PATIENT  SATISFACTION  WITH  OUTPATIENT  SURGERY 
A  NATIONAL  SURVEY  OF  MEDICARE  BENEFICIARIES 
RICHARD  P. KUSSEROW  DECEMBER  1989 
INSPECTOR  GENERAL 
OAT-09-88-01002  PURPOSE 
The purpose of this surveywasto determine and compare Medicare beneficiary 
satisfaction with selectedoutpatient surgical and diagnostic procedures in 
ambulatory surgical centers (ASCs) and hospital outpatient departments (OPDs). 
The procedures were cataract extraction with intraocular lens implant, upper 
gastrointestinal endoscopy,colonoscopyand bunionectomy. 
BACKGROUND 
The volume of outpatient surgery is increasing. By the end of 1989,an estimated 
1,123ambulatory surgical centers (ASCs) will provide outpatient surgical services. 
The number of surgeriesperformed in ASCs increasedto more than 1.7million  in 
1988,up almost 25 percent from 1987. The volume of outpatient surgery in hospital 
outpatient departments (OPDs) is also on the rise. Between 1980and 1985,the 
number of OPD surgeriesincreasedby 128percent to more than 7 million.  The 
increasein outpatient surgerieshasprompted concern about the quality of care and 
medical necessityin ambulatory settings. 
To assessthe quality of care and medical necessityof selectedoutpatient surgical 
procedures, the Office of Inspector General (OIG)  conducted interviews with 
beneficiaries and physiciansand undertook a medical and financial review of 
Medicare beneficiary records. We administered the telephone surveyto a national 
sample of 1,170Medicare beneficiaries who underwent cataract surgery,upper 
gastrointestinal endoscopy,colonoscopyand bunionectomy between January and 
March 1988. We completed interviews with 837 beneficiaries (71.5% of the sample). 
FINDINGS 
.  .  .  .  .
nefiwes  nrefer ou-erv  to ~ 
This wastrue regardlessof age,sex,surgical setting or procedure. 
.
ed urlthw  ASCs and OPDs, 
They were slightly more satisfied with ASCs than OPDs, with 98 percent of ASC 
patients and 94 percent of OPD patients rating the facilities good or better. 
.  .  . 
no mve  cow 
Ninety percent of the respondentsreported that they had no postoperative 
complications regardlessof surgical setting.  Postoperative care wasnot a problem for most beneficiaries. 

Ninety-two percent of the respondentswent home after their procedures. Of these, 

35 percent were able to care for themselves. Most respondentswho required 

assistancesaid that their relatives or friends did not have to take time off work to 

take care of them. 

Phvsicians.not beneficiaries, decide whether surgerywill be performed in an ASC or 

OPD. 

Eleven percent of cataractpatients reported no improvement in their vision after 

.surp;erv. 

Most respondentsreported symptomsthat suggesttheir procedures were medicallv 

necessarv. 

Although most respondentspaid little  (lessthan SlOO)or nothing, a few paid over 

$1000. 

Nearly 60 percent of the respondentssaid that they had no out-of-pocket expenses, 

primarily becausethey have supplemental private insurance. 

Thzlsreport analyzesthe resultsof the beneficiarysurveyand solelyrefzectsthe opinions 
-1 
of the benejkiak  who wereinterviewed In a separatereport, we will d&cussthe 

