[Federal Register Volume 83, Number 193 (Thursday, October 4, 2018)]
[Notices]
[Pages 50094-50096]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2018-21618]


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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 ``Consumer Assessment of Healthcare Providers and Systems 
(CAHPS) Clinician and Group Survey Database.'' This proposed 
information collection was previously published in the Federal Register 
on July 16th, 2018 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 November 5, 2018.

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

Renewal of the Consumer Assessment of Healthcare Providers and Systems 
(CAHPS) Clinician and Group Survey Database

    In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3521, AHRQ invites the public to comment on this proposed information 
collection. The CAHPS Database is a repository for data from selected 
CAHPS surveys. The primary purpose of the CAHPS Database is to 
facilitate comparisons of CAHPS survey results by survey users. This 
voluntary compilation of survey results from a large pool of data into 
a single database enables survey users to compare their own results to 
relevant Database results. The CAHPS Database also offers an important 
source of primary data for research related to consumer assessments of 
quality as measured by CAHPS surveys.
    The CAHPS Clinician & Group Survey (CG-CAHPS) Database is the 
newest component of the CAHPS Database. It was developed in response to 
the growing demand for Database results for the various versions of the 
CG-CAHPS Survey, including the 12-month and Visit versions. In May 
2011, the first set of Database results for both the 12-month and Visit 
versions was released through the CAHPS Database Online Reporting 
System.
    AHRQ developed the database for CAHPS CG Survey data following the 
CAHPS Health Plan Database as a model. The CAHPS Health Plan Database 
was developed in 1998 in response to requests from health plans, 
purchasers, and CMS for survey data to support public reporting of 
health plan ratings, health plan accreditation and quality improvement 
(OMB Control Number 0935-0165, expiration 5/31/2020). Demand for survey 
results from the CG Survey has grown as well, and therefore AHRQ 
developed a dedicated Clinician and Group Database to support 
benchmarking, quality improvement, and research (OMB Control Number 
0935-0197, expiration 02/28/2019).
    The CAHPS Database contains data from AHRQ's standardized CAHPS 
Surveys which provide survey measures of quality to health care 
purchasers, consumers, regulators, and policy makers. The Health Plan 
Database also provides data for AHRQ's annual National Healthcare 
Quality and Disparities Reports. The goal of this project is to renew 
the CAHPS CG Survey Database. This database will continue to update the 
CAHPS CG Database with the latest results of the CAHPS CG Survey. These 
results consist of 31 items that measure 5 areas or composites of 
patients' experiences with physicians and staff in outpatient medical 
practices. This database can be used to do the following:
    (1) Improve care provided by individual providers, sites of care, 
medical groups, or provider networks.
    (2) Offer several products and services, including providing survey 
results presented through an Online Reporting System, summary 
chartbooks, custom analyses, private reports in Excel format, and data 
for research purposes.
    (3) Provides information to help identify strengths and areas with 
potential for improvement in patient care. The five composite measures 
are:

Getting Timely Appointments, Care, and Information
How Well Providers Communicate With Patients
Helpful, Courteous, and Respectful Office Staff
Providers' Use of Information to Coordinate Patient Care
Patients' Rating of the Provider

    This study 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 health care services and with 
respect to quality measurement and improvement, and health surveys and 
database development. 42 U.S.C 299a(a)(1), (2), and (8).

Method of Collection

    To achieve the goal of this project, the following activities and 
data collections will be implemented:
    (1) Registration Form--The purpose of this form is to determine the 
eligibility status and initiate the registration process for 
participating organizations seeking to submit their CAHPS CG survey 
data voluntarily to the CAHPS CG Survey Database. The point of contact 
(POC) at the participating organization (or parent organization) will 
complete the form. The POC is either a corporate-level health manager 
or a survey vendor who contracts with a participating organization to 
collect the CAHPS CG survey data.
    (2) Data Use Agreement--The purpose of the Data Use Agreement (DUA) 
is to obtain authorization from participating organizations to use 
their voluntarily submitted CAHPS CG survey data for analysis and 
reporting according to the terms specified in the DUA. The DUA states 
how data submitted by participating organizations will be used and 
provides confidentiality assurances. The POC at the organization will 
complete the form. Vendors do not sign the DUA.
    (3) Data Submission--The number of submissions to the database may 
vary each year because medical groups and practices may not administer 
the survey and submit data each year. Data submission is typically 
handled by one POC who is either a health system, a

