MEPS HC-182: 2015 Full Year Medical Organizations Survey File
November 2017
Agency for Healthcare Research and Quality
Center for Financing, Access, and Cost Trends
5600 Fishers Lane
Rockville, MD 20857
(301) 427-1406
Table of Contents
A. Data Use Agreement
B. Background
1.0 Household Component
2.0 Medical Provider Component
3.0 Medical Organizations Survey
4.0 Survey Management and Data Collection
C. Technical and Programming Information
1.0 General Information
2.0 Data File Information
2.1 Codebook Structure
2.2 Reserved Codes
2.3 Codebook Format
2.4 Variable Naming
2.5 File Contents
2.5.1 2015 Medical Organizations Survey
2.5.2 Survey Administration
2.5.3 Organization Characteristics
2.5.4 Health Information Technology
2.5.5 Case Management & Use of Clinical Quality Data
2.5.6 Financial Arrangements
2.5.7 Analytic Weight and Variance Estimation
2.6 Linking to Other Files
2.6.1 Consolidated Data File
2.6.2 National Health Interview Survey
3.0 Survey Sample Information
3.1 MOS Sample Design and Response Rates
3.2 MOS Weighting
3.3 Variance Estimation
D. Variable-Source Crosswalk
Individual identifiers have been removed from the
micro-data contained in these files. Nevertheless, under sections 308 (d) and
903 (c) of the Public Health Service Act (42 U.S.C. 242m and 42 U.S.C. 299 a-1),
data collected by the Agency for Healthcare Research and Quality (AHRQ) and/or
the National Center for Health Statistics (NCHS) may not be used for any purpose
other than for the purpose for which they were supplied; any effort to determine
the identity of any reported cases is prohibited by law.
Therefore in accordance with the above referenced
Federal Statute, it is understood that:
- No one is to use the data in this data set in any way except
for statistical reporting and analysis; and
- If the identity of any person or establishment should be
discovered inadvertently, then (a) no use will be made of this
knowledge, (b) the Director Office of Management AHRQ will be
advised of this incident, (c) the information that would
identify any individual or establishment will be safeguarded or
destroyed, as requested by AHRQ, and (d) no one else will be
informed of the discovered identity; and
- No one will attempt to link this data set with individually
identifiable records from any data sets other than the Medical
Expenditure Panel Survey or the National Health Interview
Survey.
By using these data you signify your agreement to
comply with the above stated statutorily based requirements with the knowledge
that deliberately making a false statement in any matter within the jurisdiction
of any department or agency of the Federal Government violates Title 18 part 1
Chapter 47 Section 1001 and is punishable by a fine of up to $10,000 or up to 5
years in prison.
The Agency for Healthcare Research and Quality
requests that users cite AHRQ and the Medical Expenditure Panel Survey as the
data source in any publications or research based upon these data.
Acknowledgments
AHRQ would like to acknowledge Dr. John A. Fleishman for his work developing the Medical Organizations Survey (MOS). Dr. Fleishman developed the initial study design and funding proposal that was ultimately granted through the Robert Wood Johnson Foundation.
Additionally, the AHRQ Center for Finance, Access and Cost Trends (CFACT) would like to sincerely thank Dr. Fleishman for his critical efforts in designing the MOS, and his decades of service to the MEPS and AHRQ.
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The Medical Expenditure Panel Survey (MEPS) provides
nationally representative estimates of health care use, expenditures, sources of
payment, and health insurance coverage for the U.S. civilian
noninstitutionalized population. The MEPS Household Component (HC) also provides
estimates of respondents’ health status, demographic and socio-economic
characteristics, employment, access to care, and satisfaction with health care.
Estimates can be produced for individuals, families, and selected population
subgroups. The panel design of the survey, which includes 5 Rounds of interviews
covering 2 full calendar years, provides data for examining person level changes
in selected variables such as expenditures, health insurance coverage, and
health status. Using computer assisted personal interviewing (CAPI) technology,
information about each household member is collected, and the survey builds on
this information from interview to interview. All data for a sampled household
are reported most often by a single household respondent but in a number of
cases there may be multiple respondents.
The MEPS-HC was initiated in 1996. Each year a new
panel of sample households is selected. Because the data collected are
comparable to those from earlier medical expenditure surveys conducted in 1977
and 1987, it is possible to analyze long-term trends. Each annual MEPS-HC sample
size is about 15,000 households. Data can be analyzed at either the person or
event level. Data must be weighted to produce national
estimates.