resultsof thephysician interviewsand the medical andfinancial reviewof the 

beneficiariesrecork 
ii  TABLE  OF CONTENTS 

Page 

EXECUTIVE  SUMMARY  i 

INTRODUCTION  1 

3 

Beneficiaries prefer outpatient surgery 
to inpatient hospital stays 
Beneficiaries were very satisfied with both ASCs and OPDs 
Most respondentsreported no postoperative 
complications 
Postoperative care wasnot a problem 
for most beneficiaries 
Physicians,not beneficiaries, decide whether 
surgerywill be performed in an ASC or OPD 
Eleven percent of cataractpatients reported 
no improvement in their vision after surgery 
Most respondentsreported symptomsthat 
suggesttheir procedures were medically necessary 
Although most respondentspaid little  (lessthan $100) 
or nothing, a few paid over $1000 
APPENDICES 
Appendix A: 	 Sampleselection, surveymethods, analysisof respondents 
versusnonrespondents 
Appendix B:  Responsesto all questions  The growth of outpatient surgery hasparalleled the growth of ambulatory surgical 
centers (ASCs). Since the early 198Osw, hen the Health Care Financing 
Administration  began to reimburse ASCs for facility services,the number of ASCs 
hasincreased dramatically. In 1983,there were 239 ASCs in operation.  By the end 
of 1989,an estimated 1,123facilities will provide outpatient surgical services. The 
number of surgeriesperformed in ASCs increasedto more than 1.72million  in 1988, 
up 24.6 percent from 1.38million in 1987. 
The volume of outpatient surgery in hospital outpatient departments (OPDs) is also 
on the rise. Between 1980and 1985,the number of OPD surgeriesincreasedby 
128percent from 3,207,OOtOo 7,309,OOO. 
Ophthalmic surgery accountsfor a large share of the procedures performed in ASCs 
aswell asMedicare outpatient surgical procedures. In 1988,ophthalmic surgery 
accounted for 26.7percent of all procedures performed in ASCs. Cataract 
extraction with intraocular lens (IOL)  implant is the most frequently performed 
Medicare outpatient surgical procedure. 
The volume of cataractsurgery is growing. The number of cataract extractions with 
IOL implants increasedfrom 819,788in 1986to 954,794in 1987,a 16percent rise. 
Although the OPD is the most common site for theseprocedures, its share of all 
surgeriesremained constant at 69 percent from 1986to 1987while the share 
performed in ASCs increasedfrom 15to 19percent. 
The volume of outpatient diagnostic procedures is also growing. The number of 
upper gastrointestinal endoscopiesreimbursed by Medicare increasedfrom 658,949 
in 1986to 769,937in 1987,a 17percent rise. The number of colonoscopies 
increasedfrom 254,820to 318,180during the sameperiod, a 25 percent rise. The 
OPD is the most common site for both upper gastrointestinal endoscopiesand 
colonoscopies. Physiciansoffices are the next most common site, followed by ASCs. 
The increasein outpatient surgical servicesover the past severalyears hasprompted 
concern about the quality of care in ambulatory settings. In a recent article in 
Health Affairs, two health policy analystsfor the American Association of Retired 
Personswrote: 
Theenormousincreasein the total number of ambulatorysurgical 
proceduresand the rate of outpatient surgeryon the oldestold rake 
questionsabout the safetyand quality of ambulatorysurgeryand its 
effectson the health of thesesurgicalpatients. 
1 
 The authors also expressedconcern about the medical necessityof outpatient 
procedures aswell asthe impact of ambulatory surgery on patients families who 
provide postoperative care. 
One approach to assessingthe quality of care in outpatient settings is to measure 
patient satisfaction with medical care. Patients opinions are a useful source of 
information  on the technical, interpersonal and financial aspectsof care. Patient 
perceptions are particulariy useful asa meansof assessingthe personal dimension of 
care. 
METHODOLOGY 
We selected a random sample of 1,170Medicare beneficiaries who underwent 
cataract surgery,upper gastrointestinal endoscopy,colonoscopyor bunionectomy 
between January and March 1988. We selectedthe samplefrom all Medicare 
beneficiaries who underwent these Medicare outpatient surgical procedures 
between January and March 1988. We stratified the sample so that one-half of the 
beneficiaries underwent surgeryin ASCs and the other half underwent surgery in 
OPDs. We used the Questionnaire Programming Language developed by the U.S. 
General Accounting Office to design a computer-assistedtelephone survey 
questionnaire and conducted the survey between May 11and July 31,1989. 
We basedthe sample size of 585 beneficiaries for eachsurgical setting on the sample 
size necessaryto satisfyspecific statistical testing criteria (i.e., power, confidence 
level and detectable difference) establishedfor studies on medical outcome and 
necessity. The overall responserate for the surveywas71.5percent (837 
beneficiaries). The proxy rate was 14percent both for beneficiaries who underwent 
. 	 procedures in ASCs and beneficiaries who underwent procedures in OPDs. The 
proxy was a knowledgeable secondparty who answeredthe surveyquestions on the 
beneficiarys behalf. Appendix A includes a full discussionof the sample selection, 
surveymethod and analysisof respondentsversusnonrespondents. Appendix B 
contains the responsesto all questions. 
i%k report analyzesthe resultsof the benqficiarysurveyand solelyrejlectsthe opinions 
of the beneficiarieswho wereinterviewed In a separatereport, wewill aTi.scutshse 
resultsof thephysician interviewsand the medical andjkzncial  reviewof the 
beneficiaries recork 
1 	 ShelahLeader and MarilynMoon, Medicare Trends in Ambulatory Surgery,J&,&h Affain, 
Spring 1989, p. 167. 
2 
 FINDINGS 
BENEFICIARIES  PREFER  OUTPATIENT  SURGERY  TO INPATIENT 
HOSPITAL  STAYS 
According to our survey,Medicare beneficiaries have favorably received the 
movement of certain procedures from the inpatient to the outpatient setting. 
During the last severalyears,many procedureswhich involved hospital stayshave 
been safely and effectively performed in the outpatient setting. Proceduressuch as 
cataract surgery,bunionectomy and endoscopyare now routinely performed in the 
OPD or ASC. Perhapsthe most dramatic shift in setting has taken place for cataract 
surgery,which during the last few yearshasbecome almost entirely the province of 
the OPD and the ASC. 
Respondentsoverwhelmingly favored outpatient surgery over hospitalization, 
regardlessof age,sex,surgical setting or procedure. In fact, 91 percent of all of the 
respondentswho underwent cataract surgery and 5 out of 6 of those who had a 
bunionectomy said that they preferred the outpatient setting. This preference for 
the outpatient setting wasechoed by those beneficiaries who had upper 
gastrointestinal endoscopiesand colonoscopies. 
Out of the 837 respondents,72 said they would havepreferred to stayin the hospital 
at least overnight. Fourteen of thesebeneficiaries volunteered explanations,suchas 
heart conditions, no one to take care of them at home or a prior surgery resulting in 
postoperative complications. Despite thesebeneficiaries preference for 
hospitalization, only 3 of the 14reported postoperative complications asa result of 
the surgery that wasthe subject of our survey. 
BENEFICIARIES  WERE VERY  SATISFIED  WITH  BOTH  ASCs AND  OPDs 
Ninety-eight percent of those who had their procedures in ASCs, compared with 94 
percent of those who had their procedures in OPDs, rated the facilities good,.very 
good or excellent (seeFigure 1). When askedwhat they liked about the facilities, 
more than one-half of the respondentsmentioned the staff. 
Somerespondentsvolunteered reasonswhy they preferred ASCs over OPDs or 
hospitals. For example: 
I byfar prefer theAX  settingoverthe OPD settingbecauseof less 
paperwork, lesscost,a more convenientlocation and easierparking. 
I had another cataractsurgeryin I987 in an OPD. I muchprefer the 
ASC: no wait, verypretty, more organized,friendlier staff, transportation 
and goodfood 
3 
 I muchprefer to go to theASC insteadof to a hospital. Thehospitalsare 
so crowdedand uncomfortable. 
Castmy votefor the singledaysurgerycenters--theyare much betterthan 
hospitals. Thefood is better,they are twiceasfast and theydidnt charge 
for a million thingsyou didnt evenIcnowyou got. Id like to stayasfar 
awayfrom the hospital aspossible. 
I didk t get billsfrom diflerent sources.Billing wasmore centralizedat 
theASC. 
I liked the individualized attention at theASC. ASCs are much better 
than hospitals. 
Sevenrespondentssaid they preferred OPDs. For example: 
TheASC seemedlike aproduction line--theytake too manypatients. In 
a hospital, a patient with complicationscan quickly be transferredto the 
intensivecareunit. 
I had the colonoscopydonein the hospital and also in theASC. I didn t 
notice any difference. TheASC mademepay in advance,which I didn t 
like. 
I would havepreferred to bein a hospital. TheASC staff did not seemas 
experiencedor well-trainedashospitalstaff. Theyhad trouble with the 
I.K 
FIGURE  1. ASC PATIENTS  WERE MORE  SATISFIED  THAN  OPD  PATIENTS 
EXCELLENT 
45% 
vER+  GCCI 
39% 
OPD  (n-386) 
4 
 The preference for one setting over another may be attributed, in part, to the 
amount of time a beneficiary spendsat the facility on the day of surgery. While we 
did not ask the beneficiaries to identify where most of their time wasspent at the 
facility (admission, surgery or postoperative recovery), we did obtain some estimates 
of the total time spent. 
Respondentswho underwent cataractsurgery spent lesstime in ASCs than in OPDs. 
In almost two-thirds of the ASC cases,the beneficiaries spent lessthan 4 hours in 
the facility on the day of their cataractsurgery. On the other hand, almost 25 
percent of the OPD cataractpatients spent more than 6 hours at the hospital. The 
amount of time spent in ASCs or OPDs for upper gastrointestinal endoscopy, 
colonoscopyand bunionectomy wasnot significantly different. 
Although the satisfaction level with ASCs and OPDs varied some,suchwasnot the 
casefor physicians. Respondentsexpressedhigh levels of satisfaction with their 
physiciansfor both settings. Nearly equal percentagesof ASC (96.3 percent) and 
OPD (96.4 percent) respondentsrated their physiciansgood or better.  Beneficiaries 
were particularly satisfied with their physicianscompetence,courtesy and 
willingness to answerquestions,and almost all of the respondentswould 
recommend their physician to family and friends who needed the sameprocedure 
they had. 
MOST  RESPONDENTS  REPORTED  NO POSTOPERATIVE  COMPLICATIONS 
Although a postoperative complication may indicate lessthan acceptablequality of 
care, beneficiaries are not alwaysable to distinguish between normal postoperative 
occurrencesand true complications. For example,it is difficult  to determine if the 
pain, inflammation or changesin quality of vision describedby 13percent of the 
cataractpatients were beyond the range of acceptability. This is also true for the 
complications which were given for upper gastroendoscopy(sore throat, painful 
swallowing and chestpain) and colonoscopy(abdominal pain or reaction to 
sedative). The respondentsreported complication rates of 3 percent and 6 percent 
respectively for theseprocedures and no complications following bunionectomy. 
The complaints may not be considered complications from a clinical perspective. 
Nevertheless,from the patients perspective,they were complications which spark 
questions about quality of care. 
Given this caveat,it is noteworthy that 90 percent of the respondentsreported they 
had no postoperative complications regardlessof surgical setting or procedure. 
Therefore, from a patients perspective,the ASC and OPD are equally safe 
environments. 
5 
 POSTOPERATIVE  CARE WAS NOT A PROBLEM  FOR MOST  MEDICARE 
BENEFICIARIES 
The vast majority of the beneficiaries (92 percent) went home immediately after 
surgery. Those who did not go home stayedin nursing homes,hotels or the homes 
of relatives, friends or neighbors. Only 13 of the beneficiaries who did not go home 
had to pay for their accommodations. The costwasusually lessthan $100. Of those 
who went home, one-third said that they took care of themselves. The rest were 
cared for by spouses,friends or relatives. 
In contrast to the concernsexpressedby the authors of the Health Affairs article 
mentioned on page 2, beneficiaries did not indicate that their postoperative care 
imposed a burden on the relatives and friends who cared for them. During the 
telephone interview, we specifically askedif the caregivershad to take time off work 
and, in 90 percent of the cases,we were told that the person did not. Almost all of 
the beneficiaries (97 percent) told us they had received clear instructions that 
explained how to care for themselvesafter the surgery. More than one-half of the 
patients had received the instructions both orally and in writing. 
PHYSICIANS,  NOT BENEFICIARIES,  DECIDE  WHETHER  SURGERY  WILL  BE 
PERFORMED  IN AN ASC OR OPD 
Most beneficiaries who underwent cataract surgerysaid they have an ongoing 
relationship with an ophthalmologist who performs their routine eye exams. While 
the practice of optometry/ophthalmology referral hasbecome more prevalent in 
somelocations, this wasnot an important factor for the respondentsin our survey. 
Only 10percent of the sampledbeneficiaries said their routine eye examswere 
performed by optometrists. Approximately three-quarters of the beneficiaries said 
that 
their cataractwasdiscoveredduring a routine eye exam, 
l 
a  their ophthalmologist wasthe one who recommended surgery, 
they did not obtain a secondopinion and 
l 
the ophthalmologist decided where the surgerywould be performed. 
l 
Optometrists and opticians recommendedsurgery to 17percent of the respondents, 
and they made referrals to ophthalmologists for surgery in 14percent of the cases. 
Although gastroenterologistsare primarily referral physiciansand do not usually 
have ongoing relationships with their patients, they control the location of surgery 
almost asfrequently asophthalmologists. Approximately 60 percent of the 
beneficiaries indicated that the gastroenterologist chosethe facility for the 
endoscopy. All six respondentswho had bunionectomies reported that their 
surgeonsdecided where they would havetheir surgeries. 
6 
 ELEVEN  PERCENT  OF CATARACT  PATIENTS  REPORTED  NO 
IMPROVEMENT  IN THEIR  VISION  AFTER  SURGERY 
Outcome is another factor that is frequently considered in determining quality of 
care. Therefore, we askedbeneficiaries who underwent cataract surgery if their 
vision had improved after the surgery. Since eachof the beneficiaries underwent the 
surgery more than a year before we conducted our survey,sufficient time had 
elapsedfor total recovery. 
Ninety percent of the respondentswho underwent cataract surgery had surgery on 
