SUPPORTING STATEMENT
Part A
Medical Expenditure Panel Survey (MEPS) Household Component and the
MEPS Medical Provider Component
Version: February 21, 2018
Revision of Previously Approved OMB #0935-0118
Agency of Healthcare Research and Quality (AHRQ)
Table of contents
A. Justification 3
1. Circumstances that make the collection of information necessary 3
2. Purpose and use of information 4
3. Use of Improved Information Technology 10
4. Efforts to Identify Duplication 11
5. Involvement of Small Entities 13
6. Consequences if Information Collected Less Frequently 13
7. Special Circumstances 13
8. Federal Register and Outside Consultations 13
9. Payments/Gifts to Respondents 14
10. Assurance of Confidentiality 15
11. Questions of a Sensitive Nature 15
12. Estimates of Annualized Burden Hours and Costs 15
13. Estimates of Annualized Respondent Capital and Maintenance Costs 18
14. Estimates of Annualized Cost to the Government 18
15. Changes in Hour Burden 19
16. Time Schedule, Publication and Analysis Plans 19
17. Exemption for Display of Expiration Date 20
List of Attachments 20
This request is for approval of substantive changes to the data collection of the Household Component of the Medical Expenditure Panel Survey (MEPS) Adult Self-Administered Questionnaire (SAQ). Specifically, that for rounds 2 and 4 of 2018 a male and female prevention SAQ be fielded and for rounds 2 and 4 of 2019 a CAHPS SAQ be fielded. The proposed SAQs would replace the current adult SAQ. The male and female prevention SAQ and CAHPS SAQ would alternate years going forward. There is a slight reduction in burden hours to the SAQ given the male prevention SAQ is shorter in length; there is a reduction of 226 (86,702 to 86,476) in total burden hours. There are currently no proposed changes to the Medical Provider Component. MEPS Household Component (MEPS-HC) and Medical Provider Component (MEPS-MPC) are two of three components of the MEPS.
Household Component (MEPS-HC): A sample of households participating in the National Health Interview Survey (NHIS) in the prior calendar year are interviewed 5 times over a 2 and one half (2.5) year period. These 5 interviews yield two years of information on use of and expenditures for health care, sources of payment for that health care, insurance status, employment, health status and health care quality.
Medical Provider Component (MEPS-MPC): The MEPS-MPC collects information from medical and financial records maintained by hospitals, physicians, pharmacies and home health agencies named as sources of care by household respondents.
Insurance Component (MEPS-IC): The MEPS-IC collects information on establishment characteristics, insurance offerings and premiums from employers. The MEPS-IC is conducted by the Census Bureau for AHRQ and is cleared separately.
This request is for the MEPS-HC and MEPS-MPC only. The OMB Control Number for the MEPS-HC and MPC is 0935-0118, which was last approved by OMB on December 15th, 2015, and will expire on December 31st, 2018.
The mission of the Agency for Healthcare Research and Quality (AHRQ) set out in its authorizing legislation, The Healthcare Research and Quality Act of 1999 (see http://www.ahrq.gov/hrqa99.pdf), is to improve the quality, safety, efficiency, and effectiveness of health care for all Americans, through the establishment of a broad base of scientific research and through the promotion of improvements in clinical and health systems practices, including the prevention of diseases and other health conditions. AHRQ shall promote health care quality improvement by:
1. collecting data on and producing measures of the quality, safety, effectiveness, and efficiency of American health care and health care systems; and
2. fostering the development of knowledge about improving health care, health care systems, and capacity; and
3. partnering with stakeholders to implement proven strategies for health care improvement.
Also, AHRQ shall conduct and support research and evaluations, and support demonstration projects, with respect to (A) the delivery of health care in inner-city areas, and in rural areas (including frontier areas); and (B) health care for priority populations, which shall include (1) low-income groups, (2) minority groups, (3) women, (4) children, (5) the elderly, and (6) individuals with special health care needs, including individuals with disabilities and individuals who need chronic care or end-of-life health care.
MEPS has been conducted annually since 1996. Its current clearance is OMB# 0935-0118 with an expiration date of 12/31/2018. All of the supporting documents for the MEP can be downloaded from https://www.reginfo.gov/public/do/PRAViewDocument?ref_nbr=201509-0935-001.
