC Contact Guide/Screening Call. There is no change in this 
instrument. An initial screening call is placed to determine the 
type of facility, whether the practice or facility is in scope for 
the MEPS-MPC, the appropriate MEPS-MPC respondent and some details 
about the organization and availability of medical records and 
billing at the practice/facility. All hospitals, physician offices, 
home health agencies, institutions and pharmacies are screened by 
telephone. A unique screening instrument is used for each of these 
seven provider types in the MEPS-MPC, except for the two home care 
provider types which use the same screening form.
    2. Home Care Provider Questionnaire for Health Care Providers. 
There is no change in this instrument. 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. Some 
HMOs may be included in this provider type.
    3. Home Care Provider Questionnaire for Non[dash]Health Care 
Providers. There is no change in this instrument. This questionnaire 
is used to collect information about services provided in the home 
by non[dash]health care workers to household respondents because of 
a medical condition; for example, cleaning or yard work, 
transportation, shopping, or child care.
    4. Medical Event Questionnaire for Office[dash]Based Providers. 
There is no change in this instrument. This questionnaire is for 
office[dash]based physicians, 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.
    5. Medical Event Questionnaire for Separately Billing Doctors. 
There is no change in this instrument. This questionnaire collects 
information from physicians identified by hospitals (during the 
Hospital Event data collection) as providing care to sampled persons 
during the course of inpatient, outpatient department or emergency 
room care, but who bill separately from the hospital.
    6. Hospital Event Questionnaire. There is no change in this 
instrument. 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; doctors that do bill separately from the hospital will be 
contacted as part of the Medical Event Questionnaire for Separately 
Billing Doctors. HMOs are included in this provider type.
    7. Institutions Event Questionnaire. There is no change in this 
instrument. This questionnaire is used to collect information about 
institution events, including nursing homes, rehabilitation 
facilities and skilled nursing facilities. Institution 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. In many cases, the 
institution's administrative office also has to be contacted to 
determine whether the doctors identified by medical records billed 
separately from the institution itself. Some HMOs may be included in 
this provider type.
    8. Pharmacy Data Collection Questionnaire. There is no change in 
this instrument. This questionnaire requests the NDC and when that 
is not available the prescription name, strength and form as well as 
the date prescription was filled, payments by source, the quantity, 
and person for whom the prescription was filled. When the NDC is 
available, we do not ask for prescription name, strength or form 
because that information is embedded in the NDC; this reduces burden 
on the respondent. 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. Pharmacies are also able to provide a 
CD-ROM with the requested information if that is preferred. HMOs are 
included in this provider type.

    Dentists, optometrists, psychologists, podiatrists, chiropractors, 
and others not providing care under the supervision of a MD or DO are 
considered out of scope for the MEPS-MPC.
    The MEPS-HC and MEPS-MPC are being conducted by AHRQ through its

[[Page 25673]]

contractors, Westat and RTI International, 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 
cost and use of health care services and with respect to health 
statistics and surveys. 42 U.S.C. 299a(a)(3) and (8); 42 U.S.C. 299b-2.

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated annualized burden hours for the 
respondents' time to participate in the MEPS-HC and the MEPS-MPC
    The MEPS-HC Core Interview will be completed by 13,338 \*\ (see 
note below Exhibit 1) ``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 92 minutes to administer. The 
Adult Female SAQ will be completed once a year by each female person in 
the RU that is 18 years old and older, an estimated 12,984 persons. The 
Adult Male SAQ will be completed once a year by each male person in the 
RU that is 18 years old and older, an estimated 11,985 persons. The 
Adult SAQs each require 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 2,072 persons, and takes 
about 3 minutes to complete. The Veteran SAQ will be completed once by 
each in-scope person who is a veteran of the U.S. military identified 
in the Round 1, Panel 23 interview, an estimated 1,350 persons. The 
Veteran SAQ requires an average of 15 minutes to complete. The 
authorization form for the MEPS-MPC Provider Survey will be completed 
once for each medical provider seen by any RU member. The 12,804 RUs in 
the MEPS-HC will complete an average of 5.4 authorization forms, which 
require about 3 minutes each to complete. The authorization form for 
the MEPS-MPC Pharmacy Survey will be completed once for each pharmacy 
for any RU member who has obtained a prescription medication. RUs will 
complete an average of 3.1 forms, which take about 3 minutes to 
complete. About one third of all interviewed RUs will complete a 
validation interview as part of the MEPS-HC quality control, which 
takes an average of 5 minutes to complete. The total annual burden 
hours for the MEPS-HC are estimated to be 60,278 hours.
    All medical providers and pharmacies included in the MEPS-MPC will 
receive a screening call and the MEPS-MPC uses 7 different 
questionnaires; 6 for medical providers and 1 for pharmacies. Each 
questionnaire is relatively short and requires 2 to 19 minutes to 
complete. The total annual burden hours for the MEPS-MPC are estimated 
to be 17,388 hours. The total annual burden for the MEPS-HC and MPC is 
estimated to be 77,666 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 $1,438,233; 
the annual cost burden for the MEPS-MPC is estimated to be $291,595. 
The total annual cost burden for the MEPS-HC and MPC is estimated to be 
$1,729,828.
    The MEPS-MPC interviewer will be authorized to offer remuneration 
to providers who present cost as a salient objection to responding or 
if a flat fee is applied to any request for medical or billing records. 
Based on the past cycle of data collection fewer than one third of 
providers will request remuneration. Exhibit 3 shows the total and 
average per record remuneration by provider type, based on the 2016 
data collection, the most recent year for which data is available. For 
those providers that required remuneration the average payment per 
medical record was $37.80, this compares to $32.98 in 2010.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                                     Number of
                    Form name                        Number of     responses per     Hours per     Total burden
                                                    respondents     respondent       response          hours
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                                                     MEPS-HC
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MEPS-HC Core Interview..........................        * 13,338             2.5           92/60          51,129
Adult Female SAQ................................          12,984               1            7/60           1,515
Adult Male SAQ..................................          11,985               1            7/60           1,398
Diabetes care SAQ...............................           2,072               1            3/60             104
Veteran SAQ.....................................           1,350               1           15/60             338
Authorization form for the MEPS-MPC Provider              12,804             5.4            3/60           3,457
 Survey.........................................
Authorization form for the MEPS-MPC Pharmacy              12,804             3.1            3/60           1,985
 Survey.........................................
MEPS-HC Validation Interview....................           4,225               1            5/60             352
                                                 ---------------------------------------------------------------
    Subtotal for the MEPS-HC....................          71,562              na              na          60,278
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                                                    MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call **.............          36,598               1            2/60           1,220
Home care for health care providers                          635            1.53            9/60             146
 questionnaire..................................
Home care for non[dash]health care providers                  11               1           11/60               2
 questionnaire..................................
Office[dash]based providers questionnaire.......          11,210            1.65           10/60           3,083
Separately billing doctors questionnaire........          12,397            3.46           13/60           9,294
Hospitals questionnaire.........................           5,310            3.26            9/60           2,597
Institutions (non-hospital) questionnaire.......             116            2.05            9/60              36
Pharmacies questionnaire........................           6,919            2.92            3/60           1,010
                                                 ---------------------------------------------------------------
    Subtotal for the MEPS-MPC...................          73,196              na              na          17,388
                                                 ---------------------------------------------------------------
        Grand Total.............................         144,758              na              na          77,666
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* While the expected number of responding units for the annual estimates is 12,804, it is necessary to adjust
  for survey attrition of initial respondents by a factor of 0.96 (13,338 = 12,804/0.96).