one eye during the first quarter of 1988. The remaining 10percent underwent 
surgery in both eyesduring that period.  Eighty-nine percent of the respondentswho 
underwent cataract surgeryin one eye said their vision was either much or slightly 
better than before surgery. Fifteen respondentsvolunteered commentsabout their 
improved vision. For example: 
My vision is betterthan it has beenin manyyears. I wasable to go 
bowling two daysafter surgery. 
Cataractsurgerywaslike a miracle. Thenextday I could seeand even 
read a little. 
Theresno compcuisonbetweennot seeingand seeingcolors. 
Id recommendcataractsurgeryto anyone. It makesa big differencein 
your life to have20120vision. 
Eleven percent of the respondentswho had cataractsurgery said their vision was 
about the same(5 percent) or worse (6 percent) than before surgery. (We will 
compare the beneficiaries responseswith the medical review findings in our next 
report.) Considering the combined outcomesfor respondentswho had cataract 
surgery in both eyes,91.7percent of the eyeswere much or slightly better with a 
total of 8.3 percent of the eyesrated about the same(5.0 percent) or worse (3.3 
percent). Comments from those who were unsatisfied included the following: 
I will alwaysregretnot gettinganother opinion beforesurgery.Four 
weeksafier cataractsurgery,I still could not see. 
I had no symptoms.My doctor told me that I had cataractsand should 
havethem taken out right awaybecauseMedicare wasgoing to reduce 
reimbursement.My vision is about the sameasit usedto be. 
I did not experience&creased vision beforehand but a fiends  husband 
has had cataractsurgeryand had experiencedgreat improvementin 
vision,so I decidedto havemy eyeschecked Thesurgeonrecommended 
surgery,and I wentahead with it. Now I am verya&appointedbecause 
my vision only improvedslightly. 
7 
 I wasverypleasedwith the surgeon,facility and treatment,yet my 
eyesighthas barelyimproved 
I havebeengettingblin&r  and blinder overtheyears. I havemacular 
degeneration,and theyperformed the cataractsurgerylookingfor a 
miracle, which theydidnt find  My eyesighthascontinued to fail, ad I 
am now basicallyblind 
MOST  RESPONDENTS  REPORTED  SYMPTOMS  THAT  SUGGEST  THEIR 
PROCEDURES  WERE  MEDICALLY  NECESSARY 
Ninety-three percent of the respondentsreported symptomsranging from darkening 
of vision to blindness prior to cataractsurgery,heartburn to bleeding prior to upper 
gastroentestinal endoscopy,abdominal pain to bleeding prior to colonoscopyand 
pain to shoeswouldnt fit prior to bunionectomy. Although someof these 
symptomswould clearly justify the surgical procedure, others may not be sufficient 
from a medical review perspective. A detailed discussionof medical necessitywill 
appear in the related OIG report on outpatient surgery. 
The most common symptom reported by beneficiaries who had cataract surgerywas 
decreasedvision in one or both eyes. Other symptomsincluded darkening of vision 
and night blindness. Somebeneficiaries mentioned more than one symptom. 
Almost one-half of the respondentssaid the symptomsexistedfor more than 2 years 
prior to surgery. Three percent did not mention any symptoms. 
One of the most commonjustifications for cataractsurgeryis that the cataract 
prevents the patient from performing daily activities, i.e., the quality of life is 
impaired.  Inability to passa drivers test is frequently mentioned asthe reasonwhy 
cataract surgery is so prevalent. Since97 percent of the respondentsreported 
symptoms,it is surprising that 31 percent said that their daily activities were not 
hindered by the cataract. Actually, only 53 percent of the beneficiaries mentioned 
that the cataractwasaffecting their automobile driving, while 66 percent said it was 
affecting their ability to read. 
Respondentswho had upper gastrointestinal endoscopyreported a variety of 
medical problems and symptoms,including ulcers (37 percent), heartburn or 
indigestion (30 percent) and difficult  or painful swallowing (16 percent). Four 
percent reported no symptoms. Forty-five percent of the respondentswho had a 
colonoscopysaid they had a history of colonic polyps, while others reported 
abdominal pain (23 percent), blood in the stool (22 percent) or lower 
gastrointestinal bleeding (16 percent). Seventeenpercent of the respondentswho 
had colonoscopiesreported no symptoms,the highest of any of the procedures in the 
survey. Five of the six respondentswho had bunionectomies said that their bunions 
were painful. 
8  ALTHOUGH  MOST  RESPONDENTS  PAID  LITTLE  (LESS THAN  $100) OR 
NOTHING,  A FEW PAID  OVER $1000 
Although the Medicare program hascoinsuranceprovisions that apply to both the 
facility and surgeonsfees,most beneficiaries in the surveydid not incur 
out-of-pocket expenses.Of those who recalled their expenses(29 percent could 
not), 59 percent said that they paid nothing, primarily becausethey haveprivate 
insurance to supplement Medicare. Eighteen percent said they paid lessthan $100, 
and 19percent paid between $100and $500. Nine respondentspaid over $1000,and 
one paid more than $2000. While the percentageof those who paid more than 
$1000is lessthan 1 percent, the broad range of out-of-pocket expensesindicates that 
beneficiaries financial obligations may vary considerably for the samesurgery. All 
of the respondentswho paid more than $1000were cataractpatients with the 
exception of one respondent who had an upper gastrointestinal endoscopy. (See 
Figure 2.) 
Twenty-one respondentscomplained about the cost of their procedures. Complaints 
related to OPD surgeriesoutnumbered ASC complaints by almost 2 to 1. Eight of 
the complaints specifically mentioned that the anesthesiologychargeswere too high. 
FIGURE  2.  BENEFICIARY  COSTS  ARE MINIMAL 
COSTS 
NONE 
LESS  THAN  $100 
GREATER  THAN  $1000 
10  20  30  40  50  60  70 
PERCENT 
(N-564) 
9 
 APPENDIX  A 
SAMPLE  SELECTION,  SURVEY  METHODS, 
ANALYSIS  OF  RESPONDENTS  VERSUS  NONRESPONDENTS 
SAMPLE  SELECTION 
The purpose of this study wasto compare patient satisfaction in two outpatient 
settings--ambulatory surgical centers (ASCs) and hospital outpatient departments 
(OPDs). To draw the sample,we first selected 11 Stateswith the largest number of 
Medicare-certified ASCs: California, Texas,Arizona, Florida, North Carolina, 
Washington, Louisiana, Ohio, Maryland, Pennsylvaniaand Illinois.  Next, we 
selectedfour high-volume Medicare outpatient surgical and diagnostic procedures 
for review. We selectedthe procedures on the basisof the 1985Part B Medicare 
Annual Data (BMAD),  the Health Care Financing Administrations  (HCFA)  1986 
surveyof ASCs and input from ASC administrators, academiciansand medical 
societies. We selected cataract extraction with intraocular lens implant, upper 
gastrointestinal endoscopy,colonoscopyand bunionectomy. 
To establish the universe,we requested procedure code printouts from the 
Medicare carriers for the 11 Statesto identify beneficiaries who underwent the 
selectedprocedures between January 1 and March 31,1988. We chosethis time 
frame to allow the Medicare fiscal intermediaries ample time to complete 
conversionof their claims processingsystemsto include outpatient HCFA Common 
Procedure Coding System(HCPCS) codes,which carriers use. The conversions 
were scheduledfor completion by September 1987. We dropped Washington from 
consideration becausethe procedure code printouts showedthat ASCs in that State 
did not submit PhysiciansCurrent Procedural Terminology (CPT-4) codesfor three 
of the four high-volume procedures that we selected:upper gastrointestinal 
endoscopy,colonoscopyand bunionectomy. 
After we identified the universe,we randomly selected585 beneficiaries who 
underwent the selectedhigh-volume procedures in eachsetting for a total of 1,170 
beneficiaries. The beneficiaries were proportionately selectedfrom each State 
basedon the sum distribution of all outpatient surgery (both ASC and OPD) in the 
State. The sample sizewasbasedon HCFAs threshold of 5 percent for peer review 
organizations evaluation of the quality of care in ambulatory settings (i.e., if more 
than 5 percent of an OPDs or AKs  claims do not meet specific criteria, that facility 
is subject to special review). We assumedthe same5 percent error rate and set a 
power of 80 percent to determine a two-fold difference. Assuming an error rate of 5 
percent in OPDs, we should havean 80 percent probability of detecting a two-fold 
difference in the rates of poor quality of care between OPDs and ASCs. Since this is 
a two-tailed test, we will, for instance,determine a significant difference in the rates 
between the two settingsif the rate in ASCs exceeds10percent or falls below 2.5 
percent when the rate in OPDs in 5 percent. 
A-l  SURVEY  METHODS 
We used a computer-assistedtelephone interviewing system(the U.S. General 
Accounting Offices Questionnaire Programming Language) to administer the 
surveyand conducted interviews between May 11 and July 31,1989, from our office 
in SanFrancisco, California.  We administered the questionnaire in both English 
and Spanish. 
We used proxy respondentsfor 14percent of the interviews. These proxies 
represented beneficiaries who were either physically or cognitively impaired.  The 
most common physical problem washearing loss. The proxy rate was 14percent for 
respondentswho had their procedures in ASCs aswell asthose who had their 
procedures in OPDs. 
ANALYSIS  OF  RESPONDENTS  VERSUS  NONRESPONDENTS 
We interviewed 837 of the 1,170sampled Medicare beneficiaries. Our overall 
responserate was71.5percent: 
71.5% completed interviews 
15.9%were unreachable 
6.1% were deceased 
3.4% refused to be interviewed 
3.1% were unable to complete interview 
We were unable to reach approximately 16percent of the samplefor the following 
reasons:(1) we could not obtain telephone numbers, (2) we did not have a summer 
addressand telephone number (this wasa significant problem with beneficiaries 
who underwent their procedures in Florida) and (3) we could not reach the 
beneficiary after multiple contacts. 
Potential bias of the obtained sample introduced by the occurrence of nonresponse 
is alwaysa concern in surveys.This issuearisesbecausenonrespondentsmay be 
characteristically different from respondentsin waysthat are important to the 
objectives of the survey. Thus, to examine the nonrespondentsasa potential source 
of bias,we statistically compared them to our obtained sample of respondentsfor all 
available characteristics,including age,sex,surgical setting, type of procedure and 
State. 
There are no apparent differences in the agedistributions of respondentsand 
nonrespondents (seeTable 1). However, the respondentsconsistedof slightly (66.8 
percent) but significantly (p = 0.028) more femalesthan the nonrespondents (59.8 
percent).  (SeeTable 2.) There wasno difference in the surgical settings of the 
respondentsand nonrespondents(p = 0.698). Both groupswere nearly exactly 
divided between ASCs and OPDs (seeTable 3). 
A-2 
 Table  1 - AGE:  RESPONDENTS  VS.  NONRESPONDENTS 
1  85 +  i  81  9.7  1  42  12.6 
I  1 
Total  100.0  I 
CHI SQ. = 5.41 
degreesof freedom = 5 
P = 0.368 (n.s.) 
Table  2 - SEX:  RESPONDENTS  VS.  NONRESPONDENTS 
Respondents  Nonrespondents 
Sex  Frequency 
 %  Frequency  % 
Male  278 
 33.2  134  40.2 
Female  559 
 66.8  199  59.8 
Total  837 
 100.0  333  100.0 
CHI SQ. = 4.85 
degreesof freedom =  1 
p = 0.028 
Table  3 - SURGICAL  SETTING:  RESPONDENTS  VS.  NONRESPONDENTS 
Respondents  Nonrespondents 
Setting  Frequency  %  Frequency  % 
ASC  422  50.4  163  49.0 
OPD  415  49.6  170  51.0 
Total  837  100.0  333  100.0 
CHI SQ. = 0.15 
degreesof freedom =  1 
= 0.698 (n.s.) 
P 
A-3 
 Respondentsincluded significantly (p = 0.003)more patients who underwent 
cataract surgery and fewer patients who underwent upper gastrointestinal endoscopy 
and colonoscopy. 
PERCENTAGE  DISTRIBUTIONS  OF  RESPONDENTS 
AND  NONRESPONDENTS  BY  PROCEDURE 
UPPER  a  COLONOSCOPY  BUNIONECTOYY 
PROCEDURE 
Fewer upper gastrointestinal endoscopyand colonoscopypatients were represented 
becausemany procedure code printouts from the carriers contained erroneous 
information about surgical setting, and we had to identify 86 additional beneficiaries 
who underwent these proceduresin ASCs and OPDs. We were unable to obtain 
telephone numbers for all of the additional beneficiaries. This significant difference 
in surgical settingsbetween the two groups is not materially affected by excluding 
bunionectomies from the statistical analysis. 
Finally, the geographic distributions of the respondentsand nonrespondentswere 
significantly different.  The most noticeable differences in the distributions were for 
the Statesof California, North Carolina, Louisiana and Pennsylvania. California was 
underrepresented in the sample,and North Carolina, Louisiana, Pennsylvaniaand 
Maryland were overrepresented. 
PERCENTAGE  DISTRIBUTIONS  OF RESPONDENTS 
AND  NONRESPONDENTS  BY  STATE 
PERCENT 
401 
a  FL  TX  P*  AZ  OH  NC  IL  LA  MO 
STATE 
A-4 
 APPENDIX  B 
OUTPATIENT  SURGERY  STUDY-BENEFICIARY  SURVEY 
The frequencies  of responses are included  in parentheses.  For some questions, the 
percentage total  may not equal 100 percent because of multiple  responses. 
1.  Date  inter  view  was  done 
LA-I- I.J.J-I~I~I
Year  Month  Day 
2.  OUTPATIENT SURGERYSTUDY BENEFICIARY  SURVEY 
(CHECK ONLY ONE ANSWER) 
I 1 1.  Press  ENTER to  begin  .  .  . 
-
3. 	 Hello,  my  name  is  .  I'm 
with  the  Office  of  Inspector  General  in  the  U.S.  Department
of  Health  and  Human Services.  I  would  like  to  speak  to 
(beneficiary's  name).  We are  conducting  a  study  of  Medicare 
beneficiaries  who  had  outpatient  surgery  last  year.  Your 
name  was  randomly  chosen  from  a  national  list.  I'd  like  to 
ask  you  a  few  questions  about  the  care  you  received.  The 
interview  will  take  about  15  minutes  to  complete.  Your 
answers  will  be  confidential.  All  of  the  information  we 
gather  will  be  totaled  nationally.  The  goal  of  our  study  is 
to  improve  the  quality  of  care  for  Medicare  beneficiaries. 
May  we  start  the  interview  now? 
(CHECK ONLY ONE ANSWER) 
72%  (837)  1.  Yes,  proceed  with  the  interview  (GOT0
QUESTION 5)
3%  (  40)  2.  No,  bene  refuses  interview  (GOT0 QUESTION 134)
16%  (186)  3.  No,  bene  is  unreachable  (GOT0 QUESTION 134)
6%  (  71)  4.  No,  bene  is  deceased  (GOT0 QUESTION 134)
3%  (  36)  5.  No,  bene  cannot  complete  interview  (GOT0
QUESTION 134)
0%  (  0)  6.  No,  don't  have  time  to  talk  now 
B-l  4. 	 When can  I  call  you  back ?  (Take  notes  on  call  sheet) 
(CHECK ONLY ONE ANSWER) 
1  1 1.  Press  ENTER to  end  survey  .  .  . 
PEASE  SKIP  TO QUESTION 133 

