Using Medicare Files as Sampling frames for a Survey of Physicians

1. Using Medicare Files as Sampling framesfor 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.

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 Sampling Unit Responding Unit Analysis 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

13. 2007 Sample Performance

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 (vasudhanarayanan@westat.com) Pamela Giambo (pamelagiambo@westat.com) Sherm Edwards (shermedwards@westat.com)

16. Thank you