The set of households selected for each panel of the
MEPS HC is a subsample of households participating in the previous year’s
National Health Interview Survey (NHIS) conducted by the National Center for
Health Statistics. The NHIS sampling frame provides a nationally representative
sample of the U.S. civilian noninstitutionalized population and reflects an
oversample of Blacks and Hispanics. In 2006, the NHIS implemented a new sample
design, which included Asian persons in addition to households with Black and
Hispanic persons in the oversampling of minority populations. The linkage of the
MEPS to the previous year’s NHIS provides additional data for longitudinal
analytic purposes.
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Upon completion of the household CAPI interview and
obtaining permission from the household survey respondents, a sample of medical
providers are contacted by telephone to obtain information that household
respondents can not accurately provide. This part of the MEPS is called the
Medical Provider Component (MPC) and information is collected on dates of
visits, diagnosis and procedure codes, charges and payments. The Pharmacy
Component (PC), a subcomponent of the MPC, does not collect charges or diagnosis
and procedure codes but does collect drug detail information, including National
Drug Code (NDC) and medicine name, as well as date filled and sources and
amounts of payment. The MPC is not designed to yield national estimates. It is
primarily used as an imputation source to supplement/replace household reported
expenditure information.
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The MEPS Medical Organizations Survey (MOS) expands current MPC
data collection activities to include information on the organization of the practices
of office-based care providers identified as a usual source of care in the MEPS HC and
was seen by the HC respondent in 2015. This additional data collection is for a subset
of office-based care providers already included in the MEPS MPC sample. In the MEPS MPC
sample, primary location for individuals’ office-based usual sources of care were identified.
The MEPS MPC contacted these places where medical care was provided to determine the
appropriate respondent and administer a MEPS MOS. The design of the survey is multi-modal
including phone, fax, mail, self-administration, electronic transmission, and secure email.
The data collection method chosen for a provider was the method that resulted in the most
complete and accurate data with minimal burden to the respondent.
The MEPS MOS database is unique in providing an internally consistent
source of information both on individuals’ characteristics and health care utilization and
expenditures, and on the characteristics of the providers they use. The following areas were
addressed in the MOS as they potentially affect individuals’ access to, use of and affordability
of health care services:
- Organizational characteristics, e.g., size, ownership, and type of practice
- Use of health information technology
- Case management and use of clinical quality data
- Financial arrangements, e.g., reimbursement methods, number and types of insurance
contracts, and compensation arrangements within the practice
This project was funded in part by a grant from the Robert Wood
Johnson Foundation.
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MEPS HC, MPC, and MOS data are collected under the authority of the
Public Health Service Act. Data are collected under contract with Westat, Inc. (MEPS HC) and
Research Triangle Institute (MEPS MPC and MOS). Data sets and summary
statistics are edited and published in accordance with the confidentiality
provisions of the Public Health Service Act and the Privacy Act. The National
Center for Health Statistics (NCHS) provides consultation and technical
assistance.
As soon as data collection and editing are completed,
the MEPS survey data are released to the public in staged releases of summary
reports, micro data files, and tables via the MEPS Web site:
meps.ahrq.gov. Selected data can be
analyzed through MEPSnet, an on-line interactive tool designed to give data
users the capability to statistically analyze MEPS data in a menu-driven
environment.
Additional information on MEPS is available from the
MEPS project manager or the MEPS public use data manager at the Center for
Financing, Access, and Cost Trends, Agency for Healthcare Research and Quality,
5600 Fishers Lane, Rockville, MD 20857 (301-427-1406).
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This documentation describes the data file from the Medical
Organizations Survey (MOS), a supplement to the 2015 full-year Medical Expenditure Panel
Survey (MEPS). Released as an ASCII file (with related SAS, SPSS, and Stata programming
statements and data user information) and a SAS transport dataset, this public use file
provides information on characteristics of office-based usual source of care (USC)
providers seen by MEPS sample persons in 2015. The file contains 27 variables.
The following documentation offers a brief overview of
the types and levels of data provided, content and structure of the files, and
programming information. It contains the following sections:
- Data File Information
- Survey Sample Information
- Variable-Source Crosswalk
Both weighted and unweighted frequencies of most variables
included in the 2015 full-year MOS data file are provided in the accompanying codebook file.
The exceptions to this are the weight variable and variance estimation variables. Only
unweighted frequencies of these variables are included in the accompanying codebook file.
A database of all MEPS products released to date and a
variable locator indicating the major MEPS data items on public use files that
have been released to date can be found at the following link on the MEPS Web
site: meps.ahrq.gov.
