Survey Enhancements to Inform the Affordable Care Act National Center for Health Statistics (NCHS)

Clarice BrownDivision of Health Care Statistics

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICESCenters 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 non-

institutionalized 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

Q1 2009

Q2 Q3 Q4 Q1 2010

Q2 Q3 Q4 Q1 2011

Q2 Q3 Q40

10

20

30

40

50

60Pe

rcen

t

Uninsured

Public

• 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.

Private

25.2

35.6

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)

7

0

10

20

30

40

20

26.2

10.5

32.4Chart Title

Perc

ent

Percent of persons in families with selected financial burdens of medical care: U.S., Jan–Jun 2011

• Cohen RA, Gindi RM, Kirzinger WK. Burden of medical care cost: Early release of estimates from the National Health Interview Survey, January–June

• 2011. National Center for Health Statistics. March 2012

NHIS Sample sizes

• 2010 – 34,328 households and 89,976 persons– 20 states

• 2011– 35,509 households and 101,875 persons– 32 states

• 2012– 51,000 households and 127,500 persons– 41 states

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Percentage of persons aged 18-64 who were uninsured at the time of interview: 2011

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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.

Percentage not significantly different from U.S. overall

Percentage significantly higher than U.S. overall

Percentage significantly lower than U.S. overall (21.3%)

Estimate does not meet NCHS standard for precision

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• Ownership/ staffing• Practice sizeClinician• Specialty• Hours/ week• Demographics

Patients• Demographics• Medical conditions• Insurance statusEncounter• Diagnosis• Services ordered or provided• 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 NHAMCSASPE 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 Changes2012 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 Patient-

Centered 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

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

E-mail CRB6@cdc.gov

http://www.cdc.gov/nchs/nhcs.htm