58386 Federal Register / Vol. 77, No. 183 / Thursday, September 20, 2012 / Notices 

Request for Comments 

In accordance with the Paperwork 

Reduction Act, comments on AHRQ’s 

information collection are requested 

with regard to any of the following: (a) 

Whether the proposed collection of 

information is necessary for the proper 

performance of AHRQ healthcare 

research and healthcare 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: September 13, 2012. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2012–23165 Filed 9–19–12; 8:45 am] 

BILLING CODE 4160–90–M 

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. 

SUMMARY: This notice announces the 

intention of the Agency for Healthcare 

Research and Quality (AHRQ) to request 

that the Office of Management and 

Budget (OMB) approve the proposed 

information collection project: ‘‘Medical 

Expenditure Panel Survey (MEPS) 

Household Component and the MEPS 

Medical Provider Component.’’ In 

accordance with the Paperwork 

Reduction Act, 44 U.S.C. 3501–3521, 

AHRQ invites the public to comment on 

this proposed information collection. 

This proposed information collection 

was previously published in the Federal 

Register on June 13th, 2012 and allowed 

60 days for public comment. One 

comment was received. The purpose of 

this notice is to allow an additional 30 

days for public comment. 

DATES: Comments on this notice must be 

received by October 22, 2012. 

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 

OIRA_submission@omb.eop.gov 

(attention: AHRQ’s desk officer). 

Copies of the proposed collection 

plans, data collection instruments, and 

specific details on the estimated burden 

can be obtained from the AHRQ Reports 

Clearance Officer. 

FOR FURTHER INFORMATION CONTACT: 

Doris Lefkowitz, AHRQ Reports 

Clearance Officer, (301) 427–1477, or by 

email at doris.lefkowitz@AHRQ.hhs.gov. 

SUPPLEMENTARY INFORMATION: 

Proposed Project 

Medical Expenditure Panel Survey 

(MEPS) Household Component and the 

MEPS Medical Provider Component 

For over thirty years, results from the 

MEPS and its predecessor surveys (the 

1977 National Medical Care 

Expenditure Survey, the 1980 National 

Medical Care Utilization and 

Expenditure Survey and the 1987 

National Medical Expenditure Survey) 

have been used by OMB, DHHS, 

Congress and a wide number of health 

services researchers to analyze health 

care use, expenses, and health policy. 

Major changes continue to take place 

in the health care delivery system. The 

MEPS is needed to provide information 

about the current state of the health care 

system as well as to track changes over 

time. The MEPS permits annual 

estimates of use of health care and 

expenditures and sources of payment 

for that health care. It also permits 

tracking individual change in 

employment, income, health insurance 

and health status over two years. The 

use of the National Health Interview 

Survey (NHIS) as a sampling frame 

expands the MEPS analytic capacity by 

providing another data point for 

comparisons over time. 

Households selected for participation 

in the MEPS Household Component 

(MEPS–HC) are interviewed five times 

in person. These rounds of interviewing 

are spaced about 5 months apart. The 

interview will take place with a family 

respondent who will report for him/ 

herself and for other family members. 

The MEPS–HC has the following goal: 

• To provide nationally 

representative estimates for the U.S. 

civilian noninstitutionalized population 

for health care use, expenditures, 

sources of payment and health 

insurance coverage. 

The MEPS Medical Provider 

Component (MEPS–MPC) will contact 

medical providers (hospitals, 

physicians, home health agencies and 

institutions) identified by household 

respondents in the MEPS–HC as sources 

of medical care for the time period 

covered by the interview, and all 

pharmacies providing prescription 

drugs to household members during the 

covered time period. The MEPS–MPC is 

not designed to yield national estimates. 

The sample is designed to target the 

types of individuals and providers for 

whom household reported expenditure 

data was expected to be insufficient. For 

example, households with one or more 

Medicaid enrollees are targeted for 

inclusion in the MEPSMPC because this 

group is expected to have limited 

information about payments for their 

medical care. 

The MEPS–MPC has the following 

goal: 

• To serve as an imputation source 

for and to supplement/replace 

household reported expenditure and 

source of payment information. This 

data will supplement, replace and verify 

information provided by household 

respondents about the charges, 

payments, and sources of payment 

associated with specific health care 

encounters. 

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 condition 

enumeration, health status, health care 

utilization including prescribed 

medicines, expense and payment, 

employment, and health insurance. 

Other topical areas that are asked only 

once a year include access to care, 

income, assets, satisfaction with health 

plans and providers, children’s health, 

and adult preventive care. While many 

of the questions are asked about the 

entire reporting unit (RU), which is 

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Federal Register / Vol. 77, No. 183 / Thursday, September 20, 2012 / Notices 58387 

typically a family, only one person 

normally provides this information. 