5. 	 Time  interview  was  started. 
l-l-l-l-l-l 
6. 	 Enter  the  5-digit  code  for  the  beneficiary's  procedure.
(Type  over  default  procedure)
67%  (562)  1.  66984 

4%  (  37)  2.  66983 

8% (  70)  3.  43235 

7% (  56)  4.  43239 

5% (  40)  5.  45380 

8%  (  66)  6.  45385 

<l%  (  1)  7.  28290 

Cl%  (  3)  8.  28296 

<l%  (  2)  9.  28298 

7.  Where  was  the  procedure  performed? 
(CHECK ONLY ONE ANSWER) 
50% 	 (422)  1.  ASC 
50%  (415)  2.  OPD 
8.  Enter  the  name  of  the  setting. 
9.  Survey  participant  is  .  .  . 
(CHECK ONLY ONE ANSWER) 
86% 	 (718)  1.  beneficiary
14%  (119)  2.  proxy 
B-2 
 10. 	 According  to  our  records,  you  had  [procedure]  in  [facility]
last  year.  (Specify  name  of  doctor  on  beneficiary  history)
performed  the  procedure.  Is  this  correct? 
(CHECK ONLY ONE ANSWER) 
71%  (596)  1.  Yes,  had  cataract  (eye)  surgery  (GOT0 QUESTION 
11)
15%  (126)  2.  Yes,  had  endoscopy  (GOT0  QUESTION 50)
13%  (105)  3.  Yes,  had  colonoscopy  (GOT0 QUESTION 60) 
I%(  4.  Yes,  had  bunion  removed  (GOT0 QUESTION 72)
6) 
(1%  (  4)  5.  No,  had  other  procedure  (GOT0  QUESTION 134) 
11. 	 What  were  your  symptoms  of  cataract(s)?  (Enter  all  answers 
that  apply) 
14%  (  75)  1.  darkening  (yellowing)  of  vision 

10%  (  53)  2.  night  blindness 

79%  (428)  3.  decreased  vision  in  one  or  both  eyes

6%  (  30)  4.  near-sightedness

7% (  39)  5.  blindness  in  one  or  both  eyes

3%  (  16)  6.  no  symptoms

(  12)  7.  don't  know 
(  11)  8.  no  answer 
12.  Did  beneficiary  report  other  symptoms? 
(CHECK ONLY ONE ANSWER) 
23%  (137)  1.  yes  (GOT0 QUESTION 13) 
77%  (459)  2.  no 
PLEASE SKIP  TO QUESTION 14 
13.  What  other  symptoms  did  beneficiary  mention? 
14.  How  long  did  you  have  these  symptoms? 
(CHECK ONLY ONE ANSWER) 
14%  (  64)  1.  l-6  months  before  surgery
15%  (  72)  2.  6-12  months  before  surgery
22%  (102)  3.  l-2  years  before  surgery
49%  (229)  4.  over  2  years  before  surgery
(  94)  5.  don't  know 
(  35)  6.  no  answer 
B-3 
 15. 	 Were  any  daily  activities  difficult  because  of  your
cataract(s)? 
(CHECK ONLY ONE ANSWER) 
69%  (391)  1.  yes  (GOT0 QUESTION 16)
31%  (179)  2.  no 
(  11)  3.  don't  know 
(  15)  4.  no  answer 
PLEASE SKIP  TO QUESTION 19 
16. 	 What  activities  were  difficult  ?  (Enter  all  answers  that 
apply  1 
53%  (184)  1.  driving

