81 FR 21874 - Agency Information Collection Activities: Proposed Collection; Comment Request
DEPARTMENT OF HEALTH AND HUMAN SERVICES
Agency for Healthcare Research and Quality Federal Register Volume 81, Issue 71 (April 13, 2016)
Agency for Healthcare Research and Quality
Federal Register Volume 81, Issue 71 (April 13, 2016)
| Page Range | 21874-21876 | |
| FR Document | 2016-08403 |
[Federal Register Volume 81, Number 71 (Wednesday, April 13, 2016)] [Notices] [Pages 21874-21876] From the Federal Register Online [www.thefederalregister.org] [FR Doc No: 2016-08403] ======================================================================= ----------------------------------------------------------------------- DEPARTMENT OF HEALTH AND HUMAN SERVICES Agency for Healthcare Research and Quality Agency Information Collection Activities: Proposed Collection; Comment Request AGENCY: Agency for Healthcare Research and Quality, HHS. ACTION: Notice. ----------------------------------------------------------------------- SUMMARY: This notice announces the intention of the Agency for Healthcare Research and Quality (AHRQ) to request that the Office of Management and Budget (OMB) approve the proposed information collection project: ``AHRQ ACTION III--Measurement for Performance Improvement in Physician Practices.'' In accordance with the Paperwork Reduction Act, 44 U.S.C. 3501-3521, AHRQ invites the public to comment on this proposed information collection. DATES: Comments on this notice must be received by June 13, 2016. ADDRESSES: Written comments should be submitted to: Doris Lefkowitz, Reports Clearance Officer, AHRQ, by email at [email protected]. Copies of the proposed collection plans, data collection instruments, and specific details on the estimated burden can be obtained from the AHRQ Reports Clearance Officer. FOR FURTHER INFORMATION CONTACT: Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 427-1477, or by email at [email protected]. SUPPLEMENTARY INFORMATION: Proposed Project AHRQ ACTION III--Measurement for Performance Improvement in Physician Practices This two-year project is an important first step to fully understanding measurement for performance improvement in medical groups. This exploratory research is expected to set the stage for informing future research and policy discussions, both of which could ultimately have a more direct impact on providers, payers, and patients. As a critical first step this research breaks new ground in an important area of health care research by looking at the current landscape to better understand how medical groups are using measurement internally to improve performance and what that means to them, and how internal measurement relates to external measurement obligations and identifying where the gaps are. Project success for this exploratory work will be more relevant given the complete context of the current landscape of performance measurement, gleaned through an environmental scan, expert input, and qualitative data collection. Ultimately, success will be measured by our ability to answer the research questions that are guiding this research project (see below). The overall goal of AHRQ's Measurement for Performance Improvement in Physician Practices project is to identify the current gaps in our knowledge about how practices are using data, if at all, for performance improvement. AHRQ has developed this project to address the lack of current evidence on internal performance measurement in medical groups, identifying the following research questions:What gaps exist in the research literature regarding management for performance improvement in medical groups? What factors, both internal and external, drive efforts to use measurement to improve medical group performance? How are measures used to support internal management and improvement processes? What additional activities support use of internal performance measures? How are internal performance measures derived and reported? What specific measures, benchmarks, and comparisons are used? How have physicians responded to these measurement processes? What are the perceived benefits of internal measurement activities? What types of costs and other burdens are directly associated with internal measurement? How feasible is it to specify actual costs of reporting? What implications does evidence on internal measurement for performance improvement have for payers, policy makers, executives in delivery systems, and clinical leaders? Specific Project Objectives Identify specific measures/metrics used internally by medical groups to assess performance and support improvement activities. Describe how internal measurement activities/measures are used in medical groups to support improvement in individual, team, or organizational performance including, but not limited to, how these activities are tied to ``internal'' financial incentives. Identify types of costs and other types of burdens (e.g. staff resources, IT resources, etc.), directly related to internal measurement and reporting activities. Assess the feasibility of capturing information on costs and burdens of internal and external performance measurement, and, if feasible, collect data on the actual costs and other associated burdens of internal and external performance measurement. Based on the findings, identify implications, potential impacts, and future research opportunities for payers, regulators, and medical groups regarding internal measurements for performance improvement. Efforts to improve performance among health care providers through measurement and reporting have evolved over time and have taken many forms and many names. For example, Triple Aim, Public Reporting, Performance Measurement, Quality Improvement, Pay for Performance are all common concepts today. And, most health care providers, including medical groups, are monitoring their performance using a wide