MEPS.MPC.RFI.pdf

Request for Information Medical Expenditure Panel Survey - Medical Provider Component Page 1 of 5

Medical Expenditure Panel Survey-Medical Provider Component (MEPS-MPC) procurement

Request for Information (RFI) - HHS-AHRQ-RFI-25-10001

NOTE: THIS IS A REQUEST FOR INFORMATION (RFI) ONLY. This RFI is issued solely for information and market research planning purposes. This RFI shall not be construed as an obligation on the part of the

Government. This is NOT a Request for Quotations or Proposals. No solicitation document exists, and the

Government may or may not issue a formal solicitation as a result of the responses received to this RFI.

The information provided in this RFI is subject to change. RFI respondents are advised that the

Government will not pay for any information or administrative costs incurred in response to this RFI; all costs associated with responding to this RFI will be solely at the interested party’s expense. Failure to respond to this RFI will not preclude participation in any future solicitation. Any information received will become the property of the Government and will not be returned to the respondent. Respondents should not send any proprietary data, trade secrets, business sensitive information, or information considered confidential.

Background information

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

The goal of the MEPS Medical Provider Component (MEPS-MPC) survey is to collect data from a sample of providers (physicians, hospitals, home health agencies, and pharmacies) who provided medical care to MEPS Household Component (MEPS-HC) respondents. The MPC collects detailed information on the use of medical services, dates of visits/services, diagnosis and procedure codes for medical visits/encounters, and the charges, payments, and source of payments for the medical services provided. In addition to payments, and source of payments for each prescription fill or refill, the MPC collects from pharmacies the quantity dispensed, days supply, and either National Drug Codes (NDCs) or detailed information about the drug. The MPC supplements and/or replaces information received from HC respondents regarding their health care.

The MPC Questionnaires are designed to obtain information on both the medical and billing characteristics of medical events while the Contact Guides contain a script that guides data collection specialists through an explanation of the MEPS-MPC, its purpose, and the data collected (see https://meps.ahrq.gov/survey_comp/survey.jsp#MPC for all MPC Questionnaires and Contact Guides by year).

http://www.meps.ahrq.gov/mepsweb/about_meps/survey_back.jsp https://meps.ahrq.gov/survey_comp/survey.jsp#MPC

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Currently, MPC data collection is achieved as follows:

1. Household Component Data Collection. During the Household Component interviews, household respondents report medical visits, hospital stays, and prescribed medicines for all members of the dwelling unit. These interviews are conducted by the Contractor for the MEPS- HC contract.

2. Authorization Forms. During the household interviews, MEPS-HC interviewers collect Authorization Forms (AFs) from participating household respondents, authorizing the MEPS- MPC contractor to contact medical providers (such as hospitals, emergency rooms, physicians, outpatient departments, home health agencies, pharmacies, and long-term care facilities) directly to obtain additional information regarding the charges and expenses these respondents incurred for their health services. The MEPS-HC contractor then provides these authorization forms to the MEPS-MPC contractor. Due to data collection costs and budgetary constraints, AHRQ currently subsamples office-based providers for MPC data collection, prioritizing events that likely have higher expenditures and/or Medicaid coverage.

3. Initial Contact with Medical Providers. The MEPS-MPC contractor contacts medical providers and sends the AFs from the respondents to the providers prior to collecting any medical records or billing data.

4. Collecting Data from Medical Providers. The medical providers then provide information on each medical event (including payment data from each source of payment), either over the phone with a MEPS-MPC interviewer, or by sending billing records (which are typically received as PDF files), which are then abstracted into a database.

5. Identifying Separately-Billing Doctors (SBDs). For hospital events (inpatient stays, emergency department visits, and outpatient department visits), the medical providers also send medical records (typically received as PDF files), which are then analyzed to identify potential Separately- Billing Doctors (SBDs). SBDs are medical providers who provided care during a hospital event, such as a radiologist or surgeon who provides care at a hospital facility, then bills separately for physician services. During abstraction of medical records, potential SBDs are identified by reviewing the records for the names of physicians.

6. Collecting Data from SBDs. The potential SBDs are then contacted, AFs are sent, and the SBDs provide billing information for their services. This ensures a complete picture of payments for hospital events, which typically include a facility fee as well as SBD fees.

With the methodology currently used, a high percentage of physicians identified as potential

SBDs are identified by the contacted billing services/offices as not having rendered a bill for services. This can happen for various reasons, such as a referring physician’s name being on the medical records. Other common reasons are department head names appearing in the record and other situations where the physician did not actually bill for care, as well as the physician's professional fees turn out to be actually billed by the hospital itself. Contacting these doctors results in a disavowal, which results in undue burden on medical providers who participate in

MEPS as well higher cost for the MEPS project. For this reason, AHRQ subsamples potential

SBDs for follow-up, prioritizing ones that are more likely to bill separately and have higher likely expenditures. Rates of disavowal, refusal and other completion codes are in the MPC

Methodology Report referenced below.

