Medical Expenditure Panel Survey - Medical Provider Component

AMENDMENT 1 - Solicitation Amendment and Resonses to solicitation questions - see amended soliciation cover page for a summary of changes. The Medical Expenditure Panel Survey (MEPS) Household Component (HC), Medical Provider Component (MPC), and Insurance Component (IC) is a set of large-scale surveys of families and individuals (MEPS-HC), their medical providers (doctors, hospitals, pharmacies, etc.) (MEPS-MPC), and employers across the United States (MEPS-IC). MEPS collects data on the specific health services that Americans use, how frequently they use them, the cost of these services, and how they are paid for, as well as data on the cost, scope, and breadth of health insurance held by and available to U.S. workers. The MEPS has been conducted since 1996 and is administered by the Agency for Healthcare Research and Quality (AHRQ). For further discussion of the MEPS family of surveys as well as historical context please see: http://www.meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp This solicitation pertains to the MEPS Medical Provider Component (MEPS-MPC). The primary objective of the MPC is to collect data from medical providers (hospitals, physicians, home care agencies, pharmacies, and long-term health care facilities) on expenditures for medical services provided to MEPS Household Component (HC) respondents. The MPC data are essential to improve the accuracy of the national medical expenditure estimates derived from the MEPS-HC by providing complete and accurate information on charges and payments from all sources (e.g., private insurance, Medicare, Medicaid) The MPC data also serve as source of expenditure information on physician charges that are associated with hospital care but not billed by the hospital (i.e., Separately Billing Doctors, or SBDs), as well as serving the primary source of expenditure information for Medicaid recipients. The sample of the MEPS-MPC is designed to provide data on events for which household respondents are less likely to be fully aware of the financial transactions regarding the medical care received, to enrich the sample of events available as donors for imputation, and to provide a basis for methodological analysis of household reported payments for all types of events. Providers for the MPC sample for one year include all hospitals, emergency rooms, home care agencies, outpatient departments, pharmacies, and long-term health care facilities reported by HC respondents, as well as all physicians who provide services for patients in hospitals but bill separately from the hospital (SBDs are identified by abstracting hospital records; they are not identified during the HC survey). HMOs are included in the MPC data collection. Office based medical providers where the provider is either a Doctor of Medicine (MD) or Osteopathy (DO) or practices under the direct supervision of an MD or DO are included in the MPC as well. Each year of the MPC, all providers are screened to ascertain their eligibility, their association with the MEPS household respondent, and to obtain information to facilitate the conduct of the core MPC interview. This requires finding key personnel to contact in complex health systems and chain pharmacies across the United States. Annual data collection consists of contacting and collecting medical record and billing data from approximately: 7,000 eligible hospitals, 15,000 office-based providers, 800 home care providers, 100 institutions, 12,000 SBDs, and 8,000 pharmacies[1]. The MPC is a critical component in ensuring the timely production of Public Use Files (PUFs). All tasks must be closely coordinated with the MEPS-HC contractor to meet a tight schedule, ensuring the timely delivery of all products and maintaining the strict PUF release timeline. MPC data collection involves several key steps: Authorization Forms (AFs): The MPC contractor receives AFs from HC respondents authorizing contact with medical providers and collects reported medical events during HC interviews. Initial Contact with Medical Providers: Data Collection specialists contact medical providers, sending AFs to initiate the collection of medical and billing data. Due to circumstances sometimes medical providers, especially Office-Based-Doctors (OBDs), end up needing to be moved to the more expensive hospital data collection. Collecting Data from Medical Providers: Data Collection specialists contact medical providers to acquire information on each medical event, including payment data, either electronically, via mail or over the phone. Identifying Separately Billing Doctors (SBDs): For hospital events, medical records are reviewed to identify SBDs who provided services but billed separately. Collecting Data from SBDs: SBDs are contacted, AFs are sent, and billing information is collected to capture complete payment data for hospital events. Data Processing and Matching: MPC data is processed, edited, and matched to the HC data using probabilistic matching techniques, then sent to the HC contractor for further processing and eventual PUF release. To successfully execute the MPC data collection and processing for the MEPS survey, the contractor shall perform the following types of services under this contract: Medical Provider Data Collection and Abstraction Authorization Forms: Receive, receipt, and manage signed household authorization forms from the HC contractor, enabling the MPC sample to contact medical providers for data collection. These authorization forms arrive in three waves during the calendar year. Sample Management: Implement, prepare, and document both non-SBD and SBD portions of the MPC sample. This includes de-deduplicating the provider sample and organizing into contact groups to avoid contacting the same provider more than necessary. This process requires bundling providers across units in a health system and across locations in the pharmacy chain for efficient fielding, and reviewing disavowals to ensure that the correct providers were identified. It also involves maintaining the MPC provider directory to ensure inclusion of all relevant hospitals, office-based physicians, SBDs, and pharmacies. These