array of quality measures that reflect care processes, clinical outcomes, and patient experiences. Increasing numbers of providers are required to report their performance on quality measures by [[Page 21875]] payers such as the Centers for Medicare and Medicaid Services (CMS) and external regulatory bodies such as the National Committee for Quality Assurance (NCQA) or the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Little is known, however, about how providers make use internally of measures that are required by external bodies for payment or reporting. Nor is it known what other measures providers collect and use to improve performance. This project aims to fill this knowledge gap. In doing so, it may also inform payment and reporting initiatives by providing indications of the degree to which providers view externally mandated measures as valuable for their internal quality assessment and reporting efforts. As an initial step in understanding the landscape of measurement for performance improvement, this research will look to understand how medical groups define and measure performance improvement. This work is being conducted by AHRQ through its contractor, Westat, pursuant to AHRQ's statutory authority to conduct and support research on health care and on systems for the delivery of such care, including activities with respect to the quality, effectiveness, efficiency, appropriateness and value of health care services and with respect to quality measurement and improvement. 42 U.S.C. 299a(a)(1) and (2). Method of Collection For this study, AHRQ will conduct field data collection through semi-structured in-depth interviews. The unit of analysis for this work is the medical group. To understand measurement for performance improvement in each medical group, AHRQ will interview up to 5 administrators and frontline clinicians per medical group. Interviews with both administrators and clinicians will be facilitated using the same protocol. As discussed below, given the different levels of involvement and experience with internal performance measurement, interviews will vary in detail and thus length. But, as AHRQ works to uncover the story of each medical group involved in the study, the same guiding protocol will apply. AHRQ will audio-record and professionally transcribe each interview conducted. And, all interviews will be loaded into Dedoose for coding and analysis. The information collected in the data collection effort will be used for one main purpose: Identify the current gaps in internal measurement in physician practices. The results from the data collection will give AHRQ a snapshot on the current practices being undertaken for internal performance measurement and inform best next steps to move beyond this exploratory research phase. The intended target audiences expected to benefit most from the project include the medical groups using this information to improve performance, the health care professionals who work in these medical groups working to improve their care to patients, and the patients that can benefit from improved care. One way this research could benefit these audiences is by informing payment and reporting initiatives by providing indications of the degree to which providers view externally mandated measures as valuable for their internal quality assessment and reporting efforts. Estimated Annual Respondent Burden Exhibit 1 shows the estimated annualized burden hours for the participants' time to take part in this research. To recruit medical groups to participate, AHRQ will engage groups in a short call to assess interest and obtain a commitment to participate. AHRQ expects the need to reach out to approximately 100 medical groups to obtain a sample of 45 groups that are conducting some type of measurement for internal performance improvement, are interested in taking part, and are able to take part during the data collection window. In-depth, semi-structured qualitative interviews will then be conducted with up to 5 staff members at 45 medical groups using a single protocol. AHRQ will target small (2-9 eligible professionals (EP)), medium (10-24 EPs), and large (25+ EPs) medical groups from across the Unites States. The goal is to recruit approximately 3 administrators and 2 frontline clinicians in each Group, understanding that depending on the size and organization of the medical group staff members may operate in multiple roles. Based on the pilot study conducted for this project, AHRQ estimates that the recruitment call will average 15 minutes, and that the longest interviews will be 1.5 hours. These longest interviews will be with the highest level administrators working on internal performance measurement at the most complex medical groups. AHRQ believes these will be the largest medical groups that are part of complex systems and payment relationships. These complex organizational relationships will require more time to understand in order to understand the place, role, and operation of internal measurement for performance improvement within the group. For equivalent administrators from medium and small groups, AHRQ estimates the longest interviews will be 1.25 hours. For all other administrators and frontline clinicians, AHRQ estimates the interviews will be 1 hour. The total annualized burden is estimated to be 295 hours. Again, interviews with both frontline clinicians and all medical group administrators will use the same protocol. The screening call will be an informal conversation in which AHRQ looks to learn if the medical group self-identifies as using measurement for performance improvement and provides consent to take part. AHRQ will answer any questions the medical group has about the study on this call and confirm some basic, publicly available background information about the group that AHRQ has obtained is accurate and up to date. This background information will help put the information learned during the interview in better context. The types of background information AHRQ is looking at includes medical group size, organizational structure, specialty mix, and payment relationships. Exhibit 1--Estimated Annualized Burden Hours ---------------------------------------------------------------------------------------------------------------- Number of Hours per Total burden Form name respondents response hours ---------------------------------------------------------------------------------------------------------------- Frontline clinicians.............................................. 