2. Adult Self Administered 

Questionnaire. A brief self-administered 

questionnaire (SAQ) will be used to 

collect self-reported (rather than 

through household proxy) information 

on health status, health opinions and 

satisfaction with health care for adults 

18 and older. The satisfaction with 

health care items are a subset of items 

from the Consumer Assessment of 

Healthcare Providers and Systems 

(CAHPS®). The health status items are 

from the Short Form 12 Version 2 (SF– 

12 version 2), which has been widely 

used as a measure of self-reported 

health status in the United States, the 

Kessler Index (K6) of non-specific 

psychological distress, and the Patient 

Health Questionnaire (PHQ–2). 

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. As 

in previous panels of the MEPS, we will 

ask respondents for authorization to 

obtain supplemental information from 

their medical providers (hospitals, 

physicians, home health agencies and 

institutions) and pharmacies. 

5. MEPS Validation Interview. Each 

interviewer is required to have at least 

15 percent of his/her caseload validated 

to insure that CAPI questionnaire 

content was asked appropriately and 

procedures followed, for example the 

use of show cards. Validation flags are 

set programmatically for cases preselected 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 all 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. 

To achieve the goal of the MEPS–MPC 

the following data collections are 

implemented: 

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 

the seven provider types in the MEPS– 

MPC. 

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. 

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 itself; 

the 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 

administrative office also has to be 

contacted to determine whether the 

doctors identified by medical records 

billed separately from the institution 

itself. 

8. Pharmacy Data Collection 

Questionnaire. This questionnaire 

requests the national drug code (NDC) 

and when that is not available the 

prescription name, date prescription 

was filled, payments by source, 

prescription strength and form (when 

the NDC is not available), 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. 

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, the 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 

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58388 Federal Register / Vol. 77, No. 183 / Thursday, September 20, 2012 / Notices 

subgroups of interest. Data from the 

MEPS, both the HC and MPC, are 

intended for a number of annual reports 

required to be produced by AHRQ, 

including the National Health Care 

Quality Report and the National Health 

Care Disparities Report. 

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 15,093* (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 86 minutes to administer. The Adult 

SAQ will be completed once a year by 

each person in the RU that is 18 years 

old and older, an estimated 28,254 

persons. The Adult SAQ requires an 

average of 7 minutes to complete. The 

Diabetes care SAQ will be completed 

once a year by each person in the RU 

identified as having diabetes, an 

estimated 2,345 persons, and takes 

about 3 minutes to complete. The 

authorization form for the MEPS–MPC 

Provider Survey will be completed once 

for each medical provider seen by any 

RU member. The 14,489* RUs in the 

MEPS–HC will complete an average of 

5.2 forms, which require about 3 

minutes each to complete. The 

authorization form for the MEPS–MPC 

Pharmacy Survey will be completed 

once for each pharmacy for any RU 

member who has obtained a 

prescription medication. RUs will 

complete an average of 3.1 forms, which 

take about 3 minutes to complete. About 

one third of all interviewed RUs will 

complete a validation interview as part 

of the MEPS–HC quality control, which 

takes an average of 5 minutes to 

complete. The total annual burden 

hours for the MEPS–HC are estimated to 

be 63,907 hours. 

All 34,000 medical providers and 

pharmacies included in the MEPS–MPC 

will receive a screening call which will 

take 3 minutes on average. The MEPS– 

MPC uses 7 different questionnaires—6 

for medical providers and 1 for 

pharmacies. Each questionnaire is 

relatively short and requires 3 to 5 

minutes to complete. The total annual 

burden hours for the MEPS–MPC are 

estimated to be 18,914 hours. The total 

annual burden for the MEPS–HC and 

MPC is estimated to be 82,821 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 $1,389,339; the annual cost burden 

for the MEPS–MPC is estimated to be 

$285,680. The total annual cost burden 

for the MEPS–HC and MPC is estimated 

to be $1,675,019. 

EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS

Form name Number of 

respondents 

Number of 

responses per 

respondent 

Hours per 

response 

Total burden 

hours 

MEPS–HC 

MEPS–HC Core Interview ............................................................................... *15,093 2 .5 86/60 54,083 

Adult SAQ ........................................................................................................ 28,254 1 7/60 3,296 

Diabetes care SAQ .......................................................................................... 2,345 1 3/60 117 

Authorization form for the MEPS–MPC Provider Survey ................................ 14,489 5 .2 3/60 3,767 

Authorization form for the MEPS–MPC Pharmacy Survey ............................. 14,489 3 .1 3/60 2,246 

MEPS–HC Validation Interview ....................................................................... 4,781 1 5/60 398 

Subtotal for the MEPS–HC ....................................................................... 79,451 na na 63,907 

MEPS–MPC 

MPC Contact Guide/Screening Call** ............................................................. 34,000 1 3/60 1,700 

