1 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 AcknowledgementsAcknowledgements 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.

3 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

4 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

5 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%

6 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

7 Sample Design Utopia Analysis Unit Responding Unit Sampling Unit

8 Variables Required for MCPSS Sampling Contractor ID Tax ID Number of claims in reference year Provider type State Contact information

9 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

10 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]

11 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

12 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

Sample Performance Physician SampleRest of Sample Sample Size7,89528, Completes51.7%48.0% 2. Partial completes2.6%2.1% 3. Ineligible6.1%3.5% 4. Ineligible-Chains1.4%23.3% 5. Unknown Eligibility12.8%6.6% 6. Refusals4.4%2.1% 7. Other Non-response21.1%2.1% RR56.5%67.3% Eligibility rate91.4%71.3% Response rate Calculation (AAPOR-RR3) 1 / ( ( ) + (5*e) ) Where e = ( ) / (

14 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

15 Contacting the Authors Vasudha Narayanan Pamela Giambo Sherm Edwards

16 Thank you