90 1 90 Medical group administrators.................................. 235 Medical group administrators: Administrator with authority to 100 0.25 25 agree to participate in the study................................ Medical group administrators: Initial, highest level 45 1.5 67.5 administrators................................................... Medical group administrators: All other administrators............ 90 1.25 112.5 --------------------------------------------- [[Page 21876]] Total......................................................... 325 NA 295 ---------------------------------------------------------------------------------------------------------------- Exhibit 2 shows the estimated annualized cost burden associated with the participants' time to take part in this research. The total cost burden is estimated to be $27,270.45. Exhibit 2--Estimated Annualized Cost Burden ---------------------------------------------------------------------------------------------------------------- Average Interviewee type Total burden hourly wage Total cost hours rate * burden ---------------------------------------------------------------------------------------------------------------- Frontline clinicians............................................ 90 $103.54 \a\ $9,318.60 Medical group administrators................................ 205 87.57 \b\ 17,951.85 ----------------------------------------------- Total....................................................... 295 NA 27,270.45 ---------------------------------------------------------------------------------------------------------------- \a\ Based on the average hourly wage for one physician (29-1060; $103.54). \b\ Based on the average hourly wage for one Chief Executive (11-1011; $87.57). * National Industry-Specific Occupational Employment and Wage Estimates, May 2014, from the Bureau of Labor Statistics (available at http://www.bls.gov/oes/current/naics4_621100.htm [for Offices of Physicians, NAICS 622100]). Request for Comments In accordance with the Paperwork Reduction Act, comments on AHRQ's information collection are requested with regard to any of the following: (a) Whether the proposed collection of information is necessary for the proper performance of AHRQ health care research and health care information dissemination functions, including whether the information will have practical utility; (b) the accuracy of AHRQ's estimate of burden (including hours and costs) of the proposed collection(s) of information; (c) ways to enhance the quality, utility, and clarity of the information to be collected; and (d) ways to minimize the burden of the collection of information upon the respondents, including the use of automated collection techniques or other forms of information technology. Comments submitted in response to this notice will be summarized and included in the Agency's subsequent request for OMB approval of the proposed information collection. All comments will become a matter of public record. Sharon B. Arnold, Acting Director. [FR Doc. 2016-08403 Filed 4-12-16; 8:45 am] BILLING CODE 4160-90-P
![21874 Federal Register / Vol. 81, No. 71 / Wednesday, April 13, 2016 / Notices
SUMMARY: The GSA Labor-Management Reports Clearance Officer, AHRQ, by • How are measures used to support
Relations Council (GLMRC) previously email at doris.lefkowitz@AHRQ.hhs.gov. internal management and improvement
announced in its March 25, 2016 Copies of the proposed collection processes?
Federal Register notice that it planned plans, data collection instruments, and • What additional activities support
to hold a meeting Tuesday, April 12, specific details on the estimated burden use of internal performance measures?
2016 and Wednesday, April 13, 2016. can be obtained from the AHRQ Reports • How are internal performance
The meeting is cancelled. Clearance Officer. measures derived and reported? What
DATES: April 13, 2016. FOR FURTHER INFORMATION CONTACT:
specific measures, benchmarks, and
Doris Lefkowitz, AHRQ Reports comparisons are used?
FOR FURTHER INFORMATION CONTACT: Ms.
• How have physicians responded to
Paula Lucak, GLMRC Designated Clearance Officer, (301) 427–1477, or by
these measurement processes?
Federal Officer (DFO) at the General email at doris.lefkowitz@AHRQ.hhs.gov. • What are the perceived benefits of
Services Administration, OHRM, 1800 F SUPPLEMENTARY INFORMATION: internal measurement activities? What
Street NW., Washington, DC. 20405, types of costs and other burdens are
telephone at 202–739–1730, or email at Proposed Project
directly associated with internal
gmlrc@gsa.gov. AHRQ ACTION III—Measurement for measurement? How feasible is it to
SUPPLEMENTARY INFORMATION: The GSA Performance Improvement in Physician specify actual costs of reporting?
Labor-Management Relations Council Practices • What implications does evidence
(GLMRC) previously announced in its This two-year project is an important on internal measurement for
March 25, 2016 Federal Register notice first step to fully understanding performance improvement have for
(81 FR 16183) that it planned to hold a measurement for performance payers, policy makers, executives in
meeting Tuesday, April 12, 2016 and improvement in medical groups. This delivery systems, and clinical leaders?