The MEPS is a multi-purpose survey. In addition to collecting data to yield annual estimates for a variety of measures related to health care use and expenditures, MEPS also provides estimates of measures related to health status, consumer assessment of health care, health insurance coverage, demographic characteristics, employment and access to health care indicators. Estimates can be provided for individuals, families and population subgroups of interest. Data obtained in this study are used to provide, among others, the following national estimates:
annual estimates of health care use and expenditures for persons and families
annual estimates of sources of payment for health care utilizations, including public programs such as Medicare and Medicaid, private insurance, and out of pocket payments
annual estimates of health care use, expenditures and sources of payment of persons and families by type of utilization including inpatient stay, ambulatory care, home health, dental care and prescribed medications
the number and characteristics of the population eligible for public programs including the use of services and expenditures of the population(s) eligible for benefits under Medicare and Medicaid
the number, characteristics, and use of services and expenditures of persons and families with various forms of insurance
annual estimates of consumer satisfaction with health care, and indicators of health care quality for key conditions
annual estimates to track disparities in health care use and access
In addition to national estimates, data collected in this ongoing longitudinal study are used to study the determinants of the use of services and expenditures, and changes in the access to and the provision of health care in relation to:
socio-economic and demographic factors such as employment or income
the health status and satisfaction with health care of individuals and families
the health needs and circumstances of specific subpopulation groups such as the elderly and children
To meet the need for national data on healthcare use, access, cost and quality, MEPS-HC collects information on:
access to care and barriers to receiving needed care
satisfaction with usual providers
health status and limitations in activities
medical conditions for which health care was used
use, expense and payment (as well as insurance status of person receiving care) for health services
Given the twin problems of nonresponse and response error of some household reported data, information is collected directly from medical providers in the MEPS-MPC to improve the accuracy of expenditure estimates derived from the MEPS-HC. Because of their greater level of precision and detail, we also use MEPS-MPC data as the main source of imputations of missing expenditure data. Thus, the MEPS-MPC is designed to satisfy the following analytical objectives:
Serve as source data for household reported events with missing expenditure information
Serve as an imputation source to reduce the level of bias in survey estimates of medical expenditures due to item nonresponse and less complete and less accurate household data
Serve as the primary data source for expenditure estimates of medical care provided by separately billing doctors in hospitals, emergency rooms, and outpatient departments, Medicaid recipients and expenditure estimates for pharmacies
Allow for an examination of the level of agreement in reported expenditures from household respondents and medical providers
Data from the MEPS, both the HC and MPC components, are intended for a number of annual reports required to be produced by AHRQ, including the National Health Care Quality Report and the National Health Care Disparities Report.
For over thirty years, results from the MEPS and its predecessor surveys (the 1977 National Medical Care Expenditure Survey, the 1980 National Medical Care Utilization and Expenditure Survey and the 1987 National Medical Expenditure Survey) have been used by OMB, DHHS, Congress and a wide number of health services researchers to analyze health care use, expenses and health policy.
Major changes continue to take place in the health care delivery system. The MEPS is needed to provide information about the current state of the health care system as well as to track changes over time. The MEPS permits annual estimates of use of health care and expenditures and sources of payment for that health care. It also permits tracking individual change in employment, income, health insurance and health status over two years. The use of the National Health Interview Survey (NHIS) as a sampling frame expands the MEPS analytic capacity by providing another data point for comparisons over time.
Households selected for participation in the MEPS-HC are interviewed five times in person. These rounds of interviewing are spaced about 5 months apart. The interview will take place with a family respondent who will report for him/herself and for other family members.
The purpose of this request is to update the existing Adult Self-Administered Questionnaire (SAQ) into the MEPS (see Attachments 1, 3 and 4).
The MEPS-HC has the following goal:
To provide nationally representative estimates for the U.S. civilian noninstitutionalized population for:
health care use, expenditures, sources of payment
health insurance coverage
To achieve the goals of the MEPS-HC the following data collections are implemented:
Household Component Core Instrument. There is no change to this instrument. The core instrument collects data about persons in sample households. Topical areas asked in each round of interviewing include condition enumeration, health status, health care utilization including prescribed medicines, expense and payment, employment, and health insurance. Other topical areas that are asked only once a year include access to care, income, assets, satisfaction with health plans and providers, children's health, and adult preventive care. While many of the questions are asked about the entire reporting unit (RU), which is typically a family, only one person normally provides this information. All sections of the current core instrument are available on the AHRQ website at http://meps.ahrq.gov/mepsweb/survey_comp/survey_questionnaires.jsp.
Adult Self-Administered Questionnaire. The proposed SAQs would replace the current adult SAQ (fielded annually since 2000). Beginning in 2018, we are proposing a new SAQ to collect self-reported information on health status, health opinions, satisfaction with health care, and prevention care services for adults 18 and older (male and female versions). As there is minimal variability in SAQ responses from year to year, we propose alternating SAQ content with the focus one year being preventive services and the alternate year being CAHPS questions. The impact on burden will be minimal as the length of the gender specific SAQs are essentially the same as compared to the current SAQ. However, the male prevention SAQ is slightly shorter (a reduction of 226 total burden hours is estimated).
We are proposing that for rounds 2 and 4 of 2018 the male and female prevention SAQs would be fielded, and for rounds 2 and 4 of 2019 a CAHPS SAQ would be fielded. The male and female prevention SAQs and CAHPS SAQ would then be fielded in alternate years going forward.
