Using Medicare Files as Sampling frames for a Survey of Physicians

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Using Medicare Files as Sampling frames for a
Survey of Physicians

• Vasudha Narayanan
• Presented at
• Third International Conference on Establishment
  Surveys
• June 20, 2007

2
Acknowledgements

• Co-Authors
• Pamela Giambo Sherm Edwards from Westat
• Project Officers
• Gladys Valentin David Clark from Centers for
  Medicare Medicaid Services
• This 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 Sampling 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 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 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 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 Utopia
Sampling Unit
Responding Unit
Analysis Unit
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Variables Required for MCPSS Sampling

• Contractor ID
• Tax ID
• Number of claims in reference year
• Provider type
• State
• Contact information

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Files Available for MCPSS Physician 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 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 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 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 Performance
Physician 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) Response rate Calculation (AAPOR-RR3) Response rate Calculation (AAPOR-RR3)
1 / ( (1 2 6 7) (5e) ) 1 / ( (1 2 6 7) (5e) ) 1 / ( (1 2 6 7) (5e) )
Where e (1 2 6 7) / (1 2 6 7 3 4 Where e (1 2 6 7) / (1 2 6 7 3 4 Where e (1 2 6 7) / (1 2 6 7 3 4
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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 Authors

• Vasudha Narayanan (vasudhanarayanan_at_westat.com)
• Pamela Giambo (pamelagiambo_at_westat.com)
• Sherm Edwards (shermedwards_at_westat.com)

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Thank you