TRICARE: Standard Survey of Civilian Providers

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DIAL.SCREEN

DS. INTERVIEWER: YOU MAY DO THE INTERVIEW WITH THE NAMED RESPONDENT OR

OFFICE MANAGER.

(IWER: PROXY INTERVIEWS ARE ALLOWED, INCLUDING IF R DOES NOT SPEAK

ENGLISH.)

Hello, my name is ____ and I'm calling on behalf of the Department of

Defense TRICARE health benefits Program.

Portions of this call may be monitored and recorded for quality control.

May I speak with the office manager for [[FIRST NAME] [LAST NAME]/DR.

([FIRST NAME]) [LAST NAME]]?

(IWER IF NEEDED: "We have a few questions regarding how your office

works with the TRICARE program.")

(IWER IF NEEDED: "I'm calling from DataStat, a healthcare survey firm

and would like to speak with the office manager for [[FIRST NAME] [LAST

NAME]/DR. ([FIRST NAME]) [LAST NAME]]?)"

01. CONTINUE

02. NEW PHONE NUMBER

03. RING NO ANSWER (LET PHONE RING 6 TIMES - RC 41)

04. VOICE MAIL / ANSWERING MACHINE (RC 43)

30. CONTACT - APPTS / CODE OUTS / REFUSALS

40. NO CONTACT - NON WORKING NUMBER / RING STOP / CALL BLOCKING

60. LANGUAGE REQUEST / PROBLEM

70. CONTINUE WITH OFFICE MANAGER/PROXY

80. RETURN TO CS

90. RC ASSIST SYSTEM

95. R DOES NOT WANT TO BE RECORDED (VOLUNTEERED)

IF DIAL.SCREEN = 01, GO TO LANGVAR

IF DIAL.SCREEN = 02, ENTER NEW NUMBER ON COVERSHEET AND RE-DIAL

IF DIAL.SCREEN = 70 AND ADULT PROXIES ARE ALLOWED THEN GO TO PROX.INTRO

RETURN TO COVERSHEET

MAIL.SCREEN

MS.

Thank you for completing the survey

Do you know if the survey for [[FIRST NAME] [LAST NAME]/DR. ([FIRST

NAME]) [LAST NAME]] was completed and returned by fax, mail, or through

the web?

1. FAXED

2. MAIL

3. WEBSITE

9. NOT SURE

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GO TO ALL.DONE

RETURN TO COVERSHEET

PROX.INTRO

PROX.INTRO. (INTERVIEWER: READ PARENS TEXT IF R ISN'T PERSON WHO ANSWERED

PHONE OR HAS NOT HEARD IT YET.)

(Hello, we were told that you might be able to answer some survey

questions for [[FIRST NAME] [LAST NAME]/DR. ([FIRST NAME]) [LAST

NAME]].)

We have a few questions regarding how your office works with the TRICARE

program.

(Portions of this call may be monitored and recorded for quality control.)

(My name is ____ and I'm calling on behalf of the Department of Defense

TRICARE health benefits Program. I'm calling from DataStat, a healthcare

survey firm and would like to speak with the office manager for [[FIRST

NAME] [LAST NAME]/DR. ([FIRST NAME]) [LAST NAME]]?)

("DK" NOT ALLOWED)

01. CONTINUE

02. NEW PHONE NUMBER

03. GENERAL CALLBACK (RC 16)

04. REQUESTS SPECIFIC APPOINTMENT (RC 12)

05. REFUSAL (RC 30)

60. LANGUAGE REQUEST/PROBLEM

80. RETURN TO CS

95. PROXY - DOES NOT WANT TO BE RECORDED (VOLUNTEERED)

IF PROX.INTRO = 1, GO TO PROX.INFO

RETURN TO COVERSHEET

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REFUSAL.REASON

(IWER DO NOT READ.)

(PLEASE SELECT TO THE BEST OF YOUR ABILITY WHY THEY

COULDN'T COMPLETE THE SURVEY)

001. Initial refusal

002. No private practice

003. No office practice

004. Veterans medical system employee

005. State hospital employee

006. University/student physician

007. Military - only sees Tricare

008. Medical school

009. Hospital accreditation surveyor

010. Out of business

011. No longer employed

012. Deceased

013. Left practice

014. Retired

015. Not practicing

016. Moved practice

017. Not at this address

018. Out of area address change

019. No billing accepts walk-ins

020. Billing contact unavailable permanently

021. No such person

022. Only received messages

023. Out source billing

024. PUHU-Pick up Hang up

DK

RETURN TO COVERSHEET

PROX.INFO

PROX.INFO

Thank you for helping [TFNAME$] [TLNAME$] complete this survey. May I

have your first and last name please?

