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Jan 28 -- The National Center for Health Statistics (NCHS) invites public comment on the proposed revised National Ambulatory Medical Care Survey (NAMCS). The goal of the project is to assess the health of the population through patient use of physician offices, community health centers (CHCs), and to monitor the characteristics of physician practices.
 
The National Ambulatory Medical Care Survey (NAMCS) was conducted intermittently from 1973 through 1985, and annually since 1989. The survey is conducted under authority of Section 306 of the Public Health Service Act (42 U.S.C. 242k).

NAMCS is part of the ambulatory care component of the National Health Care Surveys (NHCS), a family of provider-based surveys that capture health care utilization from a variety of settings, including hospital in-patient and long-term care facilities. NCHS surveys of health care providers include NAMCS, the National Hospital Ambulatory Medical Care Survey (NHAMCS), the National Hospital Care Survey, and National Post-acute and Long-term Care Study.

An overarching purpose of NAMCS is to meet the needs and demands for statistical information about the provision of ambulatory medical care services in the United States; this fulfills one of NCHS missions, to monitor the nation's health. In addition, NAMCS provides ambulatory medical care data to study: (1) The performance of the U.S. health care system, (2) care for the rapidly aging population, (3) changes in services such as health insurance coverage change, (4) the introduction of new medical technologies, and (5) the use of electronic health records (EHRs). Ongoing societal changes have led to considerable diversification in the organization, financing, and technological delivery of ambulatory medical care. This diversification is evidenced by the proliferation of insurance and benefit alternatives for individuals, the development of new forms of physician group practices and practice arrangements (such as office-based practices owned by hospitals), and growth in the number of alternative sites of care.

Ambulatory services are rendered in a wide variety of settings, including physician offices and hospital outpatient and emergency departments. Since more than 65% of ambulatory medical care visits occur in physician offices, NAMCS provides data on the majority of ambulatory medical care services.

In addition to health care provided in physician offices and outpatient and emergency departments, community health centers (CHCs) play an important role in the health care community by providing care to people who might not be able to afford it, otherwise. CHCs are local, non-profit, community-owned health care settings, which serve approximately 28 million individuals throughout the United States.

This revision seeks approval to adjust the CHC sample size. In 2021, the sample size will be reduced to 50 CHCs, and in 2022 allocated funds will cover a sample size of 110 CHCs. In 2023 the sample size will increase to 115 CHCs. There will be no modification to the office-based physician sample. In the 2021 survey year we will include the supplemental sample of physicians from which visit data are collected through submission of EHRs with the approved 2019 sample size, and for subsequent survey years when deemed necessary. The annualized 2021-2023 NAMCS sample size is projected to be 6,000 office-based physicians and 92 CHCs. Questions on the traditional office-base physician survey will be modified for clarification and to keep current with medical practice and terminology. In 2020 we are also seeking to include the potential for experiments involving physician incentives for some office-based physicians. In 2021, data collection for CHCs will transition from manual abstraction to be sent through EHRs. A set-up fee will be allotted to sampled CHCs to offset the cost of this new data collection method. With this transition, a new CHC facility interview will be implemented and personally identifiable information