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This public use dataset contains data on usual source of care provider characteristics for 7,974 sample persons whose providers were respondents to the 2015 MEPS MOS. These data can be linked to MEPS sample respondents in the 2015 Full Year Consolidated File to enable analyses at the person-level using characteristics of provider practices. The analytic weight provided in this file (MOSWT15F) needs to be applied to these linked data in order to produce nationally representative estimates (see section 3.0 Survey Sample Information below for more details).
The codebook and data file sequence lists variables in
the following order:
- Unique person identifiers and survey administration variables
- Medical organizations survey variables
- Survey sample information
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The following reserved code values are used:
| Value |
Definition |
| -1 INAPPLICABLE |
Question was not asked due to skip pattern |
| -7 REFUSED |
Question was asked and respondent refused to answer question |
| -8 DK |
Question was asked and respondent did not know answer |
| -9 NOT ASCERTAINED |
Interviewer did not record the data |
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This codebook describes an ASCII data set and provides the following programming identifiers for each variable:
| Identifier |
Description |
| Name |
Variable name (maximum of 8 characters) |
| Description |
Variable descriptor (maximum 40 characters) |
| Format |
Number of bytes |
| Type |
Type of data: numeric (indicated by NUM) or character (indicated by CHAR) |
| Start |
Beginning column position of variable in record |
| End |
Ending column position of variable in record |
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In general, variable names reflect the content of the
variable, with an eight-character limitation. Edited variables end in an X and
are so noted in the variable label.
Variables contained in this delivery were obtained from
the questionnaire. The source of each variable is identified in the section of
the documentation entitled “Section D. Variable-Source Crosswalk.”
Sources for each variable are indicated in one of two ways: (1) variables that
are collected by one or more specific questions in the instrument have those
question numbers listed in the Source column; and (2) variables constructed
are labeled “Constructed.”
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The 2015 Medical Organizations Survey was fielded in 2016
during MPC data collection for the 2015 Medical Expenditure Panel Survey. Data are
for persons that had a visit to their usual source of care provider in 2015, and the
usual source of care question was asked in Panel 19 Round 4 and Panel 20 Round 2.
Only persons who saw their office-based usual source of care provider were included
in the sample frame.
The survey was designed to collect data on the organizational
and financial characteristics of the office-based usual source of care providers seen
by MEPS responding sample persons in 2015. The initial sample comprised the usual source
of care providers for approximately 13,000 persons with signed permission forms for the
2015 MPC (see section 3.1 for more details).
The sample person identifier is DUPERSID, the same as in the
MEPS full-year file.
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| MULTLOC – |
Does the medical practice have more than one location. |
| MULTLOC2 - |
For practices with multiple locations, is informant describing the practice as a whole or just one location. |
| NUMDOC – |
Approximately how many physicians work either part or full-time at the practice.
For purposes of confidentiality, this variable was top-coded at 250 physicians. |
| NUMPCP – |
Of the physicians working at the practice, how many are primary care physicians.
For purposes of confidentiality, this variable was top-coded at 80 primary care physicians. |
| NUMNPA – |
Approximately how many nurse practitioners and physician assistants work at the practice.
For purposes of confidentiality, this variable was top-coded at 50 nurse practitioners and physician assistants. |
| MULTSPEC – |
Is this a multi-specialty group practice. |
| POWNERX – |
Is the medical practice owned by physicians in the practice or another physician group.
Editing included the construction of new response values describing the recoding of several “other specify” text items into existing
or new categorical values, which are described below. The following additional values are available for the variable
3 – Non-profit/Govt clinic
4 – Academic
5 – HMO
6 – Independent practice
7 – Hospital owned
8 – Corporation owned |
| PRACTYPX – |
Type of practice. Editing included the construction of new response values
describing the recoding of several “other specify” text items into existing or new categorical values, which are described below.
The following additional value is available for the variable
6 – Corporation owned |
| ROLEX – |
What is respondent’s role in the practice. Editing included the construction
of new response values describing the recoding of several “other specify” text items into existing or new categorical values,
which are described below. The following additional values are available for the variable:
4 – Office or other Manager
5 – Office Staff Non-managerial
6 – Non-physician Medical
7 – Billing
8 – Receptionist
91- Other, please specify |
For NUMDOC, NUMPCP and NUMNPA, top coding was applied to all responses in the 99th percentile to preserve the
confidentiality of medical organizations responding to the MOS. Data users should note that top coding can affect results for
certain types of analyses. For example, users trying to compute the mix of primary care physicians versus specialists would be
impacted by not having access to top coded values for these variables in the tails of the distribution. Apparent inconsistencies
between the reported number of full and part-time physicians and the number of full or part-time primary care physicians working
at the practice were not edited to ensure alignment.
