[Federal Register Volume 84, Number 133 (Thursday, July 11, 2019)]
[Notices]
[Pages 33069-33073]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2019-14770]
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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 changes to the
currently approved information collection project: ``Medical
Expenditure Panel Survey (MEPS) Household Component and the MEPS
Medical Provider Component.''
This proposed information collection was previously published in
the Federal Register on May 1, 2019 and allowed 60 days for public
comment. AHRQ received no 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 30 days after date
of publication.
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
This request is for an update to the previously submitted and OMB-
approved clearance for the data collections of the Household and
Medical Provider Components of the MEPS. The previous OMB clearance
request for the MEPS was approved November, 2018 with an expiration
date of November 30, 2021. We propose updating the MEPS-HC by (1)
adding a section to the 2020 self-administered questionnaire (SAQ,
Male/Female) that will include questions on mental health, (2)
collecting a health insurance cost-sharing document and (3)
implementing a pilot study to evaluate the potential effectiveness of
including a sample of National Health Interview Survey (NHIS)
nonrespondents in future MEPS panels as a strategy to improve the
overall MEPS response rate.
MEPS Household Component and the MEPS Medical Provider Component
Household Component: A sample of households participating
in the NHIS in the prior calendar year are interviewed 5 times over a 2
and one half (2.5) 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.
Medical Provider Component: The MEPS-MPC collects
information from medical and financial records maintained by hospitals,
physicians, pharmacies and home health agencies named as sources of
care by household respondents.
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.
The MEPS is a multi-purpose survey. In addition to collecting data
to yield annual estimates for a variety of measures related to health
care use and expenditures, MEPS also provides estimates of measures
related to health status, consumer assessment of health care, health
insurance coverage, demographic characteristics, employment and access
to health care indicators.
Estimates can be provided for individuals, families and population
subgroups of interest. Data obtained in this study are used to provide,
among others, the following national estimates:
Annual estimates of health care use and expenditures for
persons and families
[[Page 33070]]
annual estimates of sources of payment for health care
utilizations, including public programs such as Medicare and Medicaid,
private insurance, and out of pocket payments
annual estimates of health care use, expenditures and
sources of payment of persons and families by type of utilization
including inpatient stay, ambulatory care, home health, dental care and
prescribed medications
the number and characteristics of the population eligible
for public programs including the use of services and expenditures of
the population(s) eligible for benefits under Medicare and Medicaid
the number, characteristics, and use of services and
expenditures of persons and families with various forms of insurance
annual estimates of consumer satisfaction with health
care, and indicators of health care quality for key conditions
annual estimates to track disparities in health care use
and access
In addition to national estimates, data collected in this ongoing
longitudinal study are used to study the determinants of the use of
services and expenditures, and changes in the access to and the
provision of health care in relation to:
Socio-economic and demographic factors such as employment
or income
the health status and satisfaction with health care of
individuals and families
the health needs and circumstances of specific
subpopulation groups such as the elderly and children
To meet the need for national data on health care use, access, cost
and quality, MEPS-Household Component (MEPS-HC) collects information
on:
Access to care and barriers to receiving needed care
satisfaction with usual providers
health status and limitations in activities
medical conditions for which health care was used
use, expense and payment (as well as insurance status of
person receiving care) for health services
Given the twin problems of nonresponse and response error of some
household reported data, information is collected directly from medical
providers in the MEPS-MPC to improve the accuracy of expenditure
estimates derived from the MEPS-HC. Because of their greater level of
precision and detail, we also use MEPS-MPC data as the main source of
imputations of missing expenditure data. Thus, the MEPS-MPC is designed
to satisfy the following analytical objectives:
Serve as source data for household reported events with
missing expenditure information
Serve as an imputation source to reduce the level of bias
in survey estimates of medical expenditures due to item nonresponse and
less complete and less accurate household data
Serve as the primary data source for expenditure estimates
of medical care provided by separately billing doctors in hospitals,
emergency rooms, and outpatient departments, Medicaid recipients and
expenditure estimates for pharmacies
Allow for an examination of the level of agreement in
reported expenditures from household respondents and medical providers
Data from the MEPS, both the HC and MPC components, are intended
for a number of annual reports produced by AHRQ, including the National
Healthcare Quality and Disparities Report.
This study is being conducted by AHRQ through its contractors,
Westat and RTI International, 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 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.