The proposed male and female prevention SAQs differ from the current SAQ as follows:
16 CAHPS items were removed
SF12 has been replaced by the VR12
Smoking detail has been added
Questions on the following have been added (dependent on gender)
blood pressure,
flu shot,
height and weight,
alcohol use,
pneumonia vaccine,
shingles vaccine,
aspirin use,
colon cancer screening
prostate cancer screening
cervical cancer screening
osteoporosis screening
breast cancer screening
The proposed CAHPS SAQ differs from the current SAQ as follows:
SF12 has been replaced by the VR12
Questions removed:
In the last 12 months, did you or doctor believe you needed any care, tests, or treatment?
In the last 12 months, how often was it easy to get the care, tests, or treatment you or a doctor believed necessary?
blood pressure
For the calendar year 2018 we are proposing changes for the following reasons:
Historically the data derived from the current SAQ shows little variation from year to year and thus argues for alternating content such that questions are only asked once per each two year panel.
Using an alternating design allows for additional content to be introduced, making for more efficient use of the SAQ both from the perspective of the respondent as well as analytically.
The SF12 has been replaced by the VR12 as the VR12 resides in the public domain and is available at no cost to AHRQ. The bridge for the VR-12 and the SF-12 version is straight forward and is publically available (personal communication, August 10, 2016, Lewis E. Kazis, Sc.D., Professor of Health Policy and Management, Boston University School of Public Health).
The prevention SAQs address adult preventive care services for both males and females and include questions about high-priority clinical preventive services that were identified by the National Steering Committee (NSC) based on the following criteria:
(1) being scientifically sound and
(2) clinically important.
Additional input was provided by the U.S. Preventive Services Task Force and the Advisory Committee on Immunization practices.
f) Preventive care services questions selected were deemed to be both relevant and actionable by the NSC and adopted by AHRQ. The NSC prioritized measures that address clinically preventable burden, and have the potential to contribute to the improvement of the quality of care and the promotion of health as is the mission of AHRQ.
See Attachment 1 for details pertaining to adult preventive care questions (Attachment 3 -- Female Adult – SAQ and Attachment 4 -- Male Adult – SAQ).
Diabetes Care SAQ. There is no change in this instrument: A brief self-administered paper-and-pencil questionnaire on the quality of diabetes care is administered once a year (during round 3 and 5) to persons identified as having diabetes. Included are questions about the number of times the respondent reported having a hemoglobin A1c blood test, whether the respondent reported having his or her feet checked for sores or irritations, whether the respondent reported having an eye exam in which the pupils were dilated, the last time the respondent had his or her blood cholesterol checked and whether the diabetes has caused kidney or eye problems. Respondents are also asked if their diabetes is being treated with diet, oral medications or insulin. This questionnaire is unchanged from the previous OMB clearance.
Authorization forms for the MEPS-MPC Provider and Pharmacy Survey. There is no change in this instrument. As in previous panels of the MEPS, we will ask respondents for authorization to obtain supplemental information from their medical providers (hospitals, physicians, home health agencies and institutions) and pharmacies.
MEPS Validation Interview. There is no change in this instrument. Each interviewer is required to have at least 15 percent of his/her caseload validated to insure that CAPI questionnaire content was asked appropriately and procedures followed, for example the use of show cards. Validation flags are set programmatically for cases pre-selected by data processing staff before each round of interviewing. Home office and field management may also request that other cases be validated throughout the field period. When an interviewer fails a validation all their work is subject to 100 percent validation. Additionally, any case completed in less than 30 minutes is validated. A validation abstract form containing selected data collected in the CAPI interview is generated and used by the validator to guide the validation interview.
The MEPS-MPC will contact medical providers (hospitals, physicians, home health agencies and institutions) identified by household respondents in the MEPS‑HC as sources of medical care for the time period covered by the interview, and all pharmacies providing prescription drugs to household members during the covered time period. The MEPS-MPC is not designed to yield national estimates as a stand-alone survey. The sample is designed to target the types of individuals and providers for whom household reported expenditure data was expected to be insufficient. For example, households with one or more Medicaid enrollees are targeted for inclusion in the MEPS-MPC because this group is expected to have limited information about payments for their medical care. No changes to the MEPS-MPC are being implemented at this time.
The MEPS-MPC will continue to collect event level data about medical care received by sampled persons during the relevant time period. The data collected from medical providers include:
Dates on which medical encounters during the reference period occurred
Data on the medical content of each encounter, including ICD‑9 and CPT‑4 codes
Data on the charges associated with each encounter, the sources paying for the medical care‑including the patient/family, public sources, and private insurance, and amounts paid by each source
Data collected from pharmacies include:
Date of prescription fill
National drug code (NDC) or Prescription name, strength and form
Quantity
Payments, by source
The MEPS-MPC has the following goal:
To serve as an imputation source for and to supplement/replace household reported expenditure and source of payment information. This data will supplement, replace and verify information provided by household respondents about the charges, payments, and sources of payment associated with specific health care encounters.