66%  (228)  2.  reading

14%  (  49)  3.  watching  TV 

17%  (  59)  4.  sewing  or  needlepoint 

17.  Did  beneficiary  mention  other  activities? 
(CHECK ONLY ONE ANSWER) 
18%  (  72)  1.  yes  (GOT0 QUESTION 18)
82%  (319)  2.  no 
PLEASE SKIP  TO QUESTION 19 
18.  What  other  activities  did  beneficiary  mention? 
-----  -mm----- -mm--
mm--- -mm------ -m----
lI -l- 1 
-----  -me----- ---- 
I-I 
19.  Do  you  currently  have  routine  eye  exams? 
(CHECK ONLY ONE ANSWER) 
81%  (473)  1.  yes  (GOT0 QUESTION 20)
19% 	 (112)  2.  no 
(  3)  3.  don't  know. 
(  8)  4.  no  answer 
PLEASE SKIP  TO QUESTION 23 
20.  Who performs  these  exams? 
(CHECK ONLY ONE ANSWER) 
90%  (421)  1.  ophthalmologist
10% 	 (  45)  2.  optometrist  or  optician
(  5)  3.  don't  know 
(  2)  4.  no  answer 
B-4  21.  Was the  cataract  discovered  during  a  routine  eye  exam? 
(CHECK ONLY ONE ANSWER) 
76%  (349)  1.  yes  (GOT0  QUESTION 22)
24% 	 (109)  2.  no 
(  12)  3.  don't  know 
(  3)  4.  no  answer 
PLEASE SKIP  TO QUESTION 23 
22. 	 During  that  exam,  were  you  told  about  any  other  disease  or 
condition  that  was  affecting  your  eyesight? 
(CHECK ONLY ONE ANSWER) 
17%  (  57)  1.  yes
83% 	 (281)  2.  no 
(  9)  3.  don't  know 
(  2)  4.  no  answer 
23.  Who recommended  that  you  have  cataract  surgery? 
(CHECK ONLY ONE ANSWER) 
70%  (400)  1.  ophthalmologist
17%  (  96)  2.  optometrist  or  optician
3%  (  19)  3.  primary  care  physician
8% (  43)  4.  self 
2% (  14)  5.  other  (GOT0 QUESTION 24)
(  17)  6.  don't  know 
(  7)  7.  no  answer 
PLEASE SKIP  TO QUESTION 25 
24.  Who recommended  that  beneficiary  have  cataract  surgery? 
--- 
--  ----- 
--- 
m,- me--
--- 
e ----- 
-
25.  Did  you  get  a  second  opinion  about  the  need  for  surgery? 
(CHECK ONLY ONE ANSWER) 
21%  (120)  1.  yes
79% 	 (439)  2.  no 
(  25)  3.  don't  know 
(  12)  4.  no  answer 
B-5 
 26.  How did  you  choose  your  surgeon? 
(CHECK ONLY ONE ANSWER) 
5%  (  27)  1.  saw  advertisement 
38%  (218)  2.  referred  by  friend  or  relative 
14%  (  78)  3.  referred  by  optometrist  or  optician
6%  (  36)  4.  referred  by  primary  care  physician
26%  (146)  5.  surgeon  is  my  regular  eye  doctor 
12%  (  66)  6.  other  (GOTO-QUESTION 27)
(  12)  7.  don't  know 
(  13)  8.  no  answer 
PLEASE SKIP  TO QUESTION 28 
27.  How  did  beneficiary  choose  surgeon? 
----- 
----- 
----- 
28.  Who decided  that  you  would  have  your  surgery  in  [facility]? 
(CHECK ONLY ONE ANSWER) 
76%  (428)  '1.  ophthalmologist
24% 	 (137)  2.  self 
(  13)  3.  don't  know 
(  18)  4.  no  answer 
29. 	 Were  you  given  options  about  where  you  could  have  your
surgery? 
(CHECK ONLY ONE ANSWER) 
21%  (109)  1.  yes
79% 	 (402)  2.  no 
(  48)  3.  don't  know 
(  37)  4.  no  answer 
30. 	 Did  beneficiary  have  cataract  surgery  in  both  eyes  during
1st  qtr.,  1988? 
(CHECK ONLY ONE ANSWER) 
10%  (  60)  1.  yes  (GOT0 QUESTION 32)
90%  (536)  2.  no 
B-6 
 31. 	 Did  you  have  to  have  another  operation  on  the  same  eye
after  the  cataract  was  removed? 
(CHECK ONLY ONE  ANSWER) 
3%  (  15)  1.  yes
97%  (521)  2.  no 
PLEASE SKIP  TO  QUESTION  33 
32. 	 Did  you  have  to  have  another  operation  in  either  eye  after 
your  cataracts  were  removed? 
(CHECK ONLY ONE ANSWER) 
12%  (  7)  1.  yes
88%  (  53)  2.  no 
PLEASE SKIP  TO QUESTION 36 
33. 	 Did  you  have  laser  treatment  after  surgery  (NOTE:  to 
correct  clouding  of  posterior  capsule)? 
(CHECK ONLY ONE ANSWER) 
28%  (141)  1.  yes  (GOT0 QUESTION 34)
72%  (362)  2.  no 
(  21)  3.  don't  know 
(  12)  4.  no  answer 
PLEASE SKIP  TO QUESTION 42 
34.  When did  you  have  this  treatment? 
(CHECK ONLY ONE ANSWER) 
14%  (  15)  1.  less  than  2  months  after  surgery
42%  (  46)  2.  2-6  months  after  surgery
25%  (  27)  3.  6-12  months  after  surgery
20%  (  22)  4.  more  than  a  year  after  surgery
(  31)  5.  don't  know 
(  0)  6.  no  answer 
35.  Where  did  you  have  this  treatment? 
(CHECK ONLY  ONE  ANSWER) 
41%  (  55)  1.  ambulatory  surgical  center 
33%  (  44)  2.  hospital  outpatient  department
26%  (  35)  3.  ophthalmologist's  office 
(  7)  4.  don't  know 
(  0)  5.  no  answer 
PLEASE SKIP  TO QUESTION 42 
B-7 
 36. 	 Did  you  have  laser  treatment  in  either  eye  after  surgery
(NOTE:  to  correct  clouding  of  posterior  capsule)? 
(CHECK ONLY ONE ANSWER) 
10%  (  6)  1.  yes,  right  eye  (GOT0 QUESTION 37) 
5%(  3)  2.  yes,  left  eye  (GOT0 QUESTION 40)
13%  (  8)  3.  yes,  both  eyes  (GOT0 QUESTION 39)
72%  (  43)  4.  no 
(  0)  5.  don't  know 
(  0)  6.  no  answer 
PLEASE SKIP  TO QUESTION 43 
37.  When did  you  have  the  treatment  in  your  right  eye? 
(CHECK ONLY ONE ANSWER) 
33%  (  2)  1.  less  than  2  months  after  surgery
33%  (  2)  2.  2-6  months  after  surgery
17%  (  1)  3.  6-12  months  after  surgery
17%  (  1)  4.  more  than  a  year  after  surgery 
(  0)  5.  don't  know 
(  0)  6.  no  answer 
38.  Where  did  you  have  the  treatment? 
(CHECK ONLY ONE ANSWER) 
83%  (  5)  1.  ambulatory  surgical  center 
0%  (  0)  2.  hospital  outpatient  department
17% 	 (  1)  3.  ophthalmologist's  office 
(  0)  4.  don't  know 
(  0)  5.  no  answer 
PLEASE SKIP  TO QUESTION 43 
39.  When did  you  have  the  treatment  in  your  right  eye? 
(CHECK ONLY ONE ANSWER) 
14%  (  1)  1.  less  than  2  months  after  surgery
14%  (  1)  2.  2-6  months  after  surgery
43%  (  3)  3.  6-12  months  after  surgery
29%  (  2)  4.  more  than  a  year  after  surgery 
(  1)  5.  don't  know 
(  0)  6.  no  answer 
B-8 
 40.  When did  you  have  the  treatment  in  your  left  eye? 
(CHECK ONLY ONE ANSWER) 
43%  (  3)  1.  less  than  2  months  after  surgery
14%  (  1)  2.  2-6  months  after  surgery
29%  (  2)  3.  6-12  months  after  surgery
14%  (  1)  4.  more  than  a  year  after  surgery
(  1)  5.  don't  know 
(  0)  6.  no  answer 
41.  Where  did  you  have  the  treatment(s)? 
(CHECK ONLY ONE ANSWER) 
88%  (  7)  1.  ambulatory  surgical  center 
13%  (  1)  2.  hospital  outpatient  department 
0% 	(  0)  3.  ophthalmologist's  office 
(  0)  4.  don't  know 
(  0)  5.  no  answer 
PLEASE SKIP  TO QUESTION 43 
42. 	 How would  you  compare  your  vision  now  to  your  vision  before 
the  surgery? 
(CHECK ONLY ONE ANSWER) 
70%  (363)  1.  vision  is  much  better 
19%  (  98)  2.  vision  is  slightly  better 
5% (  27)  3.  vision  is  about  the  same 
6%  (  29)  4.  vision  is  worse 
(  9)  5.  don't  know 
(  10)  6.  no  answer 
PLEASE SKIP  TO QUESTION 45 
43. 	 How would  you  compare  your  vision  in  your  right  eye  now  to 
your  vision  before  the  surgery? 
(CHECK ONLY ONE ANSWER) 
75%  (  45)  1..vision  is  much  better 
13%  (  8)  2.  vision  is  slightly  better 
7% (  4)  3.  vision  is  about  the  same 
5% (  3)  4.  vision  is  worse 
(  0)  5.  don't  know 
(  0)  6.  no  answer 
B-9 
 . 
44.  How would  you  compare  your  vision  in  your  left  eye  now  to 
your 	 vision  before  the  surgery? 
(CHECK ONLY ONE ANSWER) 
80%  (  48) 1.  vision  is  much  better 
15%  (  9)  2.  vision  is  slightly  better 
3%(  2)  3.  vision  is  about  the  same 
1) 4.  vision  is  worse 
2%( 
(  0) 5.  don't  know 
(  0)  6.  no  answer 
45. 	 Did  you have  problems  with  your  stitches  after  cataract 
surgery? 
(CHECK ONLY ONE ANSWER) 
10%  (  58)  1.  yes
90% 	 (523)  2.  no 
(  7)  3.  don't  know 
(  8)  4.  no  answer 
46.  Did  you  have  any  complications  after  surgery? 
(CHECK ONLY ONE ANSWER) 
13%  (  74)  1.  yes  (GOT0 QUESTION 47)
87% 	 (509)  2.  no 
(  4)  3.  don't  know 
(  9)  4.  no  answer 
PLEASE SKIP  TO QUESTION 92 
47. 	 What  complications  did  you  have?  (Enter  all  answers  that 
apply  ) 
26%  (  9)  1.  infection 

3%(  1) 2.  bleeding

20%  (  7) 3.  pain 

9%(  3) 4.  pressure  in  the  eye

11%  (  4) 5.  fluid  accumulation  in  the  retina 

14%  (  5) 6.  inflammation  in  the  eye

34%  (  12)  7.  changes  in  the  quality  of  vision  (e.g.,  halos) 

