MEPS Annual Methodology Report - Deliverable Number: 10.102

Submitted to:
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, Maryland 20850

Submitted by:
Westat
1650 Research Boulevard
Rockville, Maryland 20850-3195
301-251-1500

RTI Project Number 0211755.001

AHRQ Contract Number HHSA290200810009C

Final

Methodology Report #27

March 2013

Prepared for

Agency for Healthcare Research and Quality

Karen E. Davis

AHRQ, Center for Financing, Access & Cost Trends

540 Gaither Road

Rockville, MD 20850

Table of Contents

Return To Table Of Contents

1. Introduction

Return To Table Of Contents

2. Preparations for the 2009 MPC

Return To Table Of Contents

3. Data Collection

Table 3-2. 2009 MPC Data Collection Schedule

Provider Type	Start of first MPC wave	Start of last MPC Wave	End of MPC data collection	Number of Waves	Total Weeks
Hospital
Small	03/15/2010	07/29/2010	11/30/2010	2	37
Medium/Large	06/14/2010	07/29/2010	11/30/2010	2	24
Office-Based Doctors	03/01/2010	07/29/2010	11/30/2010	2	39
Institution	09/17/2010	09/17/2010	11/30/2010	2	11
Home Health Agencies	09/17/2010	09/17/2010	11/30/2010	2	11
Pharmacies	07/29/2010	07/29/2010	12/17/2010	4	20
SBDs	12/08/2010	01/15/2011	04/30/2011	2	20

Return To Table Of Contents

Table 3-3. Pairs and Events Selected for Review

	Pairs	Events
Hospital inpatient events where payment was "0" or "Missing"	2,472	11,477
Samples of other events where payment was "0" or "Missing"
OBD events with adjustment/discount mentioned in one or more events (random selection of 100 pairs)	100	584
OBD events with no mention of adjustment/discount in one or more events (random selection 100 of pairs)	100	400
Hospital events not reviewed for another reasons (random selection of 100 pairs)	100	334
Outpatient or OBD events where charges were greater than $7,500	707	3,563
Total	3,479	16,358

Table 3-4. Provider-Level Response Rates, MPC 2008 and 2009

Provider	Initial sample after subsampling	Final eligible sample	Response rate	Refusal rate	Other nonresponse rate
2008
Hospitals	5,126	4,776	0.946	0.022	0.035
Office-based providers	10,762	9,533	0.891	0.067	0.054
HMOs	243	198	0.970	-	0.031
Home care providers	498	446	0.901	0.077	0.032
Institutions	77	72	0.944	0.097	0.066
SBDs	19,262	11,364	0.860	0.097	0.066
Pharmacies	7,799	7,026	0.756	0.271	0.050
Total	43,767	33,415
2009
Hospitals	7,391	6,440	0.890	0.012	0.098
Office-based providers	10,234	9,150	0.801	0.003	0.227
HMOs	NA	NA	-	-	-
Home care providers	664	603	0.861	0.053	0.086
Institutions	105	101	0.921	0.030	0.050
SBDs	24,208	19,874	0.683	0.081	0.236
Pharmacies	8,935	7,949	0.689	0.050	0.262
Total	52,747	45,327

Table 3-5. Pair-level response rates, MPC 2008 and 2009

Patient-provider pair	Initial sample after subsampling	Final eligible sample	Response rate	Refusal rate	Other nonresponse rate
2008
Hospitals	10,672	9,600	0.943	0.026	.0340
Office-based providers	13,917	12,281	0.884	0.077	0.054
HMOs	572	449	0.958	0.002	0.042
Home care providers	564	502	0.902	0.077	0.031
Institutions	80	75	0.947	0.042	0.014
SBDs	27,498	16,144	0.846	0.133	0.049
Pharmacies	19,678	17,038	0.706	0.356	0.060
Total	72,981	56,089
2009
Hospitals	14,199	12,276	0.877	0.014	0.109
Office-based providers	13,386	11,956	0.798	0.055	0.136
HMOs	601	601	-	-	-
Home care providers	728	656	0.854	0.055	0.087
Institutions	113	109	0.927	0.028	0.046
SBDs	27,480	22,417	0.683	0.084	0.233
Pharmacies	22,587	19,683	0.632	0.260	0.108
Total	78,493	67,097

Finally, Table 3-6 displays the node-level response rates among SBDs. A “node” in the SBD data collection refers to the unique combination of hospital provider, patient, event type, event date, and SBD. As compared with provider and pair level response rates, the node response rate is a more granular way to measure the amount of information collected about expenditures related to SBD services.

The 2009 SBD data collection resulted in a much lower eligibility rate than in the 2008 MPC. This is very likely due to the reabstraction effort which is described in the previous section.

Table 3-6. SBD Node-Level Response Rate

	2008	2009
Total nodes	62,903	58,200
Out-of-scope	34,332	18,266
Net eligible	28,571	39,934
Complete	22,441	21,265
Nonresponse	6,130	2,099
Eligibility rate	0.454	0.686
Completion rate	0.785	0.533

Return To Table Of Contents

3.6.2 Refusal Conversion

Table 3-7 provides additional information about refusal conversion. The analytic unit in this table is contact group. Each contact group may include multiple providers. The final column in this table displays the percent of initial refusals that were converted to a complete or partially complete group. Over three quarters (75.9%) of hospital contact groups were converted from initial refusal to complete; the conversion rate for OBD groups is 41.3%; Home health groups is 44.4%; Pharmacy (corporate and non-corporate) is 35.4%; and 29.4% for SBD contact group.