To achieve the goal of the MEPS-MPC the following data collections will continue to be implemented:
MPC Contact Guide/Screening Call. An initial screening call is placed to determine the type of facility, whether the practice or facility is in scope for the MEPS-MPC, the appropriate MEPS-MPC respondent and some details about the organization and availability of medical records and billing at the practice/facility. All hospitals, physician offices, home health agencies, institutions and pharmacies are screened by telephone. A unique screening instrument is used for each of the seven provider types in the MEPS-MPC, except for the two home care provider types which use the same screening form.
Home Care Provider Questionnaire for Health Care Providers. This questionnaire is used to collect data from home health care agencies which provide medical care services to household respondents. Information collected includes type of personnel providing care, hours or visits provided per month, and the charges and payments for services received.
Home Care Provider Questionnaire for Non‑Health Care Providers. This questionnaire is used to collect information about services provided in the home by non‑health care workers to household respondents because of a medical condition; for example, cleaning or yard work, transportation, shopping, or child care.
Medical Event Questionnaire for Office‑Based Providers. This questionnaire is for office‑based physicians, including doctors of medicine (MDs) and osteopathy (DOs), as well as providers practicing under the direction or supervision of an MD or DO (e.g., physician assistants and nurse practitioners working in clinics). Providers of care in private offices as well as staff model HMOs are included.
Medical Event Questionnaire for Separately Billing Doctors. This questionnaire collects information from physicians identified by hospitals (during the Hospital Event data collection) as providing care to sampled persons during the course of inpatient, outpatient department or emergency room care, but who bill separately from the hospital.
Hospital Event Questionnaire. This questionnaire is used to collect information about hospital events, including inpatient stays, outpatient department, and emergency room visits. Hospital data are collected not only from the billing department, but from medical records and administrative records departments as well. Medical records departments are contacted to determine the names of all the doctors who treated the patient during a stay or visit. In many cases, the hospital administrative office also has to be contacted to determine whether the doctors identified by medical records billed separately from the hospital itself; the doctors that do bill separately from the hospital will be contacted as part of the Medical Event Questionnaire for Separately Billing Doctors. HMOs are included in this provider type.
Institutions Event Questionnaire. This questionnaire is used to collect information about institution events, including nursing homes, rehabilitation facilities and skilled nursing facilities. Institution data are collected not only from the billing department, but from medical records and administrative records departments as well. Medical records departments are contacted to determine the names of all the doctors who treated the patient during a stay. In many cases, the institution administrative office also has to be contacted to determine whether the doctors identified by medical records billed separately from the institution itself.
Pharmacy Data Collection Questionnaire. This questionnaire requests the national drug code (NDC) and when that is not available the prescription name, date prescription was filled, payments by source, prescription strength and form (when the NDC is not available), quantity, and person for whom the prescription was filled. When the NDC is available, we do not ask for prescription name, strength or form because that information is embedded in the NDC; this reduces burden on the respondent. Most pharmacies have the requested information available in electronic format and respond by providing a computer generated printout of the patient’s prescription information. If the computerized form is unavailable, the pharmacy can report their data to a telephone interviewer. Pharmacies are also able to provide a CD-ROM with the requested information if that is preferred. HMOs are included in this provider type.
Medical Organizations Survey Questionnaire. This questionnaire will collect essential information on important features of the staffing, organization, policies, and financing for identified usual source of office based care providers. This additional data are linked to MEPS sample respondents to enable analyses at the person-level using characteristics of provider practices.
Dentists, optometrists, psychologists, podiatrists, chiropractors, and others not providing care under the supervision of a MD or DO are considered out of scope for the MEPS-MPC.
This study is being conducted by AHRQ through its contractors, Westat and RTI International, pursuant to AHRQ’s statutory authority to conduct and support research on healthcare and on systems for the delivery of such care, including activities with respect to the cost and use of health care services and with respect to health statistics and surveys. 42 U.S.C. 299a(a)(3) and (8); 42 U.S.C. 299b-2.
As in previous panels of the MEPS-HC, a CAPI instrument will be used (except the SAQs). The mode of administration for the MEPS-MPC (including the pharmacy component) varies based on the preferences of the provider and includes phone interviews, mail and electronic submission of information. Starting with the 2009 MEPS-MPC data collection, a computer-assisted system was developed for both interviewing and record abstraction. This Integrated Data Collection System (IDCS) supported the effort to recruit providers by telephone and to interview medical records and billing staffs of medical facilities. For providers that prefer to send hard copy records, the IDCS is used to abstract information from medical records and patient accounts. The IDCS consists of two main systems: 1) a Web component in ASP.Net in which the MEPS-MPC forms (Contact Guides and Event Forms) are programmed for either data entry either during telephone calls or record abstraction and 2) a Case Management System (CMS) that manages the medical providers and associated forms for call scheduling, contact information, appointment times, and event/status information.
