Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Mode Experiment (CMS-10542)

Forms and Documents

Forms and supporting documents for this ICR

Document	Type	Status	Availability
Form CMS-10542 Phone Script	Form	New	Repair queued
Form CMS-10542 HCAHPS Survey+44 Supplemental Items	Form	New	Available
Form CMS-10542 Phone Script	Form	New	Available
Form CMS-10542 HCAHPS Survey+27 Supplemental Items	Form	New	Available
Form CMS-10542 Phone Script	Form	New	Available
Form CMS-10542 HCAHPS Survey+16 Supplemental Items	Form	New	Available
Form CMS-10542 Phone Script	Form	New	Available
Form CMS-10542 HCAHPS Survey+9 Supplemental Items	Form	New	Available
Form CMS-10542 Phone Script	Form	New	Available
Form CMS-10102 HCAHPS Only ARM, Mode Experiment	Form	New	Available
Response to Public Comments for HCAHPS.docx	Supplementary Document	Uploaded 2015-02-27	Available
201502-0938-011_CMS-10542 - HCAHPS OMB Supporting Statement B 20150224_C 20150420 (2).doc	Supporting Statement B	Uploaded 2015-04-21	Available
201502-0938-011_CMS-10542 - Supporting Statement A rev 02-27-2015 by OS -- CLEAN.doc	Supporting Statement A	Uploaded 2015-04-21	Available

IC Document Collections

Information collection document groups

IC ID	Collection	Type	Status	Form
216208	HCAHPS+44 Survey	Other-Cover Letter	New
216208	HCAHPS+44 Survey	Form	New	Phone Script
216208	HCAHPS+44 Survey	Form	New	HCAHPS Survey+44 Supplemental Items
216207	HCAHPS+27 Survey	Other-Cover Letter	New
216207	HCAHPS+27 Survey	Form	New	Phone Script
216207	HCAHPS+27 Survey	Form	New	HCAHPS Survey+27 Supplemental Items
216206	HCAHPS+16 Survey	Other-Cover Letter	New
216206	HCAHPS+16 Survey	Form	New	Phone Script
216206	HCAHPS+16 Survey	Form	New	HCAHPS Survey+16 Supplemental Items
216205	HCAHPS+9 Survey	Other-Cover Letter	New
216205	HCAHPS+9 Survey	Form	New	Phone Script
216205	HCAHPS+9 Survey	Form	New	HCAHPS Survey+9 Supplemental Items
215448	HCAHPS Survey	Form	New	Phone Script
215448	HCAHPS Survey	Other-Cover Letter	New
215448	HCAHPS Survey	Form	New	HCAHPS Only ARM, Mode Experiment

ICR Details

OMB Control No: 0938-1272	ICR Reference No: 201502-0938-011
Status: Historical Active	Previous ICR Reference No:
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) Mode Experiment (CMS-10542)
Type of Information Collection: New collection (Request for a new OMB Control Number)	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved without change	Conclusion Date: 05/08/2015
Retrieve Notice of Action (NOA)	Date Received in OIRA: 03/03/2015
Terms of Clearance:

table that charts list comparision

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	05/31/2018	36 Months From Approved
Responses	8,160	0	0
Time Burden (Hours)	1,474	0	0
Cost Burden (Dollars)	0	0	0

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Abstract: The HCAHPS Survey is a standardized survey instrument and data collection methodology that has been in use since 2006 to measure patients' perspectives of hospital care. While many hospitals collect information on patient satisfaction, HCAHPS created a national standard for collecting and public reporting information that enables valid comparisons to be made across all hospitals to support consumer choice. Hospital-level scores derived from national implementation of HCAHPS are publicly reported quality data on CMS' Hospital Compare website. CMS' HCAHPS initiative allows vendors to select one mode of survey administration from four approved administration protocols (mail only, telephone only, mail-telephone mixed mode, and touch-tone IVR only). Before public reporting, HCAHPS scores are adjusted for the selected mode of administration, using mail administration as the comparison mode, to correct for any inflation or deflation of scores that are a result of mode. The current mode adjustments employed for HCAHPS are the product of two separate mode experiments conducted using different versions of the survey and different sample. The purpose of the planned HCAHPS mode experiment is to conduct a mode experiment of sufficient sample and scale to determine if the mode adjustments currently employed for the 32-item HCAHPS core survey need revision. An additional goal is to collect empirical evidence on the effect of the number of additional supplemental items on survey response rate and patterns of response to the HCAHPS core demographic items (known as "About You" items).

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Authorizing Statute(s): US Code: 18 USC 1886(b)(3)(B)(viii)(IV) Name of Law: Deficit Reduction Act of 2005
   US Code: 18 USC 1886(b)(3)(B)(viii)(VII) Name of Law: Deficit Reduction Act of 2005
  

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:
	79 FR 70870	11/28/2014
30-day Notice:	Federal Register Citation:	Citation Date:
	80 FR 8085	02/13/2015
Did the Agency receive public comments on this ICR? Yes

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Number of Information Collection (IC) in this ICR: 5

table that charts list of burden

IC Title	Form No.	Form Name
HCAHPS Survey	CMS-10102, CMS-10542	HCAHPS Only ARM, Mode Experiment ,   Phone Script
HCAHPS+16 Survey	CMS-10542, CMS-10542	HCAHPS Survey+16 Supplemental Items ,   Phone Script
HCAHPS+27 Survey	CMS-10542, CMS-10542	HCAHPS Survey+27 Supplemental Items ,   Phone Script
HCAHPS+44 Survey	CMS-10542, CMS-10542	HCAHPS Survey+44 Supplemental Items ,   Phone Script
HCAHPS+9 Survey	CMS-10542, CMS-10542	HCAHPS Survey+9 Supplemental Items ,   Phone Script

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ICR Summary of Burden

table that charts list of burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	8,160	0	0	8,160	0	0
Annual Time Burden (Hours)	1,474	0	0	1,474	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

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

Burden Reduction Due to:

Short Statement: Not applicable, this is a new package.

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Annual Cost to Federal Government: $1,067,461

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: 03/03/2015

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