PX.FNAME

INTERVIEWER: ENTER PROXY FIRST NAME

___________________

PX.LNAME

INTERVIEWER: ENTER PROXY LAST NAME

___________________

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LANG.VAR

(IWER: ENTER LANGUAGE TO BE USED DURING INTERVIEW)

("DK" NOT ALLOWED)

01. ENGLISH

02. SPANISH

03. Arabic

04. Cantonese

05. Farsi

06. Ilocano

07. Korean

08. Mandarin

09. Portuguese

10. Russian

11. Vietnamese

QB1

Congress has directed the TRICARE program to survey civilian providers

across the U.S. to determine the adequacy of private health care

access for its military beneficiaries. The Department of Defense has

contracted DataStat to conduct this very short survey.

([[FIRST NAME] [LAST NAME]/DR. ([FIRST NAME]) [LAST NAME]] was

randomly selected to participate in this very important survey.)

(PRESS SPACE TO CONTINUTE)

QB3.

[Thanks for helping [[FIRST NAME] [LAST NAME]/DR. ([FIRST NAME]) [LAST NAME]] complete this survey. Your/Your] participation will help the Department of Defense gain valuable aggregated input to help improve the Military Health System.

(IWER NOTE, READ IF NEEDED: DataStat has been contracted to conduct a

short survey about the level of participation by civilian practitioners

in the TRICARE Program. Section 712 of the National Defense

Authorization Act for Fiscal Year 2015 is the statute governing this

survey. Your participation is voluntary and your answers will be kept

private and your name and the provider's kept confidential. Let me

assure you that I am not trying to sell anything. Do you have a few

minutes to answer some questions regarding how your office works with

the TRICARE program?)

(PRESS SPACE TO CONTINUE)

IF RESPONDENT IS PART OF THE PHYSICIAN SAMPLE THEN GO TO PYQ1

*************************************************************

************** BEHAVIORAL HEALTH SURVEY *********************

*************************************************************

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BHQ1

Q1. / BHQ1

On average, [does [TFNAME$] [TLNAME$]/do you] provide treatment to

patients at least 20 hours per week?

1. YES

2. NO (DOES NOT PROVIDE TREATMENT, HAS RETIRED, --> ALL.DONE

PROVIDES TREATMENT LESS THAN 20 HOURS PER WEEK)

3. DON'T KNOW (NO LONGER HERE) -------------------> ALL.DONE

BHQ2

Q2. / BHQ2

Which of the following best describes [[FIRST NAME] [LAST

NAME]'s/your] principal employer?

(READ LIST)

(PLEASE SELECT ONE)

01. GOVERNMENT SPONSORED FACILITY OR GOVERNMENT RUN PROGRAM

02. MILITARY OR VETERAN TREATMENT FACILITY,

03. SCHOOL, UNIVERSITY, OR OTHER ACADEMIC INSTITUTION,

04. CONTRACTOR PROVIDING SERVICES FOR EMPLOYMENT, INSURANCE, OR LEGAL

PROCEEDINGS,

05. CLOSED PANEL HMO,

06. OPEN PANEL HMO,

07. PRISON OR JAIL, OR

08. SOME OTHER TYPE OF EMPLOYER? ________ (SPECIFY)

DK

BHQ3

Q3. / BHQ3

[Is [TFNAME$] [TLNAME$]/Are you] a case manager or a medical student?

(MARK ALL THAT APPLY)

1. CASE MANAGER -----> ALL.DONE

2. MEDICAL STUDENT --> ALL.DONE

3. NEITHER (NO)

DK

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BHQ4

Q4. / BHQ4

Are you aware of TRICARE Select?

(IWER IF NEEDED: FORMERLY KNOWN AS TRICARE STANDARD OR EXTRA)

1. YES

2. NO

DK

BHQ5

Q5. / BHQ5

As of today, [does [TFNAME$] [TLNAME$]/do you] accept any of the

following forms of health insurance?

(READ LIST)

(MARK ALL THAT APPLY)

1. MEDICARE,

2. MEDICAID,

3. TRICARE SELECT,

4. PRIVATE INSURANCE,

5. SOME OTHER INSURANCE, ________ (SPECIFY)

6. [DOES/DO] NOT ACCEPT ANY INSURANCE, OR

7. [PROVIDES/YOU PROVIDE] TREATMENT FREE OF CHARGE? --> ALL.DONE

DK (DO NOT READ)

BHQ6

Q6. / BHQ6

As of today, [does [TFNAME$] [TLNAME$]/do you] accept TRICARE Select as

payment in full?

1. YES

2. NO ----------> BHQ8

3. DON'T KNOW

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BHQ7

Q7. / BHQ7

As of today, [is [TFNAME$] [TLNAME$]/are you] a TRICARE Select network

member?