There is no other survey that is now or has been recently conducted that will meet all of the objectives of the MEPS. Some federal surveys do collect health insurance information from households (SIPP, NHIS); however these surveys do not collect the depth of information on health care use and expenses available in the MEPS. Moreover, MEPS is the only survey which links information collected from households with information collected from medical providers to inform the estimation of expenditures.
The following table provides a summary of the overlap between the proposed prevention SAQs and the NHIS.
In summary:
Annually the NHIS adult survey instrument asks the respondent about smoking status, height and weight. These topics would also be asked annually in the MEPS-HC SAQ.
Questions pertaining to having a check-up, blood pressure taken, alcohol and aspirin use, and screening for colon, cervical, and breast cancer are asked once every two years in the NHIS adult survey instrument. This is also true for the prevention SAQ.
Questions about shingles vaccine and screening for prostate cancer are asked every five years in the NHIS adult survey instrument. These topics are asked about every two years in the prevention SAQ.
Question/Source |
In NHIS1 sample adult |
Current SAQ |
Year 1 Male Prevention |
Year 1 Female Prevention |
Year 2 CAHPS |
Demographics |
|
|
2 |
2 |
0 |
SF-12 |
|
12 |
|
|
|
VR-12 |
|
|
12 |
12 |
12 |
Kessler 6 |
|
6 |
6 |
6 |
6 |
PHQ |
|
2 |
2 |
2 |
2 |
CAHPS |
|
14 |
|
|
14 |
CAHPS specialist |
|
2 |
|
|
2 |
Smoking2 |
Annual Core |
2 |
5 |
5 |
2 |
Blood Pressure |
Rotating Core (2yrs) |
1 |
1 |
1 |
|
Had checkup |
Rotating Core (2yrs) |
In Core3 |
1 |
1 |
|
Flu shot |
Annual Core |
In Core |
1 |
1 |
|
Height and weight4 |
Annual Core |
In Core |
4 |
4 |
|
Alcohol use |
Rotating Core (2yrs) |
|
2 |
2 |
|
Pneumonia vaccine |
Annual Core |
|
1 |
1 |
|
Shingles vaccine |
Supplement (5yrs) |
|
1 |
1 |
|
Aspirin for prevention |
Rotating Core (2yrs) |
1 |
2 |
2 |
|
Colon cancer screening |
Rotating Core (2yrs) |
In Core |
4 |
4 |
|
Prostate cancer screening |
Supplement (5yrs) |
In Core |
2 |
|
|
Cervical cancer screening |
Rotating Core (2yrs) |
In Core |
|
3 |
|
Osteoporosis screening |
|
|
|
2 |
|
Breast cancer screening |
Rotating Core (2yrs) |
|
|
2 |
|
Attitudes towards insurance |
|
3 |
3 |
3 |
3 |
Total item count |
|
43 |
49 |
54 |
41 |
The MEPS-HC collects information only from households. The MEPS-MPC will survey medical facilities, physicians, and pharmacies. Some of the MPC respondents may be small businesses. The MEPS-MPC instrument and procedures used to collect data are designed to minimize the burden on all respondents.
The design of the MEPS-HC in which households are contacted 5 times over the course of 2 years enables the gathering of medical use data at the event level and permits the estimation of expenditures and payments for persons by event type. Reducing the number of rounds in which the data are collected would hamper the availability and quality of information due to long recall periods.
MEPS-MPC respondents are contacted at least once during the calendar year for the preceding data collection year. Sometimes a follow up contact is necessary to clarify ambiguous or collect missing information. Contacts on a less frequent basis than the envisioned timetable jeopardizes the access of the study to information from records that could otherwise be destroyed or archived.
Aside from offering compensation to respondents, the MEPS-HC and MPC will fully comply with 5 CFR 1320.6.
8.a. Federal Register Notice
As required by 5 CFR 1320.8(d), notices were published in the Federal Register on December 22nd, 2017, for 60 days on page 60741 (see Attachment 2 -- Federal Register Notice (02182018)) and again on February 26th, 2018 for 30 days on page 8270. No substantive comments were received.