48.  Did  beneficiary  mention  other  complications? 
(CHECK ONLY ONE ANSWER) 
78%  (  58)  1.  yes  (GOT0 QUESTION 49)
22% 	 (  16)  2.  no 
PLEASE SKIP  TO QUESTION 92 
.  B-10 
 49.  What  other  complications  did  beneficiary  mention? 
---  ------  ---------_ 
---  ------  ---------_ 
---  ------  ---------_ 
P&SE  SKIP  TO QUESTION 92 
50. 	 Who decided  that  you  should  have  your  endoscopy  in 
[facility]? 
(CHECK ONLY ONE ANSWER) 
57%  (  66)  1;  gastroenterologist
17%  (  20)  2.  primary  care  physician 
5% (  6)  3.  other 
20% 	 (  23)  4.  self 
(  5)  5.  don't  know 
(  6)  6.  no  answer 
51.  Did  you  have  symptoms  (of  upper  gastrointestinal  problems)? 
(CHECK ONLY ONE ANSWER) 
96%  (113)  1.  yes  (GOT0 QUESTION 52)
4%(  5)  2.  no 
(  5)  3.  don't  know 
(  3)  4.  no  answer 
PLEASE SKIP  TO QUESTION 55 
52.  What  were  your  symptoms ?  (Enter  all  answers  that  apply) 
30%  (  25)  1.  heartburn  or  indigestion 
6%(  5)  2.  upper  gastrointestinal  bleeding
16%  (  13)  3.  difficult  or  painful  swallowing
5%(  4)  4.  black  stool 

10%  (  8)  5.  vomiting

37%  (  31)  6.  ulcer 

5%(  4)  7.  weight  loss 

2% (  2)  8.  filling  up  fast  when  eating 

7%(  6)  9.  diarrhea 

53.  Did  beneficiary  mention  other  symptoms? 
(CHECK  ONLY  ONE  ANSWER) 
58%  (  66)  1.  yes  (GOT0 QUESTION 54)
42%  (  47)  2.  no 
PLEASE  SKIP  TO  QUESTION  55 
B-11 
 54. 	 What  other  symptoms  did  beneficiary  mention? 
- -- 
---- 
- -- 
---- 
- -- 
mm-
-
55.  Who explained  the  results  of  the  endoscopy  to  you? 
(CHECK ONLY ONE ANSWER) 
87%  (  99)  1.  gastroenterologist
8%  (  9)  2.  primary  care  physician
5% (  6)  3.  no  one  explained  the  findings
(  8)  4.  don't  know 
(  4)  5.  no  answer  ' 
56.  Did  you  have  any  complications  after  the  procedure? 
(CHECK ONLY ONE ANSWER) 
3%  (  4)  1.  yes  (GOT0 QUESTION 57)
97% 	 (118)  2.  no 
(  1)  3.  don't  know 
(  3)  4.  no  answer 
PLEASE SKIP  TO QUESTION 92 
57. 	 What  complications  did  you  have ?  (Enter  all  answers  that 
apply) 
50%  (  1)  1.  sore  throat 

50%  (  1)  2.  painful  swallowing

50%  ( 1)  3.  chest  pain

0%  (  0)  4.  fever 

0%  (  0)  5.  vomiting  blood 

0%  (  0)  6.  adverse  reaction  to  the  sedative 

0%  (  0)  7.  perforation 

58.  Did  beneficiary  mention  other  complications? 
(CHECK ONLY ONE ANSWER) 
50%  (  2)  1.  yes  (GOT0 QUESTION 59)
50%  (  2)  2.  no 
PLEASE SKIP  TO QUESTION 92 
B-12 
 59.  What  other  complications  did  beneficiary  mention? 
- --  -------  --- 
------ 
- --  -------  --- 
-mm--
- ~- -------  --- 
----m-
PLE.  SE  SKIP  TO QUESTION 92 
60. 	 Who decided  that  you  should  have  your  colonosopy  in 
[facility]? 
(CHECK ONLY ONE ANSWER) 
60%  (  62)  1.  gastroenterologist
20%  (  21)  2.  primary  care  physician 
3%  (  3)  3.  other 
17% 	 (  17)  4.  self 
(  2)  5.  don't  know 
(  0)  6.  no  answer 
61.  Did  you  have  symptoms  (of  lower  gastrointestinal  problems)? 
(CHECK ONLY ONE ANSWER) 
83%  (  84)  1.  yes  (GOT0 QUESTION 62)
17% 	 (  17)  2.  no 
(  0)  3.  don't  know 
(  4)  4.  no  answer 
PLEASE  SKIP  TO QUESTION 65 
62.  What  were  your  symptoms ?  (Enter  all  answers  tr,at  apply) 
16%  (  10)  1.  lower  gastrointestinal  bleeding

23%  (  15)  2.  abdominal  pain

22%  (  14)  3.  black  stool  or  blood  in  stool 

14%  (  9)  4.  change  in  bowel  habit  (e.g.,  constipation) 

45%  (  29)  5.  history  of  colonic  polyps 

1)  6.  iron  deficiency  (anemia) 

2%( 
63.  Did  beneficiary  mention  other  symptoms? 
(CHECK ONLY ONE  ANSWER) 
42%  (  35)  1.  yes  (GOT0 QUESTION 64) 
58%  (  49)  2.  no 
PLEASE SKIP  TO QUESTION 65 
B-13 
 64.  What  other  symptoms  did  beneficiary  mention? 
--- 
--- 
--- 
-
65. 	 Do  you  have  a  family  history  (parents  or  siblings) of  colon 
-
cancer? 
(CHECK ONLY ONE ANSWER) 
20%  (  19)  1.  yes
80% 	 (  78)  2.  no 
(  5)  3.  don't  know  . 
(  3)  4.  no  answer 
66.  Have  you  had  colon  cancer  in  the  past? 
(CHECK ONLY ONE ANSWER) 
14%  (  14)  1.  yes
86% 	 (  86)  2.  no 
(  1)  3.  don't  know 
(  4)  4.  no  answer 
67.  Who explained  the  results  of  the  colonoscopy  to  you? 
(CHECK ONLY ONE ANSWER) 
91%  (  87)  1.  gastroenterologist 
7%(  7)  2.  primary  care  physician
2% (  2)  3.  no  one  explained  the  findings
(  3)  4.  don't  know 
(  6)  -5.  no  answer 
68.  Did  you  have  any  complications  after  the  procedure? 
(CHECK ONLY ONE  ANSWER) 
6%  (  6)  1.  yes  (GOT0 QUESTION 69)
94% 	 (  98)  2.  no 
(  0)  3.  don't  know 
(  1)  4.  no  answer 
PLEASE SKIP  TO QUESTION 92 
B-14 
 69. 	 What  complications  did  you  have?  (Enter  all  answers  that 
apply  1 
67%  (  2)  1.  persistent abdominal  pain 
O%(  0) 2.  serious  or  profuse  rectal  bleeding 
0% (  0) 3.  fever 
33%  (  1)  4.  adverse  reaction  to  the  sedative 
O%(  0)  5.  perforation 
70.  Did  beneficiary  mention  other  complications? 
(CHECK ONLY ONE ANSWER) 
33%  (  2)  1.  yes  (GOT0 QUESTION 71)
67% 	 (  4j  2x0  .  -
PLEASE SKIP  TO QUESTION 92 
71.  What  other  complications  did  beneficiary  mention? 
- -- 
-
-- 
- -- 
PLE. SE  SKIP  TO QUESTION 92 
72.  Do  you  see  a  podiatrist  on  a  regular  basis? 
(CHECK ONLY ONE ANSWER) 
17%  (  1)  1.  yes
83%  (  5)  2.  no 
(  0)  3.  don't  know 
(  0)  4.  no  answer 
73. 	 How  long  did  you  have  the  bunion  that  was  removed? 
(CHECK ONLY ONE ANSWER) 
0%  (  0) 1.  less  than  a  year
20%  (  1)  2.  l-5  years
60%  (  3) 3.  5-10  years
20%  (  1) 4.  more  than  10  years
(  1)  5.  don't  know 
(  0)  no  answer 
6. 
B-15  74.  Was  the  bunion  painful? 
(CHECK ONLY ONE ANSWER) 
83%  (  5)  1.  yes  (GOT0 QUESTION 75)
17% 	 (  1)  2.  no 
(  0)  3.  don't  know 
(  0)  4.  no  answer 
PLEASE SKIP  TO QUESTION 76 
75.  How  long  was  the  bunion  painful? 
(CHECK ONLY ONE ANSWER) 
O%(  0)  1.  less  than  a  year
80%  (  4)  2.  l-5  years 
0%  (  0)  3.  5-10  years
20% 	 (  1)  4.  more  than  10  years
(  0)  5.  don't  know 
(  0)  6.  no  answer 
76.  Do  you  have  a  bunion  on  your  other  foot? 
(CHECK ONLY ONE ANSWER) 
33%  (  2)  1.  yes
67%  (  4)  2.  no 
(  0)  3.  no  answer 
77.  Why did  you,  have  surgery? 
(CHECK ONLY ONE ANSWER) 
33%  (  2)  1.  bunion  was  painful
50%  (  3)  2.  bunion  was  getting  worse 
17%  (  1)  3.  shoes  didn't  fit  properly 
0%  (  0)  4.  conservative  care  failed  (e.g.,  comfortable 
shoes) 
0%  (  0)  5.  primary  care  physician  recommended  it 
0%  (  0)  6.  podiatrist  recommended  it 
0% (  0)  7.  orthopedic  surgeon  recommended  it 
(  0)  8.  don't  know 
(  0)  9.  no  answer 
B-16 
 78.  Were  you  given  alternatives  to  surgery  (e.g.,  change  in 
shoes)?
(CHECK ONLY ONE ANSWER) 
17%  (  1)  1.  yes  (GOT0 QUESTION 79)
83% 	 (  5)  2.  no 
(  0)  3.  don't  know 
(  0)  4.  no  answer 
PLEASE SKIP  TO QUESTION 80 
79.  How  long  did  you  try  those  alternatives? 
(CHECK ONLY ONE ANSWER) 
O%(  0)  1.  less  than  a  year 
0% (  0)  2.  l-5  years
lOO%(  1)  3.  5-10  years
0% 	(  0)  4.  more  than  10  years
(  0)  5.  don't  know 
(  0)  6.  no  answer 
80.  How did  you  choose  your  surgeon? 
(CHECK ONLY ONE ANSWER) 
17%  (  1)  1.  saw  advertisement 
0%  (  0)  2.  referred  by  friend  or  relative 
50%  (  3)  3.  referred  by  primary  care  physician 
0%  (  0)  4.  I  see  podiatrist  for  other  problems
33% 	 (  2)  5.  other  (GOT0 QUESTION 81)
(  0)  6.  don't  know 
(  0)  7.  no  answer 
PLEASE SKIP  TO QUESTION 82 
81.  How did  beneficiary  choose  surgeon? 
mm ----- 
---  ----- 
---  mm--
l -I 
82.  Did  you  get  a  second  opinion  about  the  need  for  surgery? 
(CHECK ONLY ONE ANSWER) 
33%  (  2)  1.  yes
67% 	 (  4)  2.  no 
(  0)  3.  don't  know 
(  0)  4.  no  answer 
B-17 
 83. 	 Who decided  that  you  should  have  your  bunion  removed  in 
[facility]? 
(CHECK ONLY ONE ANSWER) 
83%  (  5)  1.  podiatrist
17%  (  1)  2.  orthopedic  surgeon 
0%  (  0)  3.  primary  care  physician 
O%(  0)  4.  self 
(  0)  5.  don't  know 
(  0)  6.  no  answer 
84. 	 Were  you  given  options  about  where  you  could  have  your
surgery? 
(CHECK ONLY ONE ANSWER) 
O%(  0)  1.  yes
lOO%(  6)  2.  no 
(  0)  3.  don't  know 
(  0)  4.  no  answer 
85.  What  kind  of  anesthetic  did  you  have  during  surgery? 
(CHECK ONLY ONE ANSWER) 
50%  (  2)  1.  general
50%  (  2)  2.  local 
0% 	(  0)  3.  spinal
(  2)  4.  don't  know 
(  0)  5.  no  answer 
86.  Were  you  given  choices  about  the  anesthetic  you  could  have? 
(CHECK ONLY ONE ANSWER) 
17%  (  1)  1.  yes
83% 	 (  5)  2.  no 
(  0)  3.  don't  know 
(  0)  4.  no  answer 
B-18 
 87. 	 How  long  after  surgery  could  you  wear  your  regular  shoes 
comfortably? 
(CHECK ONLY ONE ANSWER) 

