OMB Memo

Request: The Census Bureau plans to conduct additional research under the generic clearance for questionnaire pretesting research (OMB number 0607-0725). We will be conducting early stage scoping and cognitive interviews for a new question to appear on the 2019 Services Annual Survey (SAS).

Purpose: The Services Annual Survey (SAS) was developed to provide estimates of revenue and other measures for most traditional service industries. The United States Code, Title 13, authorizes this survey and provides for mandatory responses. For more information about the Services Annual Survey see https://www.census.gov/programs-surveys/sas/about.html.

This project is sponsored by the Economy Wide Division who are interested in implementing a new question to the Services Annual Survey that is intended to identify health care providers billing for telemedicine services and to capture the percentage of patient encounters and visits that can be categorized as telemedicine services. The new question to be tested will focus on select industries in the 621 and 622 NAICS sectors.

In recent years, the methods providers use to evaluate, diagnose, and treat patients have evolved to incorporate new communications’ technology (e.g., mobile or landline telephones, internet connections). These telemedicine services can include remote patient monitoring, two-way live video interactions between patients and providers, internet consultations between health care providers, and store-and-forward transmission of patient records. Both ambulatory health care providers and hospitals may provide telemedicine services. Examples include conducting diagnostic tests, closely monitoring a patient’s progress after treatment or therapy, and facilitating access to specialists that are not located in the same place as the patient.

Staff from the Data Collection Methodology & Research Branch within the Economic Statistical Methods Division (ESMD) of the Census Bureau will be conducting early stage scoping and cognitive interviews regarding this question, with support from staff from the Economy Wide Division. For this testing, we will interview up to 50 respondents.

Method:

The method of research will be cognitive interviews, which are interviews aimed at understanding the way that a person interprets the items that are being presented to them, in order to understand and reduce potential measurement error before these questions are included in the survey. We will also be asking early stage scoping questions, which have a broader focus on the respondents’ understanding and familiarity with the concepts being addressed in the survey, the way their company’s records are organized, and the terminology that they use in reference to these concepts. Early stage scoping (Stettler and Featherston, 2012) is a pretesting method designed to address the Missing Link (Willimack and Snijkers, 2012). The Missing Link refers to a conceptual gap between the questions on a survey and the concept they are designed to measure.

Potential respondents will either be contacted via email or telephone to schedule an interview. These interviews will be conducted over the phone and are expected to take up to 30 minutes. There are two variations of the new telemedicine question. Respondents will be given the variation that matches with the industry they are classified in. The proposed questions are attached, (Attachment A).

Researchers will discuss how the respondent’s company defines telemedicine/telehealth, whether the practice engages in these services, how they track these patient interactions in their records, and any thoughts they may have about where the practice will be in a few years with regard to telemedicine/telehealth.

The interviews will follow a semi-structured interview protocol, (Attachment B).

Subject area specialists from the Census Bureau will participate in most, if not all, of the cognitive interviews. Their primary purpose will be for observation, but they may also assist in cases where additional clarification of the subject matter is required, and to provide information on the purpose and uses of the survey.

Sample Population:

Staff from the Healthcare and Education Services Branch of the Economy Wide Division will provide DCMRB staff with a list of respondent contact information from the most recent Services Annual Survey.

Two versions of the question have been drafted for testing. Both questions ask respondents to report billable patient visits for telemedicine services. The difference between the first and the second version is that while the first targets the broader question of patient encounters in ambulatory health care settings, the second focuses on hospitals’ outpatient activity. For context, the full Services Annual Survey is attached, (Attachment C).

Approximately 50 interviews will be conducted in total. This number of interviews was selected because it is a manageable number of interviews for the time period allotted, and should be large enough to provide reactions to the questions and definitions that are representative of the survey population.

Different criteria will be used for recruiting. Fifty interviews will allow us to contact different geographical areas which may reflect differences in the utilization of telemedicine services. Researchers will make an effort to recruit from both urban and rural establishments. Researchers will also attempt to recruit from practices that are classified as both for-profit, and not- for- profit as well as those with taxable versus tax exempt status. Additionally, we plan to conduct interviews with a variety of sizes and different types of health care service providers. Recruitment will focus on the following NAICS:

Ambulatory Health Care Services:

• 6211: Offices of Physicians

• 6212: Offices of Dentists

• 6213: Offices of Other Health Practitioners (including mental health practitioners (except physicians))

• 6214: Outpatient Care Centers

• 6216: Home Health Care Services

Hospitals:

• 6221: General Medical and Surgical Hospitals

• 6222: Psychiatric and Substance Abuse Hospitals

• 6223: Specialty (except Psychiatric and Substance Abuse)

Sample recruitment:

We will contact potential participants via phone or email, explain the nature of our research, and ask them to participate in our study. For a draft of the phone and email recruiting scripts, see (Attachment D). The sample of participants will be those who are able to be contacted and who agree to participate in the study. Efforts will be made to sample respondents who are the individuals most likely to fill out the Services Annual Survey for their establishment.

Participants will be informed that their response is voluntary and that the information they provide is confidential and will be seen only by Census Bureau employees or those with Special Sworn Status who are involved in the research project. We will not be providing monetary incentives to participants in this study. Once interviews are scheduled, researchers will send respondents a confirmation via email, and may conduct reminder calls a few days before the meetings.

Timeline:

Recruiting for these interviews will begin in January 2019. Interviews will be conducted from January 2019 through April 2019.

We anticipate that each interview will include one participant. We estimate that, on average, the interviews will take thirty minutes. Thus, the total estimated burden for completed interviews is 25 hours. (50 interviews X 1 participant X 0.5 hour).

Our goal is to schedule up to 50 interviews. We anticipate that to reach 50 potentially interested persons, we may need to conduct 200 total calls. The anticipated maximum burden for a refusal or a non-response is two minutes; five minutes for those who agree to meet. As such, we estimate the maximum associated recruiting burden to be approximately 7.5 hours (50 screening calls x 5 minutes = 250 minutes; 150/nonresponses x 2 minutes = 300 minutes; 250 + 300 minutes = 10 hours). Thus, the estimated total public reporting burden for this research is approximately 35 hours.

Language:

Testing will be conducted in English only.

The contact person for questions regarding data collection and statistical aspects of the design of this research is listed below:

Rebecca Keegan

Data Collection Methodology & Research Branch

Economic Statistical Methods Division (ESMD)

U.S. Census Bureau

Washington, D.C. 20233

(301) 763-6003

Rebecca.Keegan@census.gov

cc:
Nick Orsini (DIR)        “          ”
Carol Caldwell             (ESMD)    “          ”
Diane Willimack             (ESMD)     “          ”
Jim Liu (ESMD)     “          ”

Amy Anderson Riemer  (ESMD)     “          ”

Kenneth Herrell (ESMD) “ “

Alice Zawacki (CES) “ “

Catherine Buffington (ADEP) “ “

Andrew Baer (EWD) “ “

Kimberly Moore (EWD) “ “

Danielle Norman (PCO) “ ”

Mary Lenaiyasa (PCO) “ “

Jennifer Hunter Childs (ADRM) “ “

Jasmine Luck (ADRM) ” “