Individuals or groups outside the Agency consulted about the MEPS project over the last several years are listed below:
Table 1. MEPS Consultants
Name |
Affiliation |
Jill Jacobsen Ashman, Ph.D. |
Centers for Disease Control and Prevention National Center for Health Statistics |
Brenda G. Cox, Ph.D |
Independent Consultant |
Judith H. Mopsik, M.H.S. |
Vice President for Business Development, Abt Associates Inc. |
Constance F. Citro, Ph.D.
|
Committee on National Statistics Division of Behavioral and Social Sciences and Education |
National Institute on Drug Abuse, National Institutes of Health |
|
Llewellyn Cornelius, Ph.D. |
University of Maryland |
Michael L. Cohen, Ph.D. |
Committee on National Statistics |
Joan S Cwi, Ph.D. |
Independent Consultant |
MEPS-HC respondents will be offered a monetary gift as a token of appreciation for their participation in the MEPS. A gift has been offered to respondents at the end of each round since the inception of MEPS in 1996; the current amount of $50 per round has been in place since 2011 (OMB approval obtained January 26, 2010 version 1). For household respondents, participation includes not only time being interviewed, but also keeping track of their medical events and expenditures between interviews. Household respondents will be informed of the gift at the first in-person contact and all eligible respondents will be given the same amount. Currently no gift is offered to respondents to the Adult SAQ, or Diabetes Care SAQ.
The $5 cash gift for the SAQ, which has been in place since the inception of the SAQ (2000), was removed in 2013 due to budget considerations. With the removal of the $5 gift there was an associated decline in response rates of approximately 5%. Response rates continued decline through 2015. In 2016 we established a formal telephone follow-up that has arrested the decline in response rates. We propose reinstituting the $5 gift in order to reestablish response rates to their historical norm.
Following are the SAQ response rates over the past five years:
Year |
Response Rate (%) |
|
2012 |
88.6 |
|
2013 |
82.1 |
Discontinued $5 gift |
2014 |
79.3 |
|
2015 |
77.3 |
|
2016 |
80.8 |
SAQ phone follow-up |
Confidentiality is protected by Sections 944(c) and 308(d) of the Public Health Service Act (42 U.S.C. 299c-3(c) and 42 U.S.C. 242m(d)). This research project will be carried out in compliance with these confidentiality statutes. Respondents will be told the purposes for which the information is being collected, that the confidentiality of their responses will be maintained, and that no information that could identify an individual or establishment will be disclosed unless that individual or establishment has consented to such disclosure.
The MEPS questionnaires for the Household Component include questions on income and medical conditions that some respondents may perceive as sensitive.
Exhibit 1 shows the estimated annualized burden hours for the respondents' time to participate in the MEPS-HC and the MEPS-MPC. The MEPS-HC Core Interview will be completed by 15,093* (see note below Exhibit 1) "family level" respondents, also referred to as RU respondents. Since the MEPS-HC consists of 5 rounds of interviewing covering a full two years of data, the annual average number of responses per respondent is 2.5 responses per year. The MEPS-HC core requires an average response time of 92 minutes to administer. The prevention SAQ will be completed once a year by each female (14,692) and male (13,562) person in the RU that is 18 years old and older, an estimated 28,254 persons. The prevention SAQ requires an average of 6 minutes to complete for the male version and 7 minutes to complete for the female version. The Diabetes care SAQ will be completed once a year by each person in the RU identified as having diabetes, an estimated 2,345 persons, and takes about 3 minutes to complete. The authorization form for the MEPS-MPC Provider Survey will be completed once for each medical provider seen by any RU member. The 14,489 RUs in the MEPS-HC will complete an average of 5.4 forms, which require about 3 minutes each to complete. The authorization form for the MEPS-MPC Pharmacy Survey will be completed once for each pharmacy for any RU member who has obtained a prescription medication. RUs will complete an average of 3.1 forms, which take about 3 minutes to complete. About one third of all interviewed RUs will complete a validation interview as part of the MEPS-HC quality control, which takes an average of 5 minutes to complete. The total annual burden hours for the MEPS-HC are estimated to be 67,600 hours.
All medical providers and pharmacies included in the MEPS-MPC will receive a screening call and the MEPS-MPC uses 7 different questionnaires; 6 for medical providers and 1 for pharmacies. Each questionnaire is relatively short and requires 2 to 15 minutes to complete. The total annual burden hours for the MEPS-MPC are estimated to be 18,876 hours. The total annual burden for the MEPS-HC and MPC is estimated to be 86,476 hours.
Exhibit 2 shows the estimated annual cost burden associated with the respondents' time to participate in this information collection. The annual cost burden for the MEPS-HC is estimated to be $1,612,935; the annual cost burden for the MEPS-MPC is estimated to be $316,532. The total annual cost burden for the MEPS-HC and MPC is estimated to be $1,929,467.
The MEPS-MPC interviewer will be authorized to offer remuneration to providers who present cost as a salient objection to responding or if a flat fee is applied to any request for medical or billing records. Based on the past cycle of data collection fewer than one third of providers will request remuneration. Exhibit 3 shows the total and average per record remuneration by provider type, based on the 2016 data collection, the most recent year for which data is available. For those providers that required remuneration the average payment per medical record was $37.80, this compares to $32.98 in 2010.