Please note that analysts can access non top coded variabels through the AHRQ Data Center. To access information
on the AHRQ Data Center including an application, please go to the following Web address:
meps.ahrq.gov/data_stats/onsite_datacenter.jsp
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| EHREMR – |
Does the practice use an electronic health record (EHR) or electronic medical record (EMR) system. Editing of this variable
focused on checking whether the skip patterns were consistent. When answered “NO”, EHRRMIND, and SECMSGS were skipped. |
| EHRRMIND – |
If the practice uses an electronic records system, does it routinely provide reminders for either guideline-based interventions
or screening tests. |
| SECMSGS – |
If the practice uses an electronic records system, is it routinely used for exchanging secure messages with patients. |
| QUALCARE – |
Does the practice regularly give reports to physicians on the clinical quality of care they individually provide. |
| SAMEDAY – |
Does the practice routinely set time aside for same-day appointments. |
| PCREMIND – |
Does the practice routinely send patients reminders for preventative care or follow-up care. |
| CASEMGR – |
Does the practice use case managers whose primary job is to coordinate patient care. |
| HOSDCCHK – |
When patients are discharged from the hospital, does someone from the practice usually contact the patient within 48 hours. |
| PRACXRAY – |
Does the practice have the ability to x-ray both chest and extremities in the office. |
| CAPITATD – |
Does the practice have any capitated contracts (per person, per month) with managed care plans. |
| ACO – |
Does the practice participate in an Accountable Care Organization (ACO) arrangement with either Medicare or private insurers. |
| MEDHOME – |
Is the practice certified as a patient-centered medical home. |
| PERMCAID – |
What percentage of the practice's patients are covered by Medicaid. |
| BASESAL – |
Are physicians in the practice paid a base salary. |
| MOSWT15F – |
MOS person weight (final) |
| VARSTR – |
Variance estimation stratum |
| VARPSU – |
Variance estimation primary sampling unit (PSU) |
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Data from the current file can be used alone or in conjunction with other files.
To expand the scope of potential estimates and analyses, records on this file can be linked
to the 2015 Full Year Consolidated Data file by the sample person identifier (DUPERSID).
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The set of households selected for MEPS is a subsample
of those participating in the National Health Interview Survey (NHIS), thus,
each MEPS panel can also be linked back to the previous year’s NHIS public use
data files. For information on obtaining MEPS/NHIS link files please see
meps.ahrq.gov/data_stats/more_info_download_data_files.jsp.
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The selection of providers for the MOS sample was designed as a subsample of the office-based
medical providers selected for inclusion in the MEPS Medical Provider Component (Zodet et. al.). Although the MOS
is a survey of physician practices, it is not an independent nationally representative sample of providers per se
because it was drawn from providers seen by MEPS sample persons. Consequently, provider-level data collected in the
survey are linked to MEPS sample respondents to enable analyses at the person-level using characteristics of
provider practices.
The table below provides a summary of MOS sample sizes. The overall target population for the MOS is persons who had one or more visits in 2015 to an office-based practice that was identified as their usual source of care. Of the 14,979 MEPS sample persons who were part of this population, 13,014 granted permission to contact their provider. Of these, 9,252 person-provider pairs (labelled “pairs” because some persons have the same usual source of care provider) were actually fielded for the study. For these 9,252 pairs the response rate was approximately 77 percent (i.e., response for 7,161 pairs). In addition to the 7,161 pairs, provider data was able to be matched to 813 pairs that were eligible for the study (i.e., granted permission) but were not fielded. Consequently, the final analytic sample size is 7,974 persons across 4,216 unique responding practices (average of 1.7 sample persons per practice). Data for the 4,216 respondent practices are only assigned to persons who gave permission to contact their practice.
Number of Sample Persons and MOS Practices by Survey Stage1
| Survey Stage |
Sample Persons (Person-Provider Pairs) |
| Sample in target population |
14,979 |
| Eligible for fielding (i.e., permission provided) |
13,014 |
| Fielded |
9,252 |
| Responding sample size |
7,161 |
| Analytical sample size2 |
7,974 |
1After accounting for post- MOS sample selection survey attrition
2Includes 813 non-fielded matched pairs
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An analytic weight was assigned to each MEPS sample person with a linked MOS response.
