(Physician) Survey of Access to Home Health Services for Medicare Beneficiaries

PROMPTING SCRIPT
Survey of Access to Home Health Services for Medicare Beneficiaries
A. Hello, my name is ____________ and I’m calling from a research organization called Social &
Scientific Systems. We’re conducting a study for the Centers for Medicare and Medicaid Services (CMS).
Is (NAME) available to come to the phone?

SPEAKING TO R .........................................

1

R NOT AVAILABLE .....................................

2

ASKS WHO IS CALLING ..............................

3 (GO TO H

(GO TO G

Go to Gatekeeper
Script

Talking to the RESPONDENT:
B. (IF R just came to phone: Hello, my name is ____________.) I’m calling from a research organization
called Social & Scientific Systems. We’re conducting a study for the Centers for Medicare and Medicaid
Services (CMS). We recently sent you a questionnaire for the Survey of Access to Home Health Services
for Medicare Beneficiaries.
C. Do you recall receiving it?
YES ......................................................1
NO ......................................................

2

D. Have you had the opportunity to review the information?
YES ......................................................1
NO ......................................................

2

(GO TO F)

E. By what date do you think you can complete the survey?
WILL SEND .............................................
ALREADY SENT .......................................

3 (Record date -Go to CLOSING1)
4 (Record date -Go to CLOSING3)

F. As the information states, we are conducting a survey to learn about access issues vulnerable
beneficiaries may face in home health care. CMS has contracted with L&M Policy Research, and their
partner, Social & Scientific Systems, to gather this information to be used to inform CMS, Congress, and
other policymakers as they consider changes to payments for home health services. The results will
help CMS, Congress, and other policymakers to better understand the access problems that may exist,

especially for beneficiaries with low income or high severity levels of illness and those who live in
medically underserved areas.
(FOR PHYSICIAN) Your participation is very important in representing physicians who refer some of the
most vulnerable Medicare beneficiaries for home health services.
(FOR HHA) Your participation is very important in representing the full range of home health agencies.
I’d like to complete the questionnaire with you over the phone now or we can make an appointment for
another time. It should take only about 15 minutes.
IF NO:
I would like to re-send you the questionnaire
RE-SEND QUESTIONNAIRE .................................1

CONFIRM ADDRESS, EXPECTED
COMPLETION DATE, END CALL

CLOSING1: Thank you for your help. We will re-mail the survey questionnaire in the next
couple of days. [END CALL]
IF NO, I CAN’T DO IT:
Is there someone one else I can contact within your office to help me?
NO, I CAN’T DO IT ...............................................2

ASK IF SOMEONE ELSE COULD HELP
AND GET CONTACT INFORMATION.
CLOSING2: Thank you for taking the time to answer my questions. We appreciate your help.
[END CALL]
IF YES:
DO INTERVIEW NOW ..........................................2

SWITCH TO HARD-COPY OF THE
QUESTIONNAIRE

NO, NOT NOW ....................................................3

SET CB OR APPT TIME, END CALL

CLOSING2: Thank you for taking the time to answer my questions. We appreciate your help.
[END CALL]

IF ALREADY SENT:
CLOSING3: Thank you for sending the information. If we haven’t received the completed

form in the next couple of weeks we’ll give you a call back. [END CALL]

GATEKEEPER Script:
G. When would be a good time to reach (RESPONDENT)?

[RECORD CALLBACK TIME OR MAKE APPOINTMENT] [END CALL]

Hi, I’m calling from a research organization called Social & Scientific Systems. We’re conducting a study
for the Centers for Medicare and Medicaid Services (CMS). Some materials about the study were
recently sent to (RESPONDENT). I am calling to follow up. Is this the correct number to reach
(RESPONDENT)?

IF YES:
Is (RESPONDENT) available now?
IF YES: [WITH RESPONDENT ON THE PHONE, GO TO Respondent script- B]
IF NO: When would be a good time to reach (RESPONDENT)?
[RECORD CALLBACK TIME OR MAKE APPOINTMENT] [END CALL]

IF NO:
Do you know this person?
IF YES: Could you give me a number where I can reach (RESPONDENT)?
IF YES: [RECORD NEW NUMBER – THANK INFORMANT] [END CALL]
If the contact refuses to give a number, ask them to have the
respondent call (TOLL-FREE LINE XXX-XXX-XXX) so that we may discuss
this study. When [RESPONDENT] calls, please ask them to refer to study
number [ID #]
[THANK INFORMANT] [END CALL]
IF NO: Thank you for your time. [END CALL]