Supporting Statement - Part B rev 121608

Supporting Statement – Part B

Collections of Information Employing Statistical Methods

1. Describe (including a numerical estimate) the potential respondent universe and any sam­pling or other respondent selection method to be used. Data on the number of entities (e.g., establishments, State and local government units, households, or persons) in the universe covered by the collection and in the corre­sponding sample are to be provided in tabular form for the universe as a whole and for each of the strata in the proposed sample. Indicate expected response rates for the collection as a whole. If the collection had been conducted previously, include the actual response rate achieved during the last collection.

RESPSONSE: Under the demonstrations, Medicare fee-for-service patients are assigned to a physician practice if the practice provides the plurality of outpatient evaluation & management services to the patient during the performance year. (In the Medicare Care Management Performance and Electronic Health Records demonstrations, the assignment is further limited to consideration of primary care services only.) The assigned patient population is the foundation from which to measure quality performance. Diagnostic data from all claims for each assigned beneficiary are used to determine whether that beneficiary has a particular condition such as diabetes, congestive heart failure, coronary artery disease, or a range of other chronic conditions. A beneficiary may be counted in one or more of each of those categories based on the number of conditions s/he has. The clinical measure denominator criteria, such as age, gender, hospitalization, etc. are further applied to each diagnostic sub-group of beneficiaries to determine which patients are eligible for reporting on the measure. Claims based measures are derived from the full subpopulation of assigned beneficiaries who meet the clinical criteria for the measure. For the Physician Group Practice Demonstration, a sample of 411 Medicare patients is pulled from this subpopulation and input into the Performance Assessment Tool in rank order for practices to complete reporting on.. For the Medicare Care Management Performance Demonstration, which involves smaller practices serving smaller populations of patients, the sample size is 218 patients. Practices in both demonstrations must complete the tool in rank order and may only exclude patients if they cannot confirm the diagnosis or if they meet one of the exclusion criteria for the measure.

2. Describe the procedures for the collection of information including:

- Statistical methodology for stratification and sample selection,

- Estimation procedure,

- Degree of accuracy needed for the pur­pose described in the justification,

- Unusual problems requiring specialized sampling procedures, and

- Any use of periodic (less frequent than annual) data collection cycles to reduce burden.

RESPONSE: The demonstrations use the National Committee for Quality Assurance’s hybrid methodology for capturing and reporting data. This method requires the practice to identify the numerator of a measure through either administrative or medical record data. The denominator consists of either the total population of Medicare beneficiaries assigned to the practice who are eligible for the measure (see above) or a systematic sample of Medicare beneficiaries drawn from the measure’s eligible population as defined above using Medicare claims data. For the Physician Group Practice Demonstration, a sample of 411 Medicare patients per measure module is pulled, rank ordered and loaded into the Performance Assessment Tool. For the Medicare Care Management Performance Demonstration the sample size is 218. The target sample size is designed to produce 95% confidence intervals of +/- 5% or less for a quality indicator rate. Because the annual populations in many sites are not much larger than the target, the sampling methodology is adjusted downward to account for the smaller populations in the MCMP and EHR Demonstrations while still maintaining sampling precision.

3. Describe methods to maximize response rates and to deal with issues of non-response. The accuracy and reliability of information collected must be shown to be adequate for intended uses. For collections based on sam­pling, a special justification must be provid­ed for any collection that will not yield 'reliable' data that can be generalized to the uni­verse studied.

RESPONSE: Since the practices participating in the demonstration are eligible for performance payments for meeting/exceeding performance benchmarks, voluntarily agreed to participate in the demonstration, and are interested in receiving feedback on their care processes, non-response has not been an issue under the demonstrations.

4. Describe any tests of procedures or methods to be undertaken. Testing is encouraged as an effective means of refining collections of information to minimize burden and improve utility. Tests must be approved if they call for answers to identical questions from 10 or more respondents. A proposed test or set of tests may be submitted for approval separate­ly or in combination with the main collection of information.

RESPONSE: The methodology was derived from commercially available methods used to compute quality measures in the commercial and Medicare managed care environment. In addition, the data collection process includes a randomized audit of submissions.

5. Provide the name and telephone number of individuals consulted on statistical aspects of the

design and the name of the agency unit, contractor(s), grantee(s), or other person(s) who will actually collect and/or analyze the information for the agency.

RESPONSE: The National Committee for Quality Assurance and RTI International were consulted on the development of the sampling methodology. RTI International administers the quality reporting methodology under the demonstrations.

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