1 using medicare files as sampling frames for a survey of physicians vasudha narayanan presented at...
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Using Medicare Files as Sampling Using Medicare Files as Sampling framesframes
for a Survey of Physiciansfor a Survey of Physicians
Using Medicare Files as Sampling Using Medicare Files as Sampling framesframes
for a Survey of Physiciansfor a Survey of Physicians
Vasudha NarayananPresented at
Third International Conference on Establishment SurveysJune 20, 2007
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AcknowledgementsAcknowledgementsAcknowledgementsAcknowledgements
Co-Authors
Pamela Giambo & Sherm Edwards from Westat
Project Officers
Gladys Valentin & David Clark from Centers for Medicare & Medicaid ServicesThis material was prepared by Westat Inc., under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy.
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Issues with Establishment Survey Issues with Establishment Survey Sampling FramesSampling Frames
Issues with Establishment Survey Issues with Establishment Survey Sampling FramesSampling Frames
• Cox (1997); Konschnik (1988)
• Complex ownership and management structures
• Frames clogged with inactive and duplicate records
• Coverage error
• Unreliable contact information
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About MCPSSAbout MCPSSAbout MCPSSAbout MCPSS
• Measures satisfaction of physicians and other medical providers with the services offered by Medicare Contractors
• Purpose of MCPSS
• Satisfy Medicare Modernization Act (2003) requirements
• Establish a uniform measure of provider satisfaction with Contractors
• Provide feedback to Contractors for QI
• Annual Survey
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About MCPSSAbout MCPSSAbout MCPSSAbout MCPSS
• Samples customers of 51 Medicare Contractors
• 19 “carriers” handle most physician claims
• Within Contractor, sample stratified by provider type and state
• Screening for a “knowledgeable” respondent
• Survey can be completed over the web, telephone or paper
• Response rate: 65%
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Who is the Customer/Analysis UnitWho is the Customer/Analysis UnitWho is the Customer/Analysis UnitWho is the Customer/Analysis Unit
• Individual(s) who interact with Contractor
• Typically not the physician
• Could have multiple customers within a practice
• Could represent a single physician, a practice, multiple solo practices, or multiple groups
• Customer may interact with more than one contractor
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Sample Design UtopiaSample Design UtopiaSample Design UtopiaSample Design Utopia
Analysis UnitAnalysis UnitAnalysis UnitAnalysis Unit
Responding UnitResponding UnitResponding UnitResponding Unit
Sampling UnitSampling UnitSampling UnitSampling Unit
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Variables Required for MCPSS Variables Required for MCPSS SamplingSampling
Variables Required for MCPSS Variables Required for MCPSS SamplingSampling
• Contractor ID
• Tax ID
• Number of claims in reference year
• Provider type
• State
• Contact information
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Files Available for MCPSS Files Available for MCPSS Physician FramePhysician Frame
Files Available for MCPSS Files Available for MCPSS Physician FramePhysician Frame
• CMS files• Claims History
• Unique Physician Identification Number (UPIN)
• Provider Enrollment, Chain, and Ownership System (PECOS)
• Non-CMS frames• AMA
• Commercial Vendors
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Sources of Contact InformationSources of Contact InformationSources of Contact InformationSources of Contact Information
• 2006 sample [2%]
• PECOS [41%]• [Did not use UPIN]
• Commercial vendor [39%]
• Contractors [as a source of last resort] [16%]
• Other files [1%][Information missing for 1% of the sample]
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Paradise LostParadise LostParadise LostParadise Lost• A disconnect between the sampling unit and
responding unit
• Sampling unit: a Tax ID with at least one claim in the last 12 months
• Responding Unit (s): a physician representative who has experience with a Medicare Contractor
• As mentioned earlier• One respondent for multiple sampled units• Multiple respondents in one sampled unit
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Screening Sampled ProvidersScreening Sampled ProvidersScreening Sampled ProvidersScreening Sampled Providers
• To locate the most knowledgeable respondent(s)• Hence determine mapping between sampled
unit and responding unit(s)
• To determine if the responding unit is a third-party billing service
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2007 Sample Performance2007 Sample Performance2007 Sample Performance2007 Sample PerformancePhysician Sample Rest of Sample
Sample Size 7,895 28,464
1. Completes 51.7% 48.0%
2. Partial completes 2.6% 2.1%
3. Ineligible 6.1% 3.5%
4. Ineligible-Chains 1.4% 23.3%
5. Unknown Eligibility 12.8% 6.6%
6. Refusals 4.4% 2.1%
7. Other Non-response 21.1% 2.1%
RR 56.5% 67.3%
Eligibility rate 91.4% 71.3%
Response rate Calculation (AAPOR-RR3)
1 / ( (1 + 2 + 6 + 7) + (5*e) )
Where e = (1 + 2 + 6 + 7) / (1 + 2 + 6 + 7 +3 + 4
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Paradise Regained?Paradise Regained?Paradise Regained?Paradise Regained?
• Utopia is inherently unrealistic
• The frame allows for a pretty good mapping of sampling and analysis units
• Nothing can be done about the ineligibles
• Problem of unknown eligibility• Poor contact information
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Contacting the AuthorsContacting the AuthorsContacting the AuthorsContacting the Authors
Vasudha Narayanan ([email protected])
Pamela Giambo ([email protected])
Sherm Edwards ([email protected])
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Thank youThank youThank youThank you