[[Page 50095]]

medical group or practice or a survey vendor who contracts with the 
medical group or practice to collect data on their behalf. After the 
POC has completed the Registration Form and the DUA, they will submit 
patient-level data collected from the CAHPS CG survey to the CAHPS CG 
Survey Database. Data on organizational characteristics such as 
ownership, number of patient visits per week, provider specialty, and 
information related to survey administration such as mode, dates of 
survey administration, sample size, and response rate, which are 
collected as part of CAHPS CG survey operations are also submitted.
    Each submission will consist of 3 data files: (1) A Group File that 
contains information about the group ownership, (2) a Practice File 
containing the practice ownership and affiliation (i.e., commercial, 
hospital or health system, university or academic medical center, 
community health center, military or county), number of providers 
working each week, sampling information, number of patient visits per 
week, contact information and (3) a Sample File that contains one 
record for each patient surveyed, the date of visit, survey disposition 
code, information about survey completion, and survey responses.
    Survey data from the CAHPS CG Database is used to produce four 
types of products: (1) An online reporting of results available to the 
public on the CAHPS Database website; (2) individual participant 
reports (in Excel format), used for comparing a participating 
organization's CAHPS survey results to the database averages, that are 
confidential and customized for each participating organization that 
submits their data, (3) an annual Chartbook that presents summary-level 
results in a downloadable file in PDF format; and (4) a de-identified 
dataset that is made available to researchers for additional analyses.
    Information for the CAHPS CG Database has been collected by AHRQ on 
an annual basis since 2010. Participating organizations are asked to 
submit their data voluntarily to the database each year. The data are 
cleaned with standardized programs, then aggregated and used to produce 
summarized results. In addition, reports in Excel format are produced 
that compare the participating organizations' results to the overall 
database results. These reports are sent via a secured FTP site upon 
the participating organization's request.
    Database results and individual participant reports can serve a 
variety of purposes:

 Identifying areas for quality improvement at multiple levels, 
including medical group, practice site, and individual practitioner.
 Briefing senior leadership on patients' views of the health 
care they receive
 Supporting public reporting of patients' assessments of care
 Combining with other quality measures to examine health care 
outcomes

    The CAHPS CG Database supports research by providing a de-
identified analytic database. Much like the CAHPS Health Plan Database 
developed in 1998 (OMB Control Number 0935-0165, Expiration Date 5/31/
2020), researchers can use the CAHPS CG Survey Database to examine:

 Disparities in CAHPS satisfaction scores by racial and ethnic 
characteristics of patients
 Comparisons of adult and child CAHPS survey results
 Analysis of case-mix factors affecting CAHPS scores, such as 
patient age, education, and self-reported health status

Estimated Annual Respondent Burden

    Exhibit 1 shows the estimated burden hours for the participating in 
the CG database. The 11 POCs in exhibit 1 are the number of estimated 
vendors. Survey vendors assist the Health/Medical entities with 
submitting data submission materials. Survey vendors generally submit 
all required survey data and other materials other than the DUA. The 86 
POCs in exhibit 1 are the number of estimated participating Health/
Medical entities based on 2017 submission.
    Each vendor will register online for submission. The online 
Registration Form will require about 5 minutes to complete. The DUA 
will be completed by the 86 participating Health/Medical entities. 
Vendors do not sign DUAs. The DUA process requires about 15 minutes to 
sign and return by fax, mail or to upload directly to the submission 
system and includes an accompanying practice site excel file that is 
uploaded to the submission system. Each submitter will provide a copy 
of their questionnaire and the survey data file in the required file 
format. Survey data files must conform to the data file layout 
specifications provided by the CAHPS Database. The average number of 
data submissions per vendor is estimated to be 10. Once a data file is 
uploaded, the file will be automatically checked to ensure it conforms 
to the specifications and a data file status report will be produced 
and made available to the submitter. Submitters will review each report 
and will be expected to fix any errors in their data file and resubmit 
if necessary. It will take about one hour to complete each file 
submission. The total burden is estimated to be 133 hours annually.

                                  Exhibit 1--Estimated Annualized Burden Hours
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                                                     Number of       Number of
                    Form name                      respondents/    responses for     Hours per     Total burden
                                                       POCs          each POC        response          hours
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Registration Form...............................              11               1            5/60               1
Data Use Agreement..............................              86               1           15/60              22
Data Submission.................................              11              10               1             110
                                                 ---------------------------------------------------------------
    Total.......................................             108              NA              NA             133
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    Exhibit 2 shows the estimated annualized cost burden based on the 
respondents' time to complete the submission process. The cost burden 
is estimated to be $6,602 annually.

[[Page 50096]]



                                   Exhibit 2--Estimated Annualized Cost Burden
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                                           Number of
               Form name                 respondents/    Total burden   Average hourly wage rate    Total cost
                                             POCs            hours                  *                 burden
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Registration Form.....................              11               1  \a\ 40.95...............             $41
Data Use Agreement....................              86              22  \b\ 93.44...............           2,056
Data Files Submission.................              11             110  \c\ 40.95...............           4,505
 
    Total.............................             108             133  NA......................           6,602
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* National Compensation Survey: Occupational wages in the United States May 2016, ``U.S. Department of Labor,
  Bureau of Labor Statistics.'' (a) and (c) Based on the mean hourly wages for Computer Programmer (15-1131).
  (b) Based on the mean hourly wage for Chief Executives (11-1011). https://www.bls.gov/oes/current/oes_nat.htm.

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. 2018-21618 Filed 10-3-18; 8:45 am]
 BILLING CODE 4160-90-P