Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool ("PAT")

Forms and Documents

Document Name	Status
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration Form and Instruction	Modified
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) -EHR Demonstration Form and Instruction	Modified
Form CMS-10136 Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - PGP Demonstration Form and Instruction	Modified
Supporting_Statement_-_Part_B_EHRDS PAT 03022011.doc Supporting Statement B	2011-06-14
PRA Screens for EHRDS - PAT- 02252011.docx Supplementary Document	2011-06-14
PRA_for web enabled EHR application Sup Statement Part A -EHRDS PAT 03022011.doc Supporting Statement A	2011-06-14

IC Document Collections

IC ID	Document Title	Status
8793	Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration Form and Instruction	Modified
186735	Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) -EHR Demonstration Form and Instruction	Modified
186734	Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - PGP Demonstration Form and Instruction	Modified

ICR Details

OMB Control No: 0938-0941	ICR Reference No: 201106-0938-013
Status: Historical Inactive	Previous ICR Reference No: 200809-0938-015
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool ("PAT")
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Withdrawn and continue	Conclusion Date: 08/09/2011
	Date Received in OIRA: 06/15/2011
Terms of Clearance: Withdrawn at agency's request

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	01/31/2012	36 Months From Approved	08/31/2011
Responses	1,060	0	1,060
Time Burden (Hours)	25,990	0	25,990
Cost Burden (Dollars)	0	0	0

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Abstract: The goal of the EHR demonstration is to foster the implementation and adoption of EHRs and health information technology (HIT) more broadly as effective vehicles to improve the quality of care provided and transform the way medicine is practiced and delivered. As part of the implementation of this demonstration, several key functions were automated. A new electronic EHR demonstration "Practice Application and Profile" system (EHRDS) was developed to help manage practice and provider data for this system. OMB approval for this system was covered under OMB Control Number 0938-0965 granted October 18, 2010. The second module of EHRDS to be developed is for the collection of ambulatory clinical quality measures. Starting in the fall of 2011, the 400 treatment group practices will be required to report 26 clinical quality measures on an annual basis for years two through five of the demonstration. The original method for collecting quality measure data in the Physician Group Practice (PGP), Medicare Care Management Performance (MCMP) and Electronic Health Records (EHR) Demonstrations was approved under OMB Control Number 0938-0941(expiration date: January 31, 2012). This is the "Performance Assessment Tool" (PAT). The second EHRDs module was developed to replace the original PAT with a web enabled, secure (3-zone architecture) methodology for collecting the same exact data. This current request for approval under the Paperwork Reduction Act is for this web-enabled version of PAT and extension of the expiration date to cover the next three years of data collection under the EHR Demonstration. The EHR Demonstration system (EHRDS) PAT module does not reflect a request for new or additional data beyond what has been previously approved. There should be no increase in burden for respondents. In fact, because all of the practices participating in the EHR Demonstration and submitting data will have EHRs, it is likely that the originally estimated burden will decrease.

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Authorizing Statute(s): PL: Pub.L. 108 - 173 649 Name of Law: MCMP Demonstration - Medicare Prescription Drug Improvement and Modernization Act of 2003
   US Code: 42 USC 1395b-1 Name of Law: EHR Demonstration
  

Citations for New Statutory Requirements: None

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Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

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Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 13415	03/11/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 31339	05/31/2011
Did the Agency receive public comments on this ICR? No

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Number of Information Collection (IC) in this ICR: 3

IC Title	Form No.	Form Name
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) -EHR Demonstration	CMS-10136	MCMP PAT
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - MCMP Demonstration	CMS-10136	MCMP PAT
Medicare Demonstration Ambulatory Care Quality Measure Performance Assessment Tool (PAT) - PGP Demonstration	CMS-10136	MCMP PAT

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Burden increases because of Program Change due to Agency Discretion: No

Burden Increase Due to:

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement:

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Annual Cost to Federal Government: $400,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

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Common Form ICR:  No

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On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 06/15/2011

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