33%  (  2) 1.  1  month  after  surgery
17%  (  1) 2.  l-2  months  after  surgery
17%  (  1) 3.  3-6  months  after  surgery 
17%  (  1) 4.  more  than  6  months  after  surgery
17%  (  1) 5.  I  still  cannot  wear  regular shoes  comfortably 
(  0) 6.  don't  know 
(  0)  7.  no  answer 
88.  Did  you  have  any  complications  after  surgery?
(CHECK ONLY ONE ANSWER) 
O%(  0)  1.  yes  (GOT0 QUESTION 89)
lOO%(  6)  2.  no 
(  0)  3.  don't  know 
(  0)  4.  no  answer 
PLEASE SKIP  TO QUESTION 92 
89. 	 What  complications  did  you  have ?  (Enter  all  answers  that 
apply  > 
0% (  0)  1.  fever 

O%C  0)  2.  infection 

0%  (  0)  3.  excessive  bleeding 

0%  (  0)  4.  excessive  pain 

0%  (  0)  5.  excessive  swelling 

90.  Did  beneficiary  mention  other  complications? 
(CHECK ONLY ONE ANSWER) 
O%(  0)  1.  yes  (GOT0 QUESTION 91)
0%  (  0)  2.  no 
PLEASE SKIP  TO QUESTION 92 
91.  What  other  complications  did  beneficiary  mention? 
-
-- 
-
-- 
-
-- 
-
B-19 
 92. 	 Would  you  have  preferred  to  stay  in  the  hospital  overnight
for  your  procedure? 
(CHECK ONLY ONE ANSWER) 
9%  (  72)  1.  yes
91% 	 (712)  2.  no 
(  26)  3.  don't  know 
(  23)  4.  no  answer 
93.  Did  you  go  home  after  the  procedure? 
(CHECK ONLY ONE ANSWER) 
92%  (736)  1.  yes  (GOT0 QUESTION 98)
8% 	(  68)  2.  no  (GOT0 QUESTION 94)
(  2)  3.  don't  know 
(  27)  4.  no  answer 
PLEASE SKIP  TO QUESTION 101 
94.  Where  did  you  stay? 
(CHECK ONLY ONE  ANSWER) 
54%  (  37)  1.  home  of  relative  or  neighbor  (GOT0  QUESTION 101)
6%(  4)  2.  nursing  home  (GOT0 QUESTION 96)  -
40%  (  27)  3.  other  -(GOT0  QUESTION 95) 
(  0)  4.  no  answer 
PLEASE SKIP  TO QUESTION 101 
95.  Where  did  beneficiary  stay? 
96.  Did  you  have  to  pay  to  stay  there? 
(CHECK ONLY ONE ANSWER) 
43% 	 (  10)  1.  no  (GOT0 QUESTION 101)
(  2)  2.  don't  know  (GOT0 QUESTION 101)
(  3)  3.  no  answer  (GOT0 QUESTION 101)
57%  (  13)  4.  yes 
B-20 
 97.  How much  did  you  have  to  pay  to  stay  there? 
(CHECK ONLY ONE ANSWER) 
80%  (  8)  1.  under  $100 
10%  (  1)  2.  $lOO-$500 
10%  (  1)  3.  $500-$1000 
0% 	(  0)  4.  over  $1000 
(  1)  5.  don't  know 
(  1)  6.  no  answer 
PLEASE SKIP  TO QUESTION 101 
98.  Who took  care  of  you  at  home  after  the  procedure? 
(CHECK ONLY ONE ANSWER) 
35%  (258)  1.  self  (GOT0 QUESTION 101)

34%  (247)  2.  spouse  (GOT0 QUESTION 100)

24%  (176)  3.  other  relative  (GOT0 QUESTION 100)

3%  (  23)  4.  neighbor  (GOT0 QUESTION 100)

4%  (  32)  5.  other 

99.  Who took  care  of  beneficiary  at  home? 
-- 
- --- 
----  --- 
-- 
- --- 
mm-- --- 
-- 
- --- 
m--- mm-
-
100. 	 Did  spouse/other  relative/neighbor/other  have  take  time 
to 
off  work  to  take  care  of  you? 
(CHECK ONLY ONE ANSWER) 
10%  (  44)  1.  yes
90% 	 (410)  2.  no 
(  6)  3.  don't  know 
(  4)  4.  no  answer 
101. 	 Were  you  given  instructions  that  explained  how  to  prepare
for  the  procedure  and  how  to  take  care  of  yourself  after 
the  procedure? 
(CHECK ONLY ONE ANSWER) 
97%  (760)  1.  yes  (GOT0 QUESTION 102)
3% 	(  24)  2.  no 
(  25)  3.  don't  know 
(  24)  4.  no  answer 
PLEASE SKIP  TO QUESTION 105 
B-21 
 102. 	 When were  you  given  these  instructions? 
(CHECK ONLY ONE ANSWER) 
53%  (370)  1.  before  the  day  of  the  procedure

13%  (  89)  2.  the  day  of  the  procedure

34%  (233)  3.  both  before  and  the  day  of  the  procedure

(  58)  4.  don't  know 

(  10)  5.  no  answer 

103. 	 Were  these  instructions  given  to  you  in  writing,  orally  or 
both? 
(CHECK ONLY ONE ANSWER) 
27%  (194)  1.  writing
14%  (102)  2.  orally
58%  (412)  3.  both 
(  41)  4.  don't  know 
(  11)  5.  no  answer 
104.  Were  the  instructions  clear  to  you? 
(CHECK ONLY ONE ANSWER) 
99%  (738)  1,  yes 
1% 	(  5)  2.  no 
(  12)  3.  don't  know 
(  5)  4.  no  answer 
105. 	 Did  a  nurse  from  the  facility,  a  nurse  from  your  doctor's 
office  or  your  doctor  call  you  the  evening  of  the 
procedure  or  the  day  after  the  procedure  to  check  on  your
progress? 
(CHECK ONLY ONE ANSWER) 
57%  (387)  1.  yes
43% 	 (296)  2.  no  (GOT0 QUESTION 106)
(109)  3.  don't  know 
(  41)  4.  no  answer 
PLEASE SKIP  TO QUESTION 107 
106.  Did  you  see  the  surgeon  the  next  day  for  follow-up  care? 
(CHECK ONLY ONE ANSWER) 
63%  (181)  1.  yes
37% 	 (105)  2.  no 
(  10)  3.  don't  know 
(  0)  4.  no  answer 
B-22  107. 	 Approximately  how  much  time  did  you  spend  in  [facility]
the  day  of  your  procedure? 
(CHECK ONLY ONE ANSWER) 
53%  (377)  1.  under  4  hours 
34%  (241)  2.  4-6  hours 
14%  (  97)  3.  over  6  hours 
(  92)  4.  don't  know 
(  26)  5.  no  answer 
108. 	 Before  the  day  of  the  procedure,  were  you  told  how  much 
you  would  have  to  pay  out-of-pocket? 
(CHECK ONLY ONE ANSWER) 
33%  (236)  1.  yes
67% 	 (484)  2.  no 
(  80)  3.  don't  know 
(  33)  4.  no  answer 
109.  Approximately  what  were  your  out-of-pocket  expenses? 
(CHECK ONLY ONE ANSWER) 
59%  (334)  1.  none  (GOT0 QUESTION 110)

