Supporting Statement B

Supporting Statement B.docx

Data Collection for the Nursing Home Value-Based Purchasing (NHVBP) Demonstration

OMB: 0938-1039

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STATISTICAL METHODS


Burden Survey


Subsequent to the first quarterly staffing data submission, CMS emailed the nursing homes participating in the demonstration regarding their burden to submit the data. Specifically, we requested each facility to provide its best estimate of the time needed to complete each section of the data request.  In addition, we informed them that we were considering adding a field called “date of termination” to the data collection tool in the future.  We requested their best estimate as to the additional amount of time they would need if we added this field.


We received responses from 69 of the 178 participants. In some cases, nursing homes reported only the total burden (not broken out by section). Also, some nursing homes responded to the question regarding the additional field, and some did not. A detailed list of the responses to the survey is attached.


Universe of Respondents


There are currently 178 nursing homes participating in the NHVBP demonstration. We expect that all participants will submit the requested staffing data on a quarterly basis. Nursing homes that fail to comply will not be eligible for an incentive payment, and may be terminated from the demonstration due to failure to comply with the terms and conditions.

Burden Survey: Responses


Response time in hours

Facility Name

ST.

Section

Section

Section

Section

Total


Added

Startup


A

B

C

D

only


field

time











A Holly Paterson

NY


1

4

2



2

Brightonian *

NY

0.1

0.75

1

0



0.5


Broadlawn

NY





20




Burch Hill care center

WI

0.25

0.25

2.5

0.25



0.25


Chandler

AZ







0.5


Chilton *

WI

0.25

0.25

2.5

0.25



0.25


Chula Vista Care

AZ





10.5


0.5


Columbia Health Care

WI





23.75


1

Elderwood at Lakewood

NY



1




0.25


Elderwood at Wedgewood

NY



1




0.25


Elizabeth Church

NY





2.5


0.5


Ellsworth *

WI

0.25

0.25

2.5

0.25



0.25


Episcopal Church Home

NY

0.1

2

4.5

1




2

Evergreen *

WI

0.25

0.25

2.5

0.25



0.25


Fairview

NY

0.1

0.3

0.25

1



1


Fort Tryon

NY





4




Franciscan Villa

WI





20




Garden Gate

NY





2




Glencroft

AZ



6




2

2

Golden Living Continental

WI





3.5




Golden Living Village Gardens

WI





3.5




Good Samaritan Fenimore *

WI







1


Good Samaritan Lodi

WI







1


Good Samaritan Scandia *

Wi







1


Good Samaritan St. Croix

WI







1


Hamilton

WI

0.25

0.25

2.5

0.25



0.25


Harris Hill

NY





2




Heritage Park

NY

0.1

0.1

2

0.1





Highlands at Brighton

NY

0.1

0.2

1.5

0.5



0.5

0.5

Homestead

WI

0.25

0.25

2.5

0.25



0.25


Hornell Gardens

NY

0.1

0.75

1

0



0.5


Infinia at Douglas *

AZ

0.1

0.25

12

0.1





James A Eddy

NY

0.1

0.5

20

0.5





Jewish Home and Care

WI

0.1

0.5

4

0



0.5


Kewaunee *

WI

0.25

0.25

2.5

0.25



0.25


Kingsbrook

NY

0.1

2

4

2



0.1


Lancaster

WI

0.25

0.25

2.5

0.25



0.25


Lutheran Homes

WI

0.1

0.3

20

0.3



5

Marquardt

WI

0.1

0.25

2.75

0.1





Marshfield

WI

0.25

0.25

2.5

0.25



0.25


Maryhill Manor

WI

0.1

0.2

3.5

0.1



0.25


Mineral Point *

WI

0.25

0.25

2.5

0.25



0.25


Mountain View

AZ

0

0.25

8.5




0.5


Nesconset

NY





0.6



0.75

North gate

NY





2




NYS Vets at Oxford

NY





6


0.1


Odd Fellow

WI

0

0.2

7

0



0.1


Our Lady of Mercy

NY







0


Parkside

WI

0.25

0.25

2.5

0.25



0.25


Penfield Place *

NY

0.1

0.75

1



0.5


Pine Haven Christian *

WI




10.5


0.5


Pioneer *

WI





6


1

Plymouth *

WI

0.25

0.25

2.5

0.25



0.25


Providence Rest

NY

0

0.5

4

0



0


Ridgewood

WI





2.5


0.5


Rock haven

WI

0

0.5

7.5

0



0.5


Rocky Knoll

WI

0.1

0.5

7

0




Sea View

NY





42


8

Seneca

NY





2



Spooner

WI





30


1

St Claire Meadows

WI





4


0.25


St Clare Meadows Care

WI





4.5




St dominic *

WI

0.25

0.25

2.5

0.25



0.25


Stevens Point

WI

0.25

0.25

2.5

0.25



0.25


The shore winds

NY

0.1

0.75

1



0.5


Wedgewood

NY

0.1

0.75

1



0.5


Williams Bay

WI

0.25

0.25

2.5

0.25



0.25


Wisconsin Rapids

WI

0.25

0.25

2.5

0.25



0.25


Woodside manor *

NY

0.1

0.75

1

0



0.5












Total hours


5.8

17.3

165.5

11.7

201.85


19.3

23.25

number of responses


39

39

42

39

21


46

10

mean


0.15

0.44

3.94

0.30

9.61


0.42

2.33











* denotes small business










small business: total hours


2.15

4.25

32.50

1.85

16.50


5.75

1.00

small business: number of responses

12

12

12

12

2


12

1

small business: mean


0.18

0.35

2.71

0.15

8.25


0.48


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