Federal Register: May 6, 2009 (Volume 74, Number 86)

DOCID: fr06my09-68 FR Doc E9-10406


Agency for Healthcare Research and Quality


DOCID: fr06my09-68



Agency Information Collection Activities: Proposed Collection; Comment Request

DATES: Comments on this notice must be received by July 6, 2009.


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
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Expenditure Panel Survey (MEPS) Household Component and the MEPS Medical Provider Component Through 2012.'' In accordance with the Paperwork Reduction Act of 1995, Public Law 10413 (44 U.S.C. 3506(c)(2)(A)), AHRQ invites the public to comment on this proposed information collection.


Agency Information Collection Activities; Proposals, Submissions, and Approvals


Proposed Project
''Medical Expenditure Panel Survey (MEPS) Household Component and the MEPS Medical Provider Component Through 2012''

AHRQ seeks to renew the Medical Expenditure Panel Survey Household Component (MEPSHC) and the MEPS Medical Provider Component (MEPSMPC) through the year 2012. For over thirty years, the results of 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. AHRQ is authorized to conduct the MEPS pursuant to 42 U.S.C. 299b2.

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 current MEPS design, unlike the previous periodic surveys, 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 surveys' analytic capacity by providing another data point for comparisons over time.

The MEPSHC and MEPSMPC are two of three components of the MEPS:

MEPSHC is a sample of households participating in the National Health Interview Survey (NHIS) in the prior calendar year that are interviewed 5 times over a 2\1/2\ year period. These 5 interviews yield two years of information on use of and expenditures for health care, sources of payment for that health care, insurance status, employment, health status and health care quality.

MEPSMPC collects information from medical and financial records maintained by hospitals, physicians, pharmacies, health care institutions, and home health agencies named as sources of care by household respondents.

Insurance Component (MEPSIC): The MEPSIC collects information on establishment characteristics, insurance offerings and premiums from employers. The MEPSIC is conducted by the Census Bureau for AHRQ and is cleared separately.

This request is for the MEPSHC and MEPSMPC only. Method of Collection

The MEPS is designed to meet the need for information to estimate health expenses, insurance coverage, access, use and quality. Households selected for participation in the MEPS 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.

After a preliminary mail contact containing an advance letter, households will be mailed MEPS record keeping materials (a calendar) and a DVD and brochure. After the advance contact, households will be contacted for the first of five inperson interviews. The interviews are conducted as a computer assisted personal interview (CAPI). The CAPI instrument is organized as a core instrument that will repeat unchanged in each of the rounds. Additional sections are asked only once a year and provide greater depth. Dependent interviewing methods in which respondents are asked to confirm or revise data provided in earlier interviews will be used to update information such as employment and health insurance data after the round in which such data are usually collected. The main data collection modules for the MEPSHC are as follows:

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, priority conditions, income, assets, satisfaction with health plans and providers, childrens health, adult preventive care. While many of the questions are asked about the entire reporting unit (RU), which is typically a family, only one person normally provides this information.

Adult Self Administered Questionnaire. A brief selfadministered questionnaire (SAQ), administered once a year in rounds 2 and 4, will be used to collect selfreported (rather than through household proxy) information on health status, health opinions and satisfaction with health care for adults 18 and older.

Diabetes Care SAQ. A brief self administered questionnaire on the quality of diabetes care is administered once a year in rounds 3 and 5 to persons identified as having diabetes.

Permission forms for the MEPSMPC. As in previous panels of the MEPS, we will ask respondents for permission to obtain supplemental information from their medical providers (hospitals, physicians, health care institutions, home health agencies and pharmacies).

MEPSMPC Instruments

The main objective of the MEPSMPC is a collection of data from medical providers that will serve as an imputation source of medical expenditure and source of payment data reported by household respondents. 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. The questionnaires used in the MEPSMPC vary according to type of provider. The data collection instruments are as follows:

Home Care for Health Care Providers Questionnaire. 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.

Home Care Provider Questionnaire for NonHealth Care Providers. This is used to collect information about services provided in the home by nonhealth care workers to household respondents because of a medical condition; for example, cleaning or yard work, transportation, shopping, or child care.

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Officebased Providers Questionnaire. This questionnaire is for the officebased physician sample, including doctors of medicine (MD5) and osteopathy (DOs), as well as providers practicing under the direction or supervision of an MO 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.

Separately Billing Doctors Questionnaire. Information from physicians identified by hospitals as providing care to sampled persons during the course of inpatient stays, outpatient department or emergency room care, but who bill separately from the hospital, is collected in this questionnaire.

Hospitals 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.

Institutions Questionnaire. This questionnaire is used to collect data from health care institutions providing care to sampled persons and includes nursing homes, assisted living facilities, rehabilitation facilities, as well as any other health care facilities providing health care to a sampled person.

Pharmacies Questionnaire. This questionnaire requests the prescription name, NDC code, date prescription was filled, payments by source, prescription strength, form and quantity, and person for whom the prescription was filled. 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.

Estimated Annual Respondent Burden

Exhibit 1 shows the estimated annualized burden hours for the respondents' time to participate in the MEPSHC and MEPSMPC. The MEPS HC Core Interview will be completed by 15,000 ``family level'' respondents, also referred to as RU respondents. Since the MEPSHC 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 MEPSHC core requires an average response time of 1 and Y2 hours 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 21,000 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 1,800 persons and takes about 3 minutes to complete. Permission forms for the MEPSMPC will be completed once for each medical provider seen by any RU member. Each of the 15,000 RUs in the MEPSHC will complete an average of 5.2 forms, which require about 3 minutes each to complete. The total annual burden hours for the MEPSHC is estimated to be 62,690 hours.

The MEPSMPC 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 MEPSHC and MPC is estimated to be 82,767 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 MEPSHC is estimated to be $1,226,216; the annual cost burden for the MEPSMPC is estimated to be $285,965. Exhibit 1Estimated Annualized Burden Hours Number of Form name Number of responses per Hours per Total burden respondents respondent response hours


Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 4271477, or by email at