Exhibit 1. Estimated annualized burden hours
Form Name |
Number of Respondents |
Number of responses per respondent |
Hours per response |
Total Burden hours |
MEPS-HC |
||||
MEPS-HC Core Interview |
15,093* |
2.5 |
92/60 |
57,857 |
Adult Female SAQ |
14,692 |
1 |
7/60 |
1,714 |
Adult Male SAQ |
13,562 |
1 |
67/60 |
1,356 |
Diabetes care SAQ |
2,345 |
1 |
3/60 |
117 |
Authorization form for the MEPS-MPC Provider Survey |
14,489 |
5.4 |
3/60 |
3,912 |
Authorization form for the MEPS-MPC Pharmacy Survey |
14,489 |
3.1 |
3/60 |
2,246 |
MEPS-HC Validation Interview |
4,781 |
1 |
5/60 |
398 |
Subtotal for the MEPS-HC |
79,451 |
Na |
na |
67,600 |
MEPS-MPC/MOS |
||||
MPC Contact Guide/Screening Call** |
35,222 |
1 |
2/60 |
1,174 |
Home care for health care providers questionnaire |
532 |
1.49 |
9/60 |
119 |
Home care for non‑health care providers questionnaire |
25 |
1 |
11/60 |
5 |
Office‑based providers questionnaire |
11,785 |
1.44 |
10/60 |
2,828 |
Separately billing doctors questionnaire |
12,693 |
3.43 |
13/60 |
9,433 |
Hospitals questionnaire |
5,077 |
3.51 |
9/60 |
2,673 |
Institutions (non-hospital) questionnaire |
117 |
2.03 |
9/60 |
36 |
Pharmacies questionnaire |
4,993 |
4.44 |
3/60 |
1,108 |
Medical Organizations Survey questionnaire |
6,000 |
1 |
15/60 |
1,500 |
Subtotal for the MEPS-MPC |
76,444 |
na |
na |
18,876 |
Grand Total |
155,895 |
na |
na |
|
* While the expected number of responding units for the annual estimates is 14,489, it is necessary to adjust for survey attrition of initial respondents by a factor of 0.96 (15,093=14,489/0.96).
** There are 6 different contact guides; one for office based, separately billing doctor, hospital, institution, and pharmacy provider types, and the two home care provider types use the same contact guide.
Exhibit 2. Estimated annualized cost burden
Form Name |
Number of Respondents |
Total Burden hours |
Average Hourly Wage Rate |
Total Cost Burden |
MEPS-HC |
||||
MEPS-HC Core Interview |
15,093 |
57,857 |
$23.86* |
$1,380,468 |
Adult Female SAQ |
14,692 |
1,714 |
$23.86* |
$40,896
|
Adult Male SAQ |
13,562 |
1,356 |
$23.86* |
$32,354 |
Diabetes care SAQ |
2,345 |
117 |
$23.86* |
$2,792 |
Authorization forms for the MEPS-MPC Provider Survey |
14,489 |
3,912 |
$23.86* |
$93,340 |
Authorization form for the MEPS-MPC Pharmacy Survey |
14,489 |
2,246 |
$23.86* |
$53,590 |
MEPS-HC Validation Interview |
4,781 |
398 |
$23.86* |
$9,496 |
Subtotal for the MEPS-HC |
79,451 |
67,826 |
Na |
$1,612,935 |
MEPS-MPC/MOS |
||||
MPC Contact Guide/Screening Call |
35,222 |
1,174 |
$16.85** |
$19,782 |
Home care for health care providers questionnaire |
532 |
119 |
$16.85** |
$2,005 |
Home care for non‑health care providers questionnaire |
25 |
5 |
$16.85** |
$84 |
Office‑based providers questionnaire |
11,785 |
2,828 |
$16.85** |
$47,652 |
Separately billing doctors questionnaire |
12,693 |
9,433 |
$16.85** |
$158,946 |
Hospitals questionnaire |
5,077 |
2,673 |
$16.85** |
$45,040 |
Institutions (non-hospital) questionnaire |
117 |
36 |
$16.85** |
$607 |
Pharmacies questionnaire |
4,993 |
1,108 |
$15.47*** |
$17,141 |
Medical Organizations Survey questionnaire |
6,000 |
1,500 |
$16.85** |
$25,275 |
Subtotal for the MEPS-MPC |
76,444 |
18,876 |
na |
$316,532 |
Grand Total |
155,895 |
86,073 |
na |
$1,929,467 |
* Mean hourly wage for All Occupations (00-0000)
** Mean hourly wage for Medical Secretaries (43-6013)
*** Mean hourly wage for Pharmacy Technicians (29-2052)
Occupational Employment Statistics, May 2016 National Occupational Employment and Wage Estimates United States, U.S. Department of Labor, Bureau of Labor Statistics. http://www.bls.gov/oes/current/oes_nat.htm#b29-0000
Exhibit 3. Total and Average Remuneration by Provider Type for the MEPS-MPC
Provider Type |
Number of Records with Payment |
Average Payment |
Total Remuneration |
Hospital |
1,718 |
$ 43.99 |
$ 75,575 |
Office Based Providers |
678 |
$ 33.88 |
$ 22,971 |
Institutions |
1 |
$ 63.71 |
$ 64 |
Home Care Provider (Health Care Providers) |
4 |
$ 78.50 |
$ 314 |
Home Care Provider (Non-Health Care Providers) |
0 |
$0 |
$0 |
Pharmacy |
10,305 |
$ 35.69 |
$ 367,785 |
Separately Billing Doctors |
412 |
$ 70.60 |
$ 29,087 |
Total MPC |
13,118 |
|
$ 495,796 |
Capital and maintenance costs include the purchase of equipment, computers or computer software or services, or storage facilities for records, as a result of complying with this data collection. There are no direct costs to respondents other than their time to participate in the study.