Method of Collection
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) is used to collect self-reported (rather than
through household proxy) health opinions and satisfaction with health
care, and information on health status, preventive care and health care
quality measures for adults 18 and older.
3. Diabetes Care SAQ. 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
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.
4. Authorization forms for the MEPS-MPC Provider and Pharmacy
Survey. We ask respondents for authorization to obtain supplemental
information from their medical providers (hospitals, physicians, home
health agencies and institutions) and pharmacies.
5. MEPS Validation Interview. 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.
6. Mental Health Questions. Added to SAQ (Male/Female). MEPS will
include questions addressing issues in regards to an individual's
mental health and mental health treatment including mental health
status, access to care, barriers to care, experiences with care, and
use of peer support and other services to the SAQ for administration
during the summer of 2020 with data collection targeting the adult (age
18 and over) population. AHRQ worked with several experts in the mental
health field to develop these questions and used their expertise to
take advantage of already tested and widely accepted measures.
7. Health Insurance Cost Sharing Collection. AHRQ is seeking to
enhance
[[Page 33071]]
data collection practices in the 2020 fielding of the MEPS-HC to
collect more detailed health insurance cost-sharing information from
respondents with current private insurance, Medicare Advantage, or
Medicare Part D Prescription Drug plans. Specifically, we will ask
respondents to provide a document for themselves and family members
that includes information on plan deductibles, out-of-pocket maximums
and other cost sharing details for specific services. An example of the
type of document we are proposing to collect is the Summary of Benefits
and Coverage. AHRQ worked with experts on a feasibility study to
identify the best methods for collecting these types of documents in a
way that would minimize respondent burden (OMB approval 0935-0124).
AHRQ proposes to provide informational materials to respondents to help
them identify the documents and also proposes to provide respondents
with a $30 per plan, post-collection incentive to facilitate response
and mitigate perceived additional burden.
8. Pilot Test on Sampling NHIS Nonrespondents. This test will be
conducted on 400 sampled addresses in 6-8 selected MEPS primary
sampling units (PSUs) in the 2020 spring data collection cycle. The
sample households for this test will be drawn from nonrespondents to
the 2019 NHIS (which are not currently part of the MEPS frame), and
only the MEPS Round 1 interview will be administered. The purpose of
the test is to evaluate the potential effectiveness of including a
sample of NHIS nonrespondents in future MEPS panels to mitigate the
impact of declining NHIS response rates on the overall MEPS response
rate. The general trend of declining response rates for household
surveys is problematic and this evaluation is designed to explore an
avenue to stop further declines and potentially improve the overall
MEPS response rate.
To achieve the goal of the MEPS-MPC the following data collections
are implemented. No updates to the MEPS-MPC are being requested:
1. MPC Contact Guide/Screening Call. 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. 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-Health Care Providers.
This questionnaire 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.
4. Medical Event Questionnaire for Office-Based Providers. This
questionnaire is for office-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. 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. 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. 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. This questionnaire
requests the National Drug Code (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.
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 (PSAQ) and Adult SAQ (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
[[Page 33072]]
persons. The Adult Male SAQ (PSAQ) and Adult SAQ (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 Mental Health Questions in the
Adult SAQ (Male/Female) will be completed during Round 2, Panel 25;
Round 4, Panel 24 by each person in the RU that is 18 years old and
older, an estimated 20,476 persons, and takes about 3.5 minutes to
complete. The Diabetes Care SAQ will be completed once a year by each
adult person in the RU identified as having diabetes, an estimated
2,072 persons, and takes about 3 minutes to complete. The 12,804 RUs in
the MEPS-HC will complete an average of 5.4 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. The
Health Insurance Cost Sharing collection will be completed during Round
1, Panel 25 and Round 3, Panel 24 by each RU with a current private
health insurance plan, a Medicare Advantage plan, or a Medicare Part D
plan. An estimated 6,258 respondents will locate and provide cost-
sharing documentation for an average of 1.3 plans per eligible RU. This
activity will require 45 minutes to complete for each plan. 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 Pilot Test Sampling NHIS Nonrespondents will
be completed by 200 * (see note below Exhibit 1) ``family level''
respondents, also referred to as RU respondents. The Pilot MEPS-HC core
requires an average response time of 92 minutes to administer. The
total annual burden hours for the MEPS-HC are estimated to be 67,542
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 13 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 86,160 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 $1,673,909;
the annual cost burden for the MEPS-MPC is estimated to be $298,580.