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7. Data Processing. Once collected, the data is stored, processed, and edited. The MPC data is matched to the HC data using probabilistic matching techniques. This matched data is sent back to the MEPS-HC Contractor for additional processing and ultimately released to the public as public-use files.

The process of obtaining this data from medical providers has remained largely unchanged for many years. Recently, however, continuing these same processes has become increasingly challenging due to factors such as medical providers being under-staffed, disruptions from the COVID-19 pandemic, concerns about patient privacy and data security, and the diverse IT platforms used for medical data collection. Additionally, the continued adoption of electronic health record (EHR) systems, along with recent requirements from the Office of the National Coordinator (ONC) for Health IT alignment, presents potential opportunities for more efficient data collection.

In 2020, a study was conducted by an outside entity to assess potential areas for improving MPC data collection, including the following tasks, several of which have been implemented in production, while others are undergoing additional investigation:

• Investigate Alternatives to Current Process for Identifying Potential Separate Billing Doctors (SBDs).

• Investigate Models for Determining which SBDs to Field. Recommendations from this task have been successfully integrated into the current MPC processes.

• Investigate Alternatives to the Current Process for Fielding SBDs. Some recommendations from this task are being investigated further in the current MEPS-MPC contract under the follow task:

o Methodological Work on Machine Learning and Natural Language Processing (NLP) Opportunities for Assisting in MPC Record Abstraction

• Increase Use of Electronic Data Collection. Some recommendations from this task are being investigated further in the current MPC contract under the following task:

o Methodological Work for Increasing the Receipt of Electronic Data Submissions from MPC Medical Providers

• Investigate Methods to Increase Collection of Payment Data from Pharmacies. After thorough review, AHRQ determined that the recommendations from this task are unlikely to yield significant benefits, and further investigation in this area is discouraged.

The following reports related to the 2020 MPC Evaluation Study and the corresponding follow-up investigations can be found https://github.com/HHS-AHRQ/GFI-for-MPC-RFI:

• MEPS-MPC Evaluation: Final Project Report (Nov 25, 2020)

• Machine Learning and NLP - Summary Report

• Electronic Data Submission for MEPS-MPC

• Electronic Health Records in MEPS-MPC https://github.com/HHS-AHRQ/GFI-for-MPC-RFI

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Additional information and reports on the MPC project can be found on the MEPS website:

• MPC Methodology Report 2022 Data Collection:

www.meps.ahrq.gov/data_files/publications/annual_contractor_report/mpc_ann_cntrct_methrpt.pdf

• MPC questionnaires: https://www.meps.ahrq.gov/mepsweb/survey_comp/survey.jsp#MPC

Goal of RFI: The goal of this RFI is to obtain information that would help the government better understand the current technological innovations and systems in the healthcare industry to inform and improve this and future efforts related to the MEPS-MPC project. Specifically, we seek information on the current state of the medical systems’ usage of electronic billing systems and medical records, as well as potential opportunities for utilizing newer technologies to enhance the efficiency and effectiveness of the MEPS-MPC project. We seek input from professional organizations, including those that represent physicians and hospital interests, government contractors, and academic institutions. We also seek input from consultants that have familiarity and experience across various billing environments.

Medical Data Landscape

• What types of billing systems or services are commonly used by medical providers?

• What types of Electronic Health Record (EHR) systems are commonly used by hospitals?

• For which types of providers can technology be used to automate or partially automate extracting data from diverse billing and record systems to create uniform data sets?

• Are there commonalities between hospital system software currently implemented that can be leveraged to obtain all or a portion of the MPC data elements?

• How fast are legacy hospital billing systems being phased out? Hospital abstraction is challenging due to the presence of many obscure codes for payments/discounts, which can often require callbacks to the point-of-contact for clarification.

• How common is it for hospital systems, which own multiple hospitals, clinic sites, or physician practices, to have multiple billing systems within the same organization??

• For hospital systems that bill insurers for the professional fees for their physicians on staff, are we accurately capturing all these payments in the billing records we receive from hospitals?

Labor and staffing

• What labor types would be needed to successfully fulfill this project?

• What is a competitive salary for the proposed labor types? Please include location-specific information.

General

• Is there something else the Government should know or something the Government should consider changing for this requirement?

• What cost-saving measures could be implemented without compromising the integrity of the data?

http://www.meps.ahrq.gov/data_files/publications/annual_contractor_report/mpc_ann_cntrct_methrpt.pdf https://www.meps.ahrq.gov/mepsweb/survey_comp/survey.jsp#MPC

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SUBMISSION INSTRUCTIONS

Interested parties are invited to address the questions above in this RFI. Only one submission will be reviewed per vendor. That submission can respond to one or more questions above. Only electronic submissions will be accepted.

Please submit responses to this RFI to Tara Bertolini (tara.bertolini@ahrq.hhs.gov) no later than 12:00

PM Eastern Time, on or before October 18, 2024. Please include the RFI number in the Subject Line of the email and include the response submission as an attachment.