1. YES

2. NO

3. DON'T KNOW

BHQ8

Q8. / BHQ8

As of today, [is [TFNAME$] [TLNAME$]/are you] accepting new TRICARE

Select patients?

1. YES ---------> BHQ10

2. NO

3. DON'T KNOW --> BHQ10

BHQ9

Q9. / BHQ9

Why [is [TFNAME$] [TLNAME$]/are you] NOT ACCEPTING new TRICARE Select

patients?

(MARK ALL THAT APPLY)

01. REIMBURSEMENT TOO LOW

02. CUSTOMER SERVICE/PAPERWORK PROBLEMS

03. PROBLEMS WITH TRICARE IN THE PAST

04. NOT AWARE OF TRICARE SELECT

05. INCONVENIENCE

06. SPECIALTY OR CREDENTIAL NOT COVERED

07. PREFERS TRICARE PRIME OR TRICARE PLUS

08. TOO BUSY

09. ONLY TAKES PRIVATE INSURANCE

10. PROBLEMS GETTING INTO PROGRAM/APPLICATION IN PROGRESS

11. NOT ACCEPTING NEW PATIENTS

12. OTHER ________ (SPECIFY)

DK

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BHQ10

Q10. / BHQ10

As of today, [is [TFNAME$] [TLNAME$]/are you] accepting new Medicare

patients?

1. YES ---------> ALL.DONE

2. NO

3. DON'T KNOW --> BHQ12

BHQ11

Q11. / BHQ11

Why [is [TFNAME$] [TLNAME$]/are you] NOT ACCEPTING new Medicare

patients?

(MARK ALL THAT APPLY)

01. REIMBURSEMENT TOO LOW

02. CUSTOMER SERVICE/PAPERWORK PROBLEMS

03. PROBLEMS WITH MEDICARE IN THE PAST

04. INCONVENIENCE

05. SPECIALTY OR CREDENTIAL NOT COVERED

06. TOO BUSY

07. ONLY TAKES PRIVATE INSURANCE

08. PROBLEMS GETTING INTO PROGRAM/APPLICATION IN PROGRESS

09. NOT ACCEPTING NEW PATIENTS

10. OTHER ________ (SPECIFY)

DK

BHQ12

Q12. / BHQ12

As of today, [is [TFNAME$] [TLNAME$]/are you] accepting new patients?

1. YES

2. NO

3. DON'T KNOW

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IF RESPONDENT IS PART OF THE BEHAVIORAL/MENTAL HEALTH SAMPLE THEN GO TO ALL.DONE

*************************************************************

****************** PRIMARY CARE SURVEY **********************

*************************************************************

PYQ1

Q1. / PYQ1

On average, [does Dr. ([TFNAME$]) [TLNAME$]/do you] provide

Treatment to patients at least 20 hours per week?

1. YES

2. NO (DOES NOT PROVIDE TREATMENT, HAS RETIRED, --> ALL.DONE

PROVIDES TREATMENT LESS THAN 20 HOURS PER WEEK)

3. DON'T KNOW (NO LONGER HERE) -------------------> ALL.DONE

PYQ2

Q2. / PYQ2

Which of the following best describes [Dr. ([FIRST NAME]) [LAST

NAME]'s/your] principal employer?

(READ LIST)

(PLEASE SELECT ONE)

01. GOVERNMENT SPONSORED FACILITY OR GOVERNMENT RUN PROGRAM

02. MILITARY OR VETERAN TREATMENT FACILITY,

03. SCHOOL, UNIVERSITY, OR OTHER ACADEMIC INSTITUTION,

04. CONTRACTOR PROVIDING SERVICES FOR EMPLOYMENT, INSURANCE, OR LEGAL

PROCEEDINGS,

05. CLOSED PANEL HMO,

06. OPEN PANEL HMO,

07. PRISON OR JAIL, OR

08. SOME OTHER TYPE OF EMPLOYER? ________ (SPECIFY)

DK

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PYQ3

Q3. / PYQ3

[Is Dr. ([TFNAME$]) [TLNAME$]/Are you] a case manager or a medical

student?

(MARK ALL THAT APPLY)

1. CASE MANAGER -----> ALL.DONE

2. MEDICAL STUDENT --> ALL.DONE

3. NEITHER (NO)

DK

PYQ4

Q4. / PYQ4

Are you aware of TRICARE Select?

(IWER IF NEEDED: FORMERLY KNOWN AS TRICARE STANDARD OR EXTRA)

1. YES

2. NO

DK

PYQ5

Q5. / PYQ5

As of today, [does Dr. ([TFNAME$]) [TLNAME$]/do you] accept any of the

following forms of health insurance?