Wednesday, April 13, 2016. The exploratory research is expected to set Specific Project Objectives
meeting is cancelled. A new notice will the stage for informing future research
be posted in the Federal Register • Identify specific measures/metrics
and policy discussions, both of which
announcing the date and time when used internally by medical groups to
could ultimately have a more direct
rescheduled. assess performance and support
impact on providers, payers, and
Dated: April 7, 2016.
improvement activities.
patients. As a critical first step this • Describe how internal measurement
Renee Y. Jones, research breaks new ground in an activities/measures are used in medical
Office of Human Resources Management, important area of health care research groups to support improvement in
OHRM Director (Acting), Office of HR Strategy by looking at the current landscape to individual, team, or organizational
and Services, Center for Talent Engagement better understand how medical groups
(COE4), General Services Administration. performance including, but not limited
are using measurement internally to to, how these activities are tied to
[FR Doc. 2016–08463 Filed 4–12–16; 8:45 am] improve performance and what that ‘‘internal’’ financial incentives.
BILLING CODE 6820–34–P means to them, and how internal • Identify types of costs and other
measurement relates to external types of burdens (e.g. staff resources, IT
measurement obligations and resources, etc.), directly related to
identifying where the gaps are. internal measurement and reporting
DEPARTMENT OF HEALTH AND Project success for this exploratory
HUMAN SERVICES activities. Assess the feasibility of
work will be more relevant given the capturing information on costs and
Agency for Healthcare Research and complete context of the current burdens of internal and external
Quality landscape of performance measurement, performance measurement, and, if
gleaned through an environmental scan, feasible, collect data on the actual costs
Agency Information Collection expert input, and qualitative data and other associated burdens of internal
Activities: Proposed Collection; collection. Ultimately, success will be and external performance measurement.
Comment Request measured by our ability to answer the • Based on the findings, identify
research questions that are guiding this implications, potential impacts, and
AGENCY: Agency for Healthcare Research research project (see below). future research opportunities for payers,
and Quality, HHS. The overall goal of AHRQ’s regulators, and medical groups
ACTION: Notice. Measurement for Performance regarding internal measurements for
Improvement in Physician Practices performance improvement.
SUMMARY: This notice announces the project is to identify the current gaps in Efforts to improve performance among
intention of the Agency for Healthcare our knowledge about how practices are health care providers through
Research and Quality (AHRQ) to request using data, if at all, for performance measurement and reporting have
that the Office of Management and improvement. AHRQ has developed this evolved over time and have taken many
Budget (OMB) approve the proposed project to address the lack of current forms and many names. For example,
information collection project: ‘‘AHRQ evidence on internal performance Triple Aim, Public Reporting,
ACTION III—Measurement for measurement in medical groups, Performance Measurement, Quality
Performance Improvement in Physician identifying the following research Improvement, Pay for Performance are
Practices.’’ In accordance with the questions: all common concepts today. And, most
asabaliauskas on DSK3SPTVN1PROD with NOTICES
Paperwork Reduction Act, 44 U.S.C. • What gaps exist in the research health care providers, including medical
3501–3521, AHRQ invites the public to literature regarding management for groups, are monitoring their
comment on this proposed information performance improvement in medical performance using a wide array of
collection. groups? quality measures that reflect care
DATES: Comments on this notice must be • What factors, both internal and processes, clinical outcomes, and
received by June 13, 2016. external, drive efforts to use patient experiences. Increasing numbers
ADDRESSES: Written comments should measurement to improve medical group of providers are required to report their
be submitted to: Doris Lefkowitz, performance? performance on quality measures by
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![21876 Federal Register / Vol. 81, No. 71 / Wednesday, April 13, 2016 / Notices
EXHIBIT 1—ESTIMATED ANNUALIZED BURDEN HOURS—Continued
Number of Hours per Total burden
Form name respondents response hours
Total ...................................................................................................................................... 325 NA 295
Exhibit 2 shows the estimated research. The total cost burden is
annualized cost burden associated with estimated to be $27,270.45.
the participants’ time to take part in this
EXHIBIT 2—ESTIMATED ANNUALIZED COST BURDEN
Average
Total burden Total cost
Interviewee type hourly
hours burden
age rate *
Frontline clinicians ....................................................................................................................... 90 $103.54 a $9,318.60
Medical group administrators ............................................................................................... 205 87.57 b 17,951.85
Total ...................................................................................................................................... 295 NA 27,270.45
a Basedon the average hourly wage for one physician (29–1060; $103.54).
b Basedon the average hourly wage for one Chief Executive (11–1011; $87.57).