Home care for health care providers questionnaire ........................................ 465 6 .5 5/60 252 

Home care for non-health care providers questionnaire ................................. 35 6 .6 5/60 19 

Office-based providers questionnaire .............................................................. 10,800 5 .8 5/60 5,220 

Separately billing doctors questionnaire .......................................................... 10,800 2 3/60 1,080 

Hospitals questionnaire ................................................................................... 5,000 6 .5 5/60 2,708 

Institutions (non-hospital) questionnaire .......................................................... 100 1 .5 5/60 13 

Pharmacies questionnaire ............................................................................... 6,800 23 .3 3/60 7,922 

Subtotal for the MEPS–MPC .................................................................... 68,000 na na 18,914 

Grand Total ....................................................................................... 147,451 na na 82,821 

* While the expected number of responding units for the annual estimates is 14,489, it is necessary to adjust for survey attrition of initial respondents by a factor of 0.96 (15,093 = 14,489/0.96). 

** There are 6 different contact guides; one for each provider type, except for the two home care provider types which use the same contact 

guide. 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN

Form name Number of 

respondents 

Total 

burden hours 

Average 

hourly wage 

rate 

Total 

cost burden 

MEPS–HC 

MEPS–HC Core Interview ............................................................................... 15,093 54,083 * $21.74 $1,175,764 

Adult SAQ ........................................................................................................ 28,254 3,296 21.74 71,655 

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Federal Register / Vol. 77, No. 183 / Thursday, September 20, 2012 / Notices 58389 

EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN—Continued 

Form name Number of 

respondents 

Total 

burden hours 

Average 

hourly wage 

rate 

Total 

cost burden 

Diabetes care SAQ .......................................................................................... 2,345 117 21.74 2,544 

Authorization forms for the MEPS–MPC Provider Survey .............................. 14,489 3,767 21.74 81,895 

Authorization form for the MEPS–MPC Pharmacy Survey ............................. 14,489 2,246 21.74 48,828 

MEPS–HC Validation Interview ....................................................................... 4,781 398 21.74 8,653 

Subtotal for the MEPS–HC ....................................................................... 79,451 63,907 na 1,389,339 

MEPS–MPC 

MPC Contact Guide/Screening Call ................................................................ 34,000 1,700 ** 15.59 26,503 

Home care for health care providers questionnaire ........................................ 465 252 15.59 3,929 

Home care for non-health care providers questionnaire ................................. 35 19 15.59 296 

Office-based providers questionnaire .............................................................. 10,800 5,220 15.59 81,380 

Separately billing doctors questionnaire .......................................................... 10,800 1,080 15.59 16,837 

Hospitals questionnaire ................................................................................... 5,000 2,708 15.59 42,218 

Institutions (non-hospital) questionnaire .......................................................... 100 13 15.59 203 

Pharmacies questionnaire ............................................................................... 6,800 7,922 *** 14.43 114,314 

Subtotal for the MEPS–MPC .................................................................... 68,000 18,347 na 285,680 

Grand Total ....................................................................................... 147,451 82,254 na 1,675,019 

* 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 2011 National Occupational Employment and Wage Estimates United States, U.S. Department of 

Labor, Bureau of Labor Statistics. http://www.bls.gov/oes/current/oes_nat.htm#b29-0000. 

Estimated Annual Costs to the Federal 

Government 

Exhibit 3 shows the total and 

annualized cost of this information 

collection. The cost associated with the 

design and data collection of the MEPS– 

HC and MEPS–MPC is estimated to be 

$51,401,596 in each of the three years 

covered by this information collection 

request. 

EXHIBIT 3—ESTIMATED TOTAL AND ANNUALIZED COST

Cost component Total cost Annualized 

cost 

Sampling Activities ................................................................................................................................................... $3,002,731 $1,000,910 

Interviewer Recruitment and Training ..................................................................................................................... 9,190,168 3,063,389 

Data Collection Activities ......................................................................................................................................... 93,611,428 31,203,809 

Data Processing ...................................................................................................................................................... 23,087,605 7,695,868 

Production of Public Use Data Files ....................................................................................................................... 21,079,118 7,026,373 

Project Management ................................................................................................................................................ 4,233,739 1,411,246 

Total .................................................................................................................................................................. 154,204,789 51,401,596 

Request for Comments 

In accordance with the Paperwork 

Reduction Act, comments on AHRQ’s 

information collection are requested 

with regard to any of the following: (a) 

Whether the proposed collection of 

information is necessary for the proper 

performance of AHRQ healthcare 

research and healthcare 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: September 6, 2012. 

Carolyn M. Clancy, 

Director. 

[FR Doc. 2012–23163 Filed 9–19–12; 8:45 am] 

BILLING CODE 4160–90–M 

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. 

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 

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