0539_Att D_Table of Changes in the Survey Instrument revised

Table of Proposed Changes to the SECAP II Survey Instruments (2010 submission)
	Questions to be dropped from the survey instrument previously approved for OMB 0920-0590 (based on initial approval of 0920-0539)	Questions to be added to the proposed SECAP II survey instrument (current reinstatement request for 0920-0539)
Capacity Questions (directly asking for numbers on current, past, potential volume or numbers used in calculating annual capacity)		Q2 – weeks/year site has normal operations Q7 – # procedures in 2009 Q49 – procedural volumes based on electronic medical records
Questions Related to Capacity (e.g., # procedure rooms, limiting factors, steps to increase capacity, waiting time)		Q4 - # procedure rooms available for lower endoscopies Q16 a-k – limiting factors, colonoscopies Q17 primary limiting factor, colonoscopies Q33 a-j – limiting factors, flexible sigmoidoscopies Q34 primary limiting factor, flexible sigmoidoscopies
Other Questions (i.e., descriptive information about providers, polyps, incompletes, type of facility, etc.)	Q2 – all endoscopy sites in hospital Q6 – medical specialty and # of physicians at site Q19 – biopsy during a flexible sigmoidoscopy? Q20 – action taken for polyps of various sizes during a flexible sigmoidoscopy Q36 – waiting time for a colonoscopy referral appointment at another clinic Q41 – to whom reimbursement sent when a non-physician endoscopist performs a flexible sigmoidoscopy or colonoscopy Q42 – Q45, Q47 patient characteristics Q49 – Q50 medical specialty/sub-specialty of physician respondent Q51 race/ethnicity of physicians	Q8 – type of sedation used for colonoscopy, flexible sigmoidoscopies Q9 – who typically monitors sedation Q13 - % of colonoscopies for surveillance & diagnostic Q22 – quality measures routinely monitored Q26 – number of colonoscopies that are follow-up to a CTC Q47 – professional services Medicare classification Q48 – facility Medicare classification Q53 – single/multi-specialty ASC? Q55 – hospital department/lab serve outpatients only? Q56 – hospital voluntary non-profit, government, or proprietary for profit facility?