Exhibit 3 shows the total and annualized cost of this information collection. The cost associated with the design and data collection of the MEPS-HC and MEPS-MPC is estimated to be $51,401,596 in each of the three years covered by this information collection request.
Exhibit 3. Estimated Total and Annualized Cost
Cost Component |
Total Cost |
Annualized Cost |
Sampling Activities |
$3,002,731 |
$1,000,910 |
Interviewer Recruitment and Training |
$9,190,168 |
$3,063,389 |
Data Collection Activities |
$93,611,428 |
$31,203,809 |
Data Processing |
$23,087,605 |
$7,695,868 |
Production of Public Use Data Files |
$21,079,118 |
$7,026,373 |
Project Management |
$4,233,739 |
$1,411,246 |
Total |
$154,204,789 |
$51,401,596 |
Exhibit 4: Annual Cost to AHRQ for MEPS-HC Oversight
Tasks/Personnel |
Staff Count |
|
Annual Salary |
% of Time |
Cost |
Management Support: GS-15, Step 5 average |
2 |
|
$149,337 |
50.0% |
$149,337 |
Survey/Statistical Support: GS-14, Step 5 average |
3 |
|
$126,958 |
33.3% |
$126,958 |
Research Support: GS-13, Step 5 average |
4 |
|
$107,435 |
50.0% |
$214,870 |
Research Support: GS-12, Step 5 average |
2 |
|
$90,350 |
75.0% |
$135,5253 |
Total |
|
|
|
|
$626,690 |
Annual salaries based on 2017 OPM Pay Schedule for Washington/DC area: https://www.opm.gov/policy-data-oversight/pay-leave/salaries-wages/salary-tables/pdf/2017/DCB.pdf
Note that these oversight costs are included in “Overhead” in Exhibit 3.
There is a slight reduction in burden hours for the prevention SAQ given the male SAQ is shorter in length (the female SAQ is essentially the same length as the current SAQ, thus no change in burden hours); there is a reduction of 226 (86,702 to 86,476) in total burden hours. During CAHPS SAQ years there would be no change in burden as compared to the current SAQ; the CAHPS SAQ will be administered to both males and females.
Data collected from the MEPS will be used in a variety of descriptive analysis. Our website www.meps.ahrq.gov contains examples of publications. Those publications include statistical briefs, research findings, chartbooks, and journal articles. In addition, tabular data is presented on the website as static tables, as interactive tables, and through an interactive tool – MEPSnet. Special analytic reports will be issued on an ad-hoc basis, and other analyses will be presented at annual meetings of professional associations and in professional journals.
To the extent possible, given our commitment to respondent confidentiality, we have endeavored to release public use files from this project as soon as possible.
16b. Schedule for Data Collection
Data collection for the MEPS under this request begins in late January 2013. Rounds 1, 3, and 5 of the MEPS-HC start in January and continue through mid-July. Rounds 2 and 4 begin in July of each year and continue through early December. The dates for each round of data collection are included in the response rate tables in The Supporting Statement Part B. Data collection for the MEPS-MPC will begin in February 2013.
AHRQ does not seek this exemption.
List of Attachments:
Attachment 1 -- MEPS-HC SAQ Summary and Changes (022018)
Attachment 2 -- Federal Register Notice (02182018)
Attachment 3 -- Female Adult - SAQ
Attachment 4 -- Male Adult - SAQ
1 Similar content – questions are not necessarily identical nor do they cover the same reference period
2 New version includes questions on receipt of advice on smoking and medical assistance with quitting in the year of the prevention emphasis
3 In core means in the Prevention care supplement administered annually through the MEPS household respondent
4 New version includes receipt of advice from a health professional on weight management
| File Type | application/vnd.openxmlformats-officedocument.wordprocessingml.document |
| File Title | OMB Clearance Application |
| Author | hamlin-ben |
| File Modified | 0000-00-00 |
| File Created | 2021-01-21 |