The total annual cost burden for the MEPS-HC and MPC is estimated to be
$1,972,489.
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 (PSAQ)--Years 2019 and 2021; 12,984 1 7/60 1,515
Adult SAQ (SAQ)--Year 2020.....................
Adult Male SAQ (PSAQ)--Years 2019 and 2021; 11,985 1 7/60 1,398
Adult SAQ (SAQ)--Year 2020.....................
Diabetes care SAQ............................... 2,072 1 3/60 104
Mental Health Questions Included in Adult SAQ 20,476 1 3.5/60 1,194
(Male/Female)--Year 2020.......................
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.........................................
Health Insurance Cost Sharing Collection--2020.. 6,258 1.3 45/60 6,101
MEPS-HC Validation Interview.................... 4,225 1 5/60 352
Pilot Test on Sampling NHIS Nonrespondents--2020 200 1 92/60 307
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Subtotal for the MEPS-HC.................... 102,366 na na 67,542
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MEPS-MPC
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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
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Subtotal for the MEPS-MPC................... 73,196 na na 17,388
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Grand Total............................. 175, 562 na na 84,930
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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).
** 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, which use the same contact guide.
The total estimated annual burden hours for the MEPS has increased
from 77,666 hours in the previous clearance to 84,930 hours in this
clearance request, a difference of 7,264 hours. The addition of 1,194
hours due to the addition of Mental Health questions to the Adult SAQ
(Male/Female), 6,101 additional hours due to the health
[[Page 33073]]
insurance cost sharing collection, and 307 additional hours due to the
pilot test on sampling NHIS nonrespondents account for the difference.
While the burden associated with these added tasks totals 7,602 hours,
reductions in other burden estimates leave a net difference of 7,264
hours overall.
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 * $24.34 $1,244,479
Adult Female SAQ (PSAQ)-Years 2019 and 2021; 12,984 1,515 * 24.34 36,875
Adult SAQ (SAQ)--Year 2020.....................
Adult Male SAQ (PSAQ)--Years 2019 and 2021; 11,985 1,398 * 24.34 34,027
Adult SAQ (SAQ) -Year 2020.....................
Diabetes care SAQ............................... 2,072 104 * 24.34 2,531
Mental Health Questions Included in Adult SAQ 20,476 1,194 * 24.34 29,062
(Male/Female)--Year 2020.......................
Authorization forms for the MEPS-MPC Provider 12,804 3,457 * 24.34 84,143
Survey.........................................
Authorization form for the MEPS-MPC Pharmacy 12,804 1,985 * 24.34 48,314
Survey.........................................
Health Insurance Cost Sharing Collection--2020.. 6,258 6,101 * 24.34 148,498
MEPS-HC Validation Interview.................... 4,225 352 * 24.34 8,567
Pilot Test on Sampling NHIS Nonrespondents--2020 200 307 * 24.34 7,472
---------------------------------------------------------------
Subtotal for the MEPS-HC.................... 102,366 67,542 na 1,643,968
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MEPS-MPC
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MPC Contact Guide/Screening Call................ 36,598 1,220 ** 17.25 21,045
Home care for health care providers 635 146 ** 17.25 2,519
questionnaire..................................
Home care for non[dash]health care providers 11 2 ** 17.25 35
questionnaire..................................
Office[dash]based providers questionnaire....... 11,210 3,083 ** 17.25 53,182
Separately billing doctors questionnaire........ 12,397 9,294 ** 17.25 160,322
Hospitals questionnaire......................... 5,310 2,597 ** 17.25 44,798
Institutions (non-hospital) questionnaire....... 116 36 ** 17.25 621
Pharmacies questionnaire........................ 6,919 1,010 *** 15.90 16,059
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Subtotal for the MEPS-MPC................... 73,196 17,388 na 298,580
rrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrrr
Grand Total............................. 175,562 na na 1,942,548
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* 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 2017 National Occupational
Employment and Wage Estimates United States, U.S. Department of Labor,
Bureau of Labor Statistics.
Request for Comments
In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-
3521, 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.
Dated: July 8, 2019.
Virginia L. Mackay-Smith,
Associate Director.
[FR Doc. 2019-14770 Filed 7-10-19; 8:45 am]
BILLING CODE 4160-90-P