Transcript BioSense Overview

Survey Enhancements to Inform
the Affordable Care Act
National Center for Health Statistics
(NCHS)
Clarice Brown
Division of Health Care Statistics
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
Centers for Disease Control and Prevention
National Center for Health Statistics
Acknowledgements
• Jane Gentlemen and Renee Ginde
Division of Health Interview Statistics
• David Woodwell
Division of Health Care Statistics
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NCHS and the Affordable Care Act (ACA)
National Health Interview Survey
-- monitor the early effects on the
population health
National Health Care Surveys
-- monitor the effects on the health
care delivery
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National Health Interview Survey (NHIS)
• Continuously fielded since 1957
• In-person household survey of noninstitutionalized civilian population
• Data are collected by the US Census
Bureau
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NHIS and ACA
• Existing questions provide baseline
and trend data
–
Insurance
–
Access to care
• New questions added to address
targeted issues
• Larger sample size for more state-level
estimates
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Percent of adults aged 19-25 with health insurance, by
coverage type, and percent uninsured:2009-2011
60
Private
50
40
Percent
Uninsured
35.6
30
25.2
Public
20
10
0
Q1 Q2
2009
•
Q3
Q4
Q1 Q2
2010
Q3
Q4
Q1 Q2
2011
Q3
Source: Cohen RA, Martinez ME. Health insurance coverage: Early
release of estimates from the National Health Interview Survey, 2011.
National Center for Health Statistics. June 2012.
Q4
ACA questions (NHIS 2011, 2012, 2013)
• Problems paying medical bills in past
12 months
• Currently have medical bills that are
being paid over time
• Currently have medical bills that they
are unable to pay at all
• Any financial burden of medical care
(summary)
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Percent of persons in families with selected financial
burdens of medical care: U.S., Jan–Jun 2011
40
32.4
Percent
30
20
26.2
20.0
10.5
10
0
Problems paying
medical bills in the
past 12 months
•
Currently have
medical bills paid
over time
Currently have
medical bills
unable to pay at
all
Any financial
burden of medical
care
Cohen RA, Gindi RM, Kirzinger WK. Burden of medical care cost: Early
release of estimates from the National Health Interview Survey,
January–June
NHIS Sample sizes
• 2010
–
34,328 households and 89,976 persons
–
20 states
• 2011
–
35,509 households and 101,875 persons
–
32 states
• 2012
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–
51,000 households and 127,500 persons
–
41 states
Percentage of persons aged 18-64 who were
uninsured at the time of interview: 2011
Percentage significantly lower than U.S. overall (21.3%)
Percentage not significantly different from U.S. overall
Percentage significantly higher than U.S. overall
Estimate does not meet NCHS standard for precision
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Source: Cohen RA, Martinez ME. Health insurance coverage: Early release
of estimates from the National Health Interview Survey, 2011. National
Center for Health Statistics. June 19, 2012.
National Health Care Surveys
• Ambulatory and hospital care surveys
–
National Ambulatory Medical Care Survey
(NAMCS)
–
National Hospital Ambulatory Medical Care
Survey (NHAMCS)
–
National Hospital Discharge Survey (NHDS)
–
New National Hospital Care Survey (NHCS)
• Long-term care surveys
–
New National Study of Long-Term Care
Providers (NSLTCP)
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Examples of Data
Provider Organization
• Sources of revenue
Patients
• Demographics
• Ownership/ staffing
• Medical conditions
• Practice size
• Insurance status
Clinician
Encounter
• Specialty
• Diagnosis
• Hours/ week
• Services ordered or provided
• Demographics
• Medications
• Visit Duration
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Building on NAMCS/NHAMCS
• Infrastructure already in place to collect
data for physician offices, emergency and
outpatient departments and community
health centers
• NAMCS/NHAMCS data on characteristics
of physician offices and hospitals,
produces a rich data set to evaluate the
effects of the ACA according to different
practice characteristics.
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Changes to the Health Care Surveys
ACA funded Improvements to
NAMCS/NHAMCS
• State-Based Estimates of Clinical Preventive
Services
• Clinical Data to Evaluate the Quality of Care to
Prevent Heart Disease and Stroke “Lookback”
ASPR funded sample increases to NHAMCS
ASPE funded questions of practice
characteristics
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National Ambulatory Medical Care
Survey (NAMCS)
• Visits to non-federal, office-based
physicians primarily engaged in patient
care
• Data at practice, clinician, and patient level
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NAMCS Changes
2012 and 2013
• Affordable Care Act (ACA) funding will allow for
major increases in sample– from 3,000
physicians to nearly 20,000
• Main impetus: monitoring and evaluation of the
effects of health reform with greater precision
and more geographic detail
• Provides state-specific estimates of care
provided in physician office and community
health centers for 34 states
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Quality of Care to Prevent
Heart Disease and Stroke
• Identifies patients at high risk
• Expands the current data collection to
include risk factors and clinical management
12 months prior to the office visit
• Permits the monitoring and evaluation of
clinical preventive services for prevention
and treatment of the Nation’s major cause of
death and disability: Heart Disease and
Stroke
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Additional Data on the Healthcare
Workforce NAMCS 2013
• How team based care is provided
• Staffing patterns related to the
provision of preventive services
• How advanced practice nurses and
physician assistants are being used
• Is the practice certified as a PatientCentered Medical Home and by whom
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NAMCS Mail Survey
• Are you currently accepting new patients?
• From those new patients, which of the
following types of payment do you
accept?
• What percent of your current patients
have Medicaid/CHIP?
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Percent of Office-Based Physicians Accepting
New Medicaid Patients:2011
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Source: Decker, SL. In 2011, nearly one-third of physicians sid they would
not accept Medicaid patients but rising fees may help. Health
Aff.2012;31(1673-1679)
National Hospital Ambulatory Medical
Care Survey (NHAMCS)
• NHAMCS’ objectives are similar to NAMCS,
but with a focus on care in different settings:
–
Outpatient Departments
–
Emergency Departments
–
Hospital-based Ambulatory Surgery Centers
(since 2009)
–
Free-standing Ambulatory Surgery Centers
(since 2010)
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NHAMCS changes
• Many of the NAMCS changes also
apply to NHAMCS:
–
Computerization of data collection
–
Lookback module
–
Lab values
• 2012 core sample will remain the
same, but augmented by supplemental
sample of EDs only in five states
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Role of the ED under Health Reform
• 2012 -- Adds 167 EDs to the NHAMCS
sample in the 5 most populous states – CA
TX NY FL IL
• Permits state-specific estimates of length of
visit, wait time and volume by payment type.
• Supports state activities to monitor the
effects of the expansion of Medicaid
programs on Emergency Departments
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For More Information
http://www.cdc.gov/nchs/nhcs.htm
E-mail [email protected]
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