(READ LIST)

(MARK ALL THAT APPLY)

1. MEDICARE,

2. MEDICAID,

3. TRICARE SELECT,

4. PRIVATE INSURANCE,

5. SOME OTHER INSURANCE, ________ (SPECIFY)

6. [DOES/DO] NOT ACCEPT ANY INSURANCE, OR

7. [PROVIDES/YOU PROVIDE] TREATMENT FREE OF CHARGE? --> ALL.DONE

DK (DO NOT READ)

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PYQ6

Q6. / PYQ6

As of today, [does Dr. ([TFNAME$]) [TLNAME$]/do you] accept TRICARE

Select as payment in full?

1. YES

2. NO ----------> PYQ8

3. DON'T KNOW

PYQ7

Q7. / PYQ7

As of today, [is Dr. ([TFNAME$]) [TLNAME$]/are you] a TRICARE Select

network member?

1. YES

2. NO

3. DON'T KNOW

PYQ8

Q8. / PYQ8

As of today, [is Dr. ([TFNAME$]) [TLNAME$]/are you] accepting new

TRICARE Select patients?

1. YES ---------> PYQ10

2. NO

3. DON'T KNOW --> PYQ10

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PYQ9

Q9. / PYQ9

Why [is Dr. ([TFNAME$]) [TLNAME$]/are you] NOT ACCEPTING new TRICARE

Select patients?

(MARK ALL THAT APPLY)

01. REIMBURSEMENT TOO LOW

02. CUSTOMER SERVICE/PAPERWORK PROBLEMS

03. PROBLEMS WITH TRICARE IN THE PAST

04. NOT AWARE OF TRICARE SELECT

05. INCONVENIENCE

06. SPECIALTY OR CREDENTIAL NOT COVERED

07. PREFERS TRICARE PRIME OR TRICARE PLUS

08. TOO BUSY

09. ONLY TAKES PRIVATE INSURANCE

10. PROBLEMS GETTING INTO PROGRAM/APPLICATION IN PROGRESS

11. NOT ACCEPTING NEW PATIENTS

12. OTHER ________ (SPECIFY)

DK

PYQ10

Q10. / PYQ10

As of today, [is Dr. ([TFNAME$]) [TLNAME$]/are you] accepting new

Medicare patients?

1. YES ---------> ALL.DONE

2. NO

3. DON'T KNOW --> PYQ12

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PYQ11

Q11. / PYQ11

Why [is Dr. ([TFNAME$]) [TLNAME$]/are you] NOT ACCEPTING new Medicare

patients?

(MARK ALL THAT APPLY)

01. REIMBURSEMENT TOO LOW

02. CUSTOMER SERVICE/PAPERWORK PROBLEMS

03. PROBLEMS WITH MEDICARE IN THE PAST

04. INCONVENIENCE

05. SPECIALTY OR CREDENTIAL NOT COVERED

06. TOO BUSY

07. ONLY TAKES PRIVATE INSURANCE

08. PROBLEMS GETTING INTO PROGRAM/APPLICATION IN PROGRESS

09. NOT ACCEPTING NEW PATIENTS

10. OTHER ________ (SPECIFY)

DK

PYQ12

Q12. / PYQ12

As of today, [is Dr. ([TFNAME$]) [TLNAME$]/are you] accepting new

patients?

1. YES

2. NO

3. DON'T KNOW

ALL.DONE

THANKS.SCREEN.

Those are all the questions I have.

Thank you for taking part in this important interview.

Have a nice (day/evening). Good bye.

RETURN TO COVERSHEET

EDIT.FLG

(IWER: DO YOU NEED TO TYPE AN EDIT?)

5. YES

7. NO

ALTPRO 2025 Page 14

IF EDIT.FLG = 7 THEN GO TO CK.END.EDIT

EDIT.OTH

EDIT.OTH. (IWER: PLEASE TYPE YOUR EDIT-BE SPECIFIC-INCLUDE:

1) QUESTION NUMBER(S)

2) WHAT WAS ENTERED

3) WHAT NEEDS TO BE CHANGED

___________________

CK.END.EDIT

LANG.DID

LANG.DID. IWER: DID YOU DO THIS INTERVIEW IN...

("DK" NOT ALLOWED)

01. ENGLISH

02. SPANISH

03. Arabic

04. Cantonese

05. Farsi

06. Ilocano

07. Korean

08. Mandarin

09. Portuguese

10. Russian

11. Vietnamese

END.SCREEN

COVERSHEET NOT NEEDED

I may need to contact you again later, but today we are only interviewing

patients of the Department of Defense TRICARE health benefits program, so

those are all the questions I have. Thank you very much for your help.

( RC = [RC%] )

RETURN TO COVERSHEET