Form CMS-10303 Advance Letters and Focus Group Discussion Protocols

ATTACHMENT C
ADVANCE LETTERS

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to
persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

CMS or RTI Letterhead
Dear Dr. [FIRST NAME] [LAST NAME]:
I am writing to ask for your help with an important study of the Medicare Physician Hospital
Collaboration (PHC) Demonstration. The agency that oversees Medicare, the Centers for
Medicare & Medicaid Services (CMS) has asked RTI International, a not-for-profit research
organization, to conduct an evaluation of this important demonstration. Part of the evaluation
includes conducting physician focus groups.
You have elected to participate in the Medicare Physician Hospital Collaboration Demonstration
program and CMS would like to understand this decision. The purpose of the focus group is to
gather physician feedback so that CMS can take physicians’ views into consideration when
monitoring this demonstration and evaluating potential changes.
In a few days, a representative from RTI International will call you to ask for your participation
in our focus group. It will be held on XXXXX at XXXXXX. The focus group will last no longer
than one hour.
Please be assured that your participation is completely voluntary and that all perspectives you
provide during the focus group will be kept confidential to the extent provided under law. We are
required by federal law to protect this information. Neither you nor your practice will be
identified by name in the reports from this study. If you have questions related to your rights as a
survey respondent, you may call RTI’s Office of Research Protections toll-free at 1-866-2142043. If you have questions about this study, please contact us toll-free at 1-XXX-XXX-XXXX
or by e-mail at XXXX@rti.org. According to the Paperwork Reduction Act of 1995, no persons
are required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0938-XXXX. The
time required to complete this information collection is estimated to average (1 hours) or (60
minutes) per response, including the time to review instructions, search existing data resources,
gather the data needed, and complete and review the information collection. If you have
comments concerning the accuracy of the time estimate(s) or suggestions for improving this
form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer,
Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
Your help is extremely important to the success of the Medicare program and CMS, and we
thank you in advance for your participation.
Sincerely,

Leslie M. Greenwald, PhD
RTI Project Director
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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to
persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

ATTACHMENT D
FOCUS GROUP DISCUSSION PROTOCOL

D-1
INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to
persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

MEDICARE PHYSICIAN HOSPITAL COLLABORATION DEMONSTRATION
DISCUSSION GUIDE: PHYSICIANS PARTICIPATING IN THE DEMONSTRATION
Purpose: The purpose of this discussion is to gain a better understanding of how the Medicare
Physician Hospital Collaboration Demonstration has impacted the relationship between this
hospital and affiliated physicians. In particular, we are interested in how the demonstration may
have changed physician and staff work relationships, processes of care, and impact on patient
quality of care.
No responses will be attributed to individuals. According to the Paperwork Reduction Act of
1995, no persons are required to respond to a collection of information unless it displays a valid
OMB control number. The valid OMB control number for this information collection is 0938XXXX. The time required to complete this information collection is estimated to average
( 1 hour) or (60 minutes) per response, including the time to review instructions, search existing
data resources, gather the data needed, and complete and review the information collection. If
you have comments concerning the accuracy of the time estimate(s) or suggestions for
improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports
Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
GENERAL INFORMATION
1. Please describe the way that physicians are organized at this hospital. Has that changed in
any way as a result of the decision of the hospital to participate in the Medicare Physician
Hospital Collaboration Demonstration?
2. Were you eager, or resistant, to participate in the demonstration? Has that changed at all
over time?
3. Why did each of you decide to participate, or not participate, in the Medicare Physician
Hospital Collaboration Demonstration?
GAINSHARING HOSPITAL RELATIONSHIP WITH PHYSICIANS
1. How would you describe the relationship this hospital has with its affiliated physicians?
Has that relationship changed as a result of the gainsharing initiative? In what way?
2. How would you describe the targeted physician behavioral changes prompted by the
gainsharing initiative? How much were physicians involved in the development of these
targeted changes?
3. What generally are physicians’ views of the targeted changes resulting from gainsharing?
Has that view changed in any way over time, particularly after implementation?
4. Do physicians have any view of the likely success of the gainsharing targeted behavior
changes? What appear to be their impact on quality of care? Costs?
5. In your judgment, are gainsharing arrangements just reinforcing changes in care that had
already been made? Or are they facilitating real changes in care processes, organization,
and delivery?

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to
persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.

GAINSHARING PAYMENTS
1. Have physicians actually received gainsharing payments yet? If so, how did that process
work? Have there been any disagreements or complications in making the gainsharing
payments to physicians?
2. What is your view of the incentives these payments provide to physicians to modify how
their practice? Is it a strong incentive? Weak incentive? Is the payment too low or too far
removed from the behavioral change?
3. What is your view of the methodology used to determine payment amounts?
4. Have the gainsharing payments changed the way you practice in this hospital? Do you
view these changes as positive--or perhaps as negative?
QUALITY MONITORING SYSTEMS
1. Do you see reports about quality, safety, or satisfaction with care? How often do reports
come out? How do you personally use these types of information to improve quality of
care? How has this changed as a result of the PHC Demonstration?
2. In what areas does this institution excel? In what areas does it need to improve? Has
gainsharing impacted issues of quality of care in which improvement was most needed?
PATIENT SATISFACTION
1. Do you know if this hospital contracts with an outside firm to conduct patient satisfaction
surveys and analyze the data? Is this information shared with physicians?
2. Do you have any sense of your patient’s satisfaction with care at this hospital? Has that in
any way changed as a result of the demonstration?
SUMMARY
1. Overall, how would you describe the impact of the PHC Demonstration on this hospital,
and its affiliated physicians?
2. What is your overall view of the gainsharing model? Does it hold promise as a policy tool
to improve quality of care and/or reduce costs?
3. How would you improve or otherwise modify the gainsharing model implemented at this
hospital should the project continue in the future?
Thank you for your time.

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INFORMATION NOT RELEASABLE TO THE PUBLIC UNLESS AUTHORIZED BY LAW: This information has not been publicly
disclosed and may be privileged and confidential. It is for internal government use only and must not be disseminated, distributed, or copied to
persons not authorized to receive the information. Unauthorized disclosure may result in prosecution to the full extent of the law.