Return To Table Of Contents

3.6.3 Components of MPC Data Collection

Figures 3-1 through 3-4 summarize major components of the MEPS MPC data collection for the history of the survey for hospitals, OBDs, SBDs, and pharmacies (corporate and non-corporate). Following the practice of earlier years, these graphs present data at the provider level. Each graph displays:

Sample size, as a proportion of the sample field in 2002
Sample eligibility rate,
Final completion rate, and
Final refusal.

Table 3-7. Refusal Conversion Outcomes: Final Disposition of Contact Groups Initially Coded as Refusal, 2009 MPC

					Final Disposition of Ever Coded Refusal
Contact Group Provider Type	Initial Sample¹	Ever coded refusal			Ineligible		Final Refusal		Other Nonresponse		Complete
	N	N	Pct of Initial Sample	Pct of Ever Coded Refusal	N	Pct of Ever Coded Refusal	N	Pct of Ever Coded Refusal	N	Pct of Ever Coded Refusal	N	Pct of Ever Coded Refusal
Hospital	4,298	299	7.0%	100.0%	6	2.0%	41	13.7%	25	8.4%	227	75.9%
Office-based	8,635	876	10.1%	100.0%	20	2.3%	323	36.9%	171	19.5%	362	41.3%
Home Health	624	36	5.8%	100.0%	1	2.8%	16	44.4%	3	8.3%	16	44.4%
Pharmacy	2,783	161	5.8%	100.0%	9	5.6%	64	39.8%	31	19.3%	57	35.4%
SBDs	16,718	1423	8.5%	100.0%	91	6.4%	634	44.6%	280	19.7%	418	29.4%
Note counts in this table are of contact groups, not individual providers.

Year	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009
Sample Rel to 2002	0.526	0.658	0.513	0.519	0.548	0.822	1.000	0.882	0.897	0.885	0.867	0.842	0.755	1.018
Eligibility Rate	0.023	-0.024	0.064	0.068	0.078	0.074	0.067	0.074	0.069	0.076	0.068	0.067	0.068	0.129
Completion Rate	0.951	0.894	0.939	0.926	0.910	0.912	0.900	0.898	0.920	0.931	0.941	0.944	0.946	0.890
Final Refusal Rate	0.021	0.058	0.025	0.036	0.037	0.038	0.048	0.047	0.027	0.026	0.022	0.023	0.022	0.012

Year	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009
Sample Rel to 2002	0.568	0.516	0.539	0.592	0.818	1.324	1.000	1.011	1.324	1.238	0.884	0.988	0.698	0.670
Eligibility Rate	0.256	0.271	0.125	0.122	0.138	0.125	0.103	0.101	0.106	0.107	0.105	0.117	0.114	0.106
Completion Rate	0.881	0.871	0.861	0.888	0.864	0.850	0.837	0.835	0.864	0.859	0.869	0.875	0.891	0.801
Final Refusal Rate	0.069	0.053	0.043	0.053	0.071	0.069	0.097	0.095	0.076	0.086	0.074	0.077	0.067	0.003

Year	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009
Sample Rel to 2002	0.623	0.379	0.551	0.521	0.503	0.922	1.000	0.870	0.946	0.928	0.931	0.888	0.813	1.018
Eligibility Rate	0.300	0.659	0.280	0.318	0.370	0.376	0.346	0.347	0.342	0.345	0.384	0.361	0.410	0.179
Completion Rate	0.949	0.885	0.862	0.842	0.840	0.795	0.773	0.828	0.840	0.846	0.823	0.874	0.860	0.683
Final Refusal Rate	0.042	0.104	0.063	0.061	0.065	0.094	0.121	0.104	0.076	0.075	0.111	0.072	0.097	0.081

Year	1996	1997	1998	1999	2000	2001	2002	2003	2004	2005	2006	2007	2008	2009
Sample Rel to 2002	0.574	0.791	0.558	0.546	0.556	0.878	1.000	0.874	0.827	0.817	0.808	0.837	0.758	1.018
Eligibility Rate	0.129	0.145	0.099	0.113	0.106	0.107	0.091	0.088	0.110	0.099	0.116	0.100	0.099	0.110
Completion Rate	0.722	0.700	0.838	0.822	0.820	0.761	0.790	0.729	0.794	0.787	0.799	0.797	0.756	0.689
Final Refusal Rate	0.061	0.068	0.084	0.079	0.078	0.113	0.122	0.200	0.159	0.167	0.149	0.165	0.271	0.050

These figures indicate that the sample size for these providers is large relative to recent years of the MPC. The eligibility rate for hospitals, OBDs, and pharmacies is consistent with recent years, however the eligibility rate for SBD is lower. As noted above, the completion rate for all provider types is lower than recent years of the MPC.

Return To Table Of Contents

3.6.4 Timing

Hours per completed pair is displayed in Table 3-8. These figures include both telephone and hard copy record abstraction as well as recruiting efforts.

Table 3-8. Hours per Completed Pair, 2006—2009 MPC

[1] Note that these counts and percentages are based on participation at the contact group level, not individual providers. As noted in section 2, contact groups may consist of multiple providers as, for example, a health care system that may contain several hospitals. Note as well that contact group is a different metric than the concept of “provider wave” reported in previous rounds of the MPC. In a provider wave, a provider is counted one for each wave of the sample in which it is represented. Table 3.1 reports the percentage of contact groups that provided medical and billing records.