tasks are carried out for each wave of patient-provider pairs and must also be coordinated across the waves. Hospital cases are prioritized, and providers may be reclassified into a different data collection type based on new information. For example, Office-Based Doctors (OBDs) may be shifted to the hospital data collection process if they are found to be part of a hospital system, allowing collection of both facility and SBD fees. It is not uncommon for household respondent to identify a provider as an office-based doctor when the provider is actually part of a hospital system. Material Development: Develop and produce medical provider respondent materials such as advanced letters and data collection forms, ensuring that all required language is including on the forms in accordance with federal regulations. Data Collection Operations: Conduct nationwide, large-scale data collection efforts from diverse medical and billing offices across multiple provider types, including hospitals, Office-Based Doctors (OBDs), SBDs, home health agencies, long-term care institutions, and pharmacies. Ensure comprehensive data collection using a multi-mode approach tailored to provider capabilities, including phone interviews, fax submissions, mail, secure email, and electronic transmission via a secure web portal. OBD data collection usually requires a mix of phone interviews and abstraction of billing data while hospital data collection involves mostly data abstraction. Data Abstraction - Billing Records: Abstraction of billing records to gather payment information from each medical event, including charges, payments, sources of payment, and payment adjustments. Separately-Billing Doctors (SBDs): Identify potential SBDs for each hospital event. Historically, SBD identification has been conducted by abstracting hospital medical records to locate physician names. Once identified, de-duplicate the SBD sample, contact providers to confirm eligibility, and collect the payment data from the SBDs. SBD providers are sub-sampled based on demographic characteristics, facility event, and SBD characteristics. Data Management and Processing, and Data File Production and Documentation Data security. Provide data security for a system designated with a FIPS-199 moderate classification for a national large survey database. This includes the secure and confidential transmission of data between the central office, data collection staff, and abstractors as well as the transmission of data between AHRQ, the HC contractor, and the MPC contractor. Forms control and receipt. Manage and control the intake of various data collection forms with the ability to handle both electronic and hard copy submissions. Examples of forms include signed Authorization Forms from the HC respondents, and medical records and billing/payment records from medical providers or billing offices. Receipt of hard copy forms requires specialized data entry, including detailed scanning and keying, and appropriate verification procedures. Data coding. Perform data coding to convert various text fields into standardized numeric codes. This includes coding text sources of payment (SOP) into 10 broad categories (private, Medicare, Medicaid, Veterans Affairs, Tricare, other federal, etc.) based on AHRQ-provided specifications, classifying medical conditions using the ICD-10-CM classification system, coding medical supplies using BETOS specifications, and coding prescribed drug details into generic product indicators, a system of codes developed and maintained by Wolters-Kluwer Medi-Span. Data editing, processing, and quality control. Edit data to identify and remove duplicate events, roll up events when necessary, resolve zero dollar and negative payments, resolve cases where payments equal or exceed charges and verify outliers. Project Management, Reporting, and Meetings General Project Management: Including creation and maintenance of coordination points between the of MEPS HC and MPC contractor tasks. Recruitment and Training: Recruit, train, and manage staff for the successful completion of a large, nationwide survey. This includes Data Collection Specialists (DCS) and Abstractors (ABS) skilled in phone-based data collection and abstraction of financial and medical records from diverse provider types, as well as teams of coders, verifiers, and supervisors responsible for data coding (e.g., ICD-10-CM and CPT4 coding), including ICD-10-CM conditions, CPT-4 procedures, prescribed medicines. MEPS-MPC Continuity: Ensure continuity of MEPS-MPC operations by managing overlapping contracts and coordinating closely with AHRQ to meet production schedules. Cooperation with the HC contractor assuring timely, accurate and complete file transfers so the HC contractor can complete editing/imputation work (for all files but prescribed medicines) and public use file development for all MEPS event files on schedule. Liaison and Collaboration: Liaison and cooperation with MEPS principals (AHRQ Contracting Officer's Representative (COR) and key staff as well as the contractor's Project Director and key staff working on the project). Documentation and Reporting: Preparation of MEPS-MPC documentation (including but not limited to the bi-annual project management plan, annual methodology report, monthly progress and financial reporting, sample preparation and implementation plan, data collection instruments and materials, technical document, data management and processing plans, and training plans). Reporting, including progress and cost reports, work planning, and management meetings throughout the year. Meeting Coordination: Meeting arrangements between AHRQ's COR, key AHRQ personnel, and MPC contractor personnel. The contractor will prepare and distribute to AHRQ all meeting agendas and resulting minutes. Regulatory Compliance: Cooperation with AHRQ to secure necessary clearances and approvals, including OMB clearance for the survey, and ensure compliance with federal data security and confidentiality guidelines. Project closeout/transfer of operations within 90 days of request. Further discussion and detail pertaining to the MEPS-MPC may be found at: http://meps.ahrq.gov/mepsweb/survey_comp/mpc.jsp