The MEPS-HC full-year poverty-adjusted person weight served as the base weight in developing this analytic weight [see the
HC-181: 2015 Full Year Consolidated File documentation], followed by two stages of adjustment
for non-permission and nonresponse respectively, and a raking adjustment to the control totals for the target
population estimated from MEPS full-year data. At the first stage the base weight was adjusted for lack of
permission to contact the provider, while at the second stage further adjustment was made for non-response
to the MOS. Finally, a raking procedure was applied to the nonresponse adjusted weight to ensure the sums of
weights were consistent with estimated totals for key demographic subgroups. The sum of the final MOS weights
across sample persons in this file is 150,803,945, which represents the estimated number of persons in the U.S.
civilian noninstitutionalized population who had one or more visits to their office-based usual source of care
provider in 2015.
To obtain estimates of variability (such as the standard error of sample estimates or
corresponding confidence intervals) for MOS estimates, analysts need to take into account the complex sample
design of MEPS, since the MOS sample is based on the MEPS sample. The identifiers for variance strata (VARSTR)
and variance PSU (VARPSU) needed to calculate appropriate standard errors based on the Taylor-series linearization
method are included on this file. Software packages that permit the use of the Taylor-series linearization method
include SUDAAN, Stata, SAS (version 8.2 and higher), and SPSS (version 12.0 and higher). For complete information
on the capabilities of each package, analysts should refer to the corresponding software user documentation.
For detailed information on the MOS sample design, see
Zodet, M., S. Chowdhury, S. Machlin, and J. Cohen. 2016. Linked designs of the MEPS Medical Provider and Organization Surveys.
In JSM Proceedings, Survey Research Methods Section. Alexandria, VA: American Statistical Association. 1914-1921.
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MOS VARIABLES – PUBLIC USE
| VARIABLE |
DESCRIPTION |
SOURCE |
| DUPERSID |
PERSON ID (DUID + PID) |
Assigned in Sampling |
| POWNERX |
PRACTICE OWNERSHIP |
MOS01X (edited) |
| MULTSPEC |
MULTISPECIALTY GROUP PRACTICE |
MOS02 |
| MULTLOC |
DOES PRACT HAVE MORE THAN 1 LOCATION |
MOS03 |
| MULTLOC2 |
RESPONSES FOR ALL OR 1 LOC |
MOS23 |
| PRACTYPX |
PRACTICE DESCRIPTION |
MOS04X (edited) |
| NUMDOC |
APPROX # FT + PT PHYSICIANS IN PRACTICE |
MOS05 |
| NUMPCP |
APPROX # PRIM CARE PHYSICIANS IN PRACT |
MOS06 |
| NUMNPA |
APPROX # NURSE PRACTNRS + PHYS ASSISTS |
MOS07 |
| PRACXRAY |
PRACTICE XRAY CHEST & EXTREMITIES ONSITE |
MOS08 |
| PERMCAID |
PERCENT COVERED BY MEDICAID |
MOS09 |
| CAPITATD |
PRACTICE HAS CAPITATED CONTRACTS |
MOS10 |
| ACO |
PARTICIPATE IN ACO W/MEDICRE OR PRIV INS |
MOS11 |
| BASESAL |
PHYSICIANS PAID BASE SALARY |
MOS12 |
| SAMEDAY |
PRACT SET TIME ASIDE FOR SAME-DAY APPTS |
MOS13 |
| MEDHOME |
CERTIFIED PATIENT-CENTERED MEDICAL HOME |
MOS14 |
| PCREMIND |
SEND PREVENTIVE CARE REMINDERS TO P |
MOS15 |
| QUALCARE |
REPORTS TO PHYS ON CLINICAL QUAL CARE |
MOS16 |
| CASEMGR |
CASE MANAGER COORDINATE PATIENT CARE |
MOS17 |
| HOSDCCHK |
CHECK IN W/P 48 HRS AFTER HOSP DISCHARGE |
MOS18 |
| EHREMR |
PRACTICE USES EHR OR EMR |
MOS19 |
| EHRRMIND |
EHR/EMR REMINDERS FOR GUIDELINES/SCREEN |
MOS20 |
| SECMSGS |
EHR/EMR EXCHANGE SECURE MESSAGES W/P |
MOS21 |
| ROLEX |
ROLE OF RESPONDENT IN PRACTICE |
MOS22X (edited) |
| MOSWT15F |
MOS FILE PERSON WEIGHT, 2015 |
Constructed |
| VARSTR |
VARIANCE ESTIMATION STRATUM - 2015 |
Constructed |
| VARPSU |
VARIANCE ESTIMATION PSU - 2015 |
Constructed |
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