[[Page 25674]]

 
** There are 6 different contact guides; one for office based, separately billing doctor, hospital, institution,
  and pharmacy provider types, and the two home care provider types use the same contact guide.


                                   Exhibit 2--Estimated Annualized Cost Burden
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                                                                                      Average
                    Form name                        Number of     Total burden    hourly  wage     Total cost
                                                    respondents        hours           rate           burden
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                                                     MEPS-HC
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MEPS-HC Core Interview..........................          13,338          51,129        * $23.86      $1,219,938
Adult Female SAQ................................          12,984           1,515         * 23.86          36,148
Adult Male SAQ..................................          11,985           1,398         * 23.86          33,356
Diabetes care SAQ...............................           2,072             104         * 23.86           2,481
Veteran SAQ.....................................           1,350             338         * 23.86           8,065
Authorization forms for the MEPS-MPC Provider             12,804           3,457         * 23.86          82,484
 Survey.........................................
Authorization form for the MEPS-MPC Pharmacy              12,804           1,985         * 23.86          47,362
 Survey.........................................
MEPS-HC Validation Interview....................           4,225             352         * 23.86           8,399
                                                 ---------------------------------------------------------------
    Subtotal for the MEPS-HC....................          71,562          60,278              na       1,438,233
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                                                    MEPS-MPC
----------------------------------------------------------------------------------------------------------------
MPC Contact Guide/Screening Call................          36,598           1,220        ** 16.85          20,557
Home care for health care providers                          635             146        ** 16.85           2,460
 questionnaire..................................
Home care for non[dash]health care providers                  11               2        ** 16.85              34
 questionnaire..................................
Office[dash]based providers questionnaire.......          11,210           3,083        ** 16.85          51,949
Separately billing doctors questionnaire........          12,397           9,294        ** 16.85         156,604
Hospitals questionnaire.........................           5,310           2,597        ** 16.85          43,759
Institutions (non-hospital) questionnaire.......             116              36        ** 16.85             607
Pharmacies questionnaire........................           6,919           1,010       *** 15.47          15,625
                                                 ---------------------------------------------------------------
    Subtotal for the MEPS-MPC...................          73,196          17,388              na         291,595
----------------------------------------------------------------------------------------------------------------
        Grand Total.............................         144,758          77,666              na       1,729,828
----------------------------------------------------------------------------------------------------------------
* Mean hourly wage for All Occupations (00-0000).
** Mean hourly wage for Medical Secretaries (43-6013).
*** Mean hourly wage for Pharmacy Technicians (29-2052).

    Occupational Employment Statistics, May 2016 National Occupational 
Employment and Wage Estimates United States, U.S. Department of Labor, 
Bureau of Labor Statistics. https://www.bls.gov/oes/current/oes_nat.htm#b29-0000.

                   Exhibit 3--Total and Average Remuneration by Provider Type for the MEPS-MPC
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                                                                     Number of
                          Provider type                            records with       Average          Total
                                                                      payment         payment      remuneration
----------------------------------------------------------------------------------------------------------------
Hospital........................................................           1,718          $43.99         $75,575
Office Based Providers..........................................             678           33.88          22,971
Institutions....................................................               1           63.71              64
Home Care Provider (Health Care Providers)......................               4           78.50             314
Home Care Provider (Non-Health Care Providers)..................               0               0               0
Pharmacy........................................................          10,305           35.69         367,785
Separately Billing Doctors......................................             412           70.60          29,087
                                                                 -----------------------------------------------
    Total MPC...................................................          13,118  ..............         495,796
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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's 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.

Francis D. Chesley, Jr.,
Acting Deputy Director.
[FR Doc. 2018-11927 Filed 6-1-18; 8:45 am]
BILLING CODE 4160-90-P