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[Federal Register Volume 77, Number 183 (Thursday, September 20, 2012)]
[Notices]
[Pages 58386-58389]
From the Federal Register Online via the Government Printing Office [www.gpo.gov]
[FR Doc No: 2012-23163]

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DEPARTMENT OF HEALTH AND HUMAN SERVICES

Agency for Healthcare Research and Quality

Agency Information Collection Activities: Proposed Collection; 
Comment Request

AGENCY: Agency for Healthcare Research and Quality, HHS.

ACTION: Notice.

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SUMMARY: This notice announces the intention of the Agency for 
Healthcare Research and Quality (AHRQ) to request that the Office of 
Management and Budget (OMB) approve the proposed information collection 
project: ``Medical Expenditure Panel Survey (MEPS) Household Component 
and the MEPS Medical Provider Component.'' 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

[[Page 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[supreg]). 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 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 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

[[Page 58388]]

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
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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...........................         *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               14,489            5.2            3/60           3,767
 Survey..........................................
Authorization form for the MEPS-MPC Pharmacy               14,489            3.1            3/60           2,246
 Survey..........................................
MEPS-HC Validation Interview.....................           4,781            1              5/60             398
                                                  --------------------------------------------------------------
    Subtotal for the MEPS-HC.....................          79,451           na                na          63,907
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                                                    MEPS-MPC
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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                        35            6.6            5/60              19
 questionnaire...................................
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
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* 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
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                                                     Number of     Total burden   Average hourly    Total cost
                    Form name                       respondents        hours         wage rate        burden
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                                                     MEPS-HC
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MEPS-HC Core Interview..........................          15,093          54,083        * $21.74      $1,175,764
Adult SAQ.......................................          28,254           3,296           21.74          71,655

[[Page 58389]]

 
Diabetes care SAQ...............................           2,345             117           21.74           2,544
Authorization forms for the MEPS-MPC Provider             14,489           3,767           21.74          81,895
 Survey.........................................
Authorization form for the MEPS-MPC Pharmacy              14,489           2,246           21.74          48,828
 Survey.........................................
MEPS-HC Validation Interview....................           4,781             398           21.74           8,653
                                                 ---------------------------------------------------------------
    Subtotal for the MEPS-HC....................          79,451          63,907              na       1,389,339
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                                                    MEPS-MPC
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MPC Contact Guide/Screening Call................          34,000           1,700        ** 15.59          26,503
Home care for health care providers                          465             252           15.59           3,929
 questionnaire..................................
Home care for non-health care providers                       35              19           15.59             296
 questionnaire..................................
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
------------------------------------------------------------------------
                                                            Annualized
             Cost component                 Total cost         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
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