18%  (100)  2.  under  $100 

19%  (106)  3.  from  $lOO-$500 

3%  (  15)  4.  from  $501-$1000 

1%  (  8)  5.  from  $lOOl-$2000 

<l% 	 (  1)  6.  over  $2000 
(240)  7.  don't  know 
(  29)  8.  no  answer 
PLEASE SKIP  TO QUESTION 113 
110.  Are  you  covered  by  Medicaid  (Medi-Cal  in  California)? 
(CHECK ONLY ONE ANSWER) 
13%  (43)  l.yes
87%  (291)  2.  no 
111.  Do  you  have  private  insurance  to  supplement  Medicare? 
(CHECK ONLY ONE ANSWER) 
78%  (260)  1.  yes
22%  (  74)  2.  no 
B-23 
 112. 	 Did  the  facility  or  the  physician  send  you  a  bill  you  for 
the  procedure? 
(CHECK ONLY ONE ANSWER) 
18%  (  59)  1.  yes
82%  (275)  2.  no 
113. 	 Did  you  get  any  bills  after  you  had  the  procedure  that  you
had  not  expected? 
(CHECK ONLY ONE ANSWER) 
14%  (108)  1.  yes  (GOT0 QUESTION 114)
86% 	 (647)  2.  no 
(  44)  3.  don't  know 
(  34)  4.  no  answer 
PLEASE SKIP  TO QUESTION 116 
114. 	 Who billed  you ?  (If  beneficiary  received  bills  from  more 
than  one  provider,  record  answer  under  other  category) 
(CHECK ONLY ONE ANSWER) 
15%  (  13)  1.  surgeon  (GOT0 QUESTION 116) 
0% (  0)  2.  assistant  surgeon  (GOT0 QUESTION 116)
40%  (  36)  3.  facility  (GOT0 QUESTION 116)
3% (  3)  4.  laboratory  (GOT0 QUESTION 116)
18% 	 (  16)  5.  anesthesiologist  (GOT0 QUESTION 116)
(  18)  6.  don't  know  (GOT0 QUESTION 116)
(  1)  7.  no  answer  (GOT0 QUESTION 116)
24%  (  21)  8.  other 
115.'  Who sent  these  bills  to  the  beneficiary? 
I -I 
116. 	 Did  you  have  to  travel  outside  your community  to  have 
[procedure]? 
(CHECK ONLY ONE ANSWER) 
25%  (201)  1.  yes  (GOT0 QUESTION 117)
75% 	 (605)  2.  no 
(  5)  3.  don't  know 
(  22)  4.  no  answer 
PLEASE SKIP  TO QUESTION 119 
B-24 
 P 
117.  Why did  you  have  to  travel  outside  your  community? 
(CHECK ONLY ONE ANSWER) 

33%  (  57).  1.  no  outpatient  facility  in  my  area 
 (GOT0 
QUESTION 119) 

67%  (116)  2.  my  surgeon  did  not  practice  in  my
 area  (GOT0 
QUESTION 119) 

(  4)  3.  no  answer  (GOT0 QUESTION 119)

(  24)  4.  other 

118.  Why did  beneficiary  have  to  travel  outside 
 community? 
----------mm------
----------m-------
-----------m--m---
-
119.  How would  you  rate  the  doctor  who  performed  the  procedure?
(CHECK ONLY ONE ANSWER) 
57%  (449)  1.  excellent 
31%  (248)  2.  very  good
9%(  68)  3.good
2% (  14)  4.  fair 
2% 	(  15)  5.  poor
(  21)  6.  don't  know 
(  18)  7.  no  answer 
120. 	 What  did  you  like  about  the  doctor  who  performed  the 

procedure  ?  (Enter  all  answers  that  apply) 

38%  (284) 1.  competence 

49%  (369) 2.  courtesy  (bedside  manner)

26%  (193) 3.  willingness  to  answer  questions

16%  (122) 4.  willingness  to  spend  time  with  patient 

22%  (163) 5.  no  specific  comment 

(  10) 6.  don't  know 

(  46)  7.  no  answer 

121. 	 Did  beneficiary  mention  anything  else  that  he  or  she  liked 
about  the  doctor  who  performed  the  procedure? 
(CHECK ONLY ONE ANSWER) 
17%  (146)  1.  yes  (GOT0 QUESTION 122)
82%  (687)  2.  no 
PLEASE SKIP  TO QUESTION 123 
B-25 
 122.  What  did  beneficiary  mention? 
---  --  - --- 
---m---m-
---  --  - --- 
---------- 
---  --  - --- 
-L-----m--
I-I 
123. 	 If  a  member  of  your  family  or  a  friend  required
[procedure]  in  the  future,  would  you  recommend  (specify
doctor)? 
(CHECK ONLY ONE ANSWER) 
94%  (728)  1.  yes
6% 	(  47)  2.  no 
(  29)  3.  don't  know 
(  29)  4.  no  answer 
124.  How would  you  rate  [facility]? 
(CHECK ONLY ONE ANSWER) 
39%  (307)  1.  excellent 
38%  (293)  2.  very  good
19%  (149)  3.  good
4%  (  28)  4.  fair 
1st  4)  5.  poor 
(  6.  don't  know 
23) 
(  29)  7.  no  answer 
125. 	 What  did  you  like  about  [facility]?  (Enter  all  answers 
that  apply  1 
51%  (368)  1.  staff 
18%  (127)  2.  atmosphere
10%  (  72)  3.  comfort 
8%  (  56)  4.  convenience 
7%  (  SO)  5.  waiting  time 
37% 	 (269)  6.  no  specific  comment 
(  15)  7.  don't  know 
(  ,8.  no  answer 
48) 
126. 	 Did  beneficiary  mention  anything  else  that  he  or  she  liked 
about  [facility]? 
(CHECK ONLY ONE ANSWER) 
25%  (206)  1.  yes  (GOT0 QUESTION 127)
75%  (627)  2.  no 
PLEASE SKIP  TO QUESTION 128 
B-26 
 127.  What  did  beneficiary  mention? 
---  - -
---  - -
---  - -
I-I 
128..If  a  member  of  your  family  or  a  friend  required  [  6  1  in 
the  future,  would  you  recommend  [facility]? 
(CHECK ONLY ONE ANSWER) 
96%  (725)  1.  yes
4%(31)  2.no 
(  34)  3.  don't  know 
(  43)  4.  no  answer 
129. 	 Is  there  anything  that  you  disliked  about  the  doctor  who 
performed  the  procedure  or  the  facility? 
(CHECK ONLY ONE ANSWER) 
14%  (119)  1.  yes  (GOT0 QUESTION 130)
85%  (714)  2.  no 
PLEASE SKIP  TO QUESTION 134 
130.  What  did  you  dislike?  (Enter  all  answers  that  apply  1 
23%  (  15)  1.  cost  of  care 
39%  (  26)  2.  waiting  time 
42%  (  28)  3.  inadequate  explanations 
5% 	(  3)  4.  no  specific  comment 
(  0)  5.  don't  know 
(  1)  6.  no  answer 
131. 	 Did  beneficiary  mention  anything  else  that  he  or  she 
-
disliked? 
(CHECK ONLY ONE ANSWER) 
74%  (  88)  1.  yes  (GOT0 QUESTION 132)
26%  (31)  2.no 
PLEASE SKIP  TO QUESTION 134 
132.  What  did  beneficiary  mention? 
--  - - 
mm-
--  - - 
--- 
--  - - 
mm-
k&E  SKIP  TO QUESTION 134 
B-27  133. 	 I  look  forward  to  talking  to  you  on  (specify  date 
scheduled  for  interview).
Press  ENTER to  exit  survey  .  .  . 
(CHECK ONLY ONE ANSWER) 
1  1 1.  Exit  beneficiary  survey
PEASE  SKIP  TO QUESTION 138 
134. 	 That  was  my  last  question.  Thank  you  very  much  for  your
time  and  cooperation.  Do  you  have  any  other  comments 
about  your  procedure  ?  (Take  notes  on  call  sheet)  Please 
enter  your  initials  (type  over  default  initials). 
135. 	 Enter  the  a-letter  abbreviation  for  the  beneficiary's 
state.  (Type  over  default  state) 
25%  (298)  1.  CA 
18%  (206)  2.  FL 
17%  (200)  3.  TX 
10%  (118)  4.  PA 
8%  (  92)  5.  OH 
6%  (  70)  6.  NC 
5% (  58)  7.  IL 
4%  (  48)  8.  LA 
4%  (  46)  9.  AZ 
3%  (  34)  10.  MD 
136.  Enter  the  beneficiary's  sex.  (Type  over  default  sex) 
33%  (278)  1.  male 
67%  (559)  2.  female 
137.  Enter  the  beneficiary's  age. 
3%  (  25)  1.  under  65  years  old 
15%  (124)  2.  65-69 
27%  (227)  3.  70-74 
26%  (215)  4.  75-79 
20%  (165)  5.  80-84 
10%  (  81)  6.  85  and  older 
138. 	 Enter  the  beneficiary  number.  (Enter  1171  only  for 
beneficiaries  whose  interviews  must  be  rescheduled) 
l-l-l-l-l 
B-28 
 139. 	 Do  you  want  to  review  your  answers? 
(CHECK ONLY ONE ANSWER) 
I I 1.  yes  (GOT0 QUESTION 2)
-
2.  no 
-
140. 	 Time  interview  was  completed 
I-I-I-LL.J 
B-29