* National Industry-Specific Occupational Employment and Wage Estimates, May 2014, from the Bureau of Labor Statistics (available at http://
www.bls.gov/oes/current/naics4_621100.htm [for Offices of Physicians, NAICS 622100]).
Request for Comments DEPARTMENT OF HEALTH AND • Federal eRulemaking Portal:
HUMAN SERVICES Regulation.gov. Follow the instructions
In accordance with the Paperwork for submitting comments.
Reduction Act, comments on AHRQ’s Agency for Toxic Substances and • Mail: Leroy A. Richardson,
information collection are requested Disease Registry Information Collection Review Office,
with regard to any of the following: (a) Centers for Disease Control and
Whether the proposed collection of [60Day–16–0041; Docket No. ATSDR–2016– Prevention, 1600 Clifton Road NE., MS–
0005]
information is necessary for the proper D74, Atlanta, Georgia 30329.
performance of AHRQ health care Instructions: All submissions received
Proposed Data Collection Submitted
research and health care information must include the agency name and
for Public Comment and
dissemination functions, including Docket Number. All relevant comments
Recommendations
whether the information will have received will be posted without change
practical utility; (b) the accuracy of AGENCY: Agency for Toxic Substances to Regulations, gov, including any
AHRQ’s estimate of burden (including and Disease Registry (ATSDR), personal information provided. For
Department of Health and Human access to the docket to read background
hours and costs) of the proposed
Services (HHS). documents or comments received, go to
collection(s) of information; (c) ways to
ACTION: Notice with comment period. Regulations.gov.
enhance the quality, utility, and clarity
of the information to be collected; and Please note: All public comment should be
SUMMARY: The Agency for Toxic submitted through the Federal eRulemaking
(d) ways to minimize the burden of the Substances and Disease Registry portal (Regulations.gov) or by U.S. mail to the
collection of information upon the (ATSDR), as part of its continuing address listed above.
respondents, including the use of efforts to reduce public burden and
automated collection techniques or FOR FURTHER INFORMATION CONTACT: To
maximize the utility of government request more information on the
other forms of information technology. information, invites the general public proposed project or to obtain a copy of
Comments submitted in response to and other Federal agencies to take this the information collection plan and
this notice will be summarized and opportunity to comment on proposed instruments, contact the Information
included in the Agency’s subsequent and/or continuing information Collection Review Office, Centers for
request for OMB approval of the collections, as required by the Disease Control and Prevention, 1600
proposed information collection. All Paperwork Reduction Act of 1995. This Clifton Road NE., MS–D74, Atlanta,
comments will become a matter of notice invites comment on the Georgia 30329; phone: 404–639–7570;
public record. ‘‘National Amyotrophic Lateral Email: omb@cdc.gov.
Sclerosis (ALS) Registry.’’ The National SUPPLEMENTARY INFORMATION: Under the
Sharon B. Arnold, ALS Registry collects information from Paperwork Reduction Act of 1995 (PRA)
asabaliauskas on DSK3SPTVN1PROD with NOTICES
Acting Director. persons with ALS to better describe the (44 U.S.C. 3501–3520), Federal agencies
[FR Doc. 2016–08403 Filed 4–12–16; 8:45 am] prevalence and potential risk factors for must obtain approval from the Office of
BILLING CODE 4160–90–P
ALS. Management and Budget (OMB) for each
DATES: Written comments must be collection of information they conduct
received on or before June 13, 2016. or sponsor. In addition, the PRA also
ADDRESSES: You may submit comments, requires Federal agencies to provide a
identified by Docket No. ATSDR–2016– 60-day notice in the Federal Register
0005 by any of the following methods: concerning each proposed collection of
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Document Created: 2016-04-13 03:11:49
Document Modified: 2016-04-13 03:11:49
| Category | Regulatory Information | |
| Collection | Federal Register | |
| sudoc Class | AE 2.7: GS 4.107: AE 2.106: | |
| Publisher | Office of the Federal Register, National Archives and Records Administration | |
| Section | Notices | |
| Action | Notice. | |
| Dates | Comments on this notice must be received by June 13, 2016. | |
| Contact | Doris Lefkowitz, AHRQ Reports Clearance Officer, (301) 427-1477, or by email at [email protected] | |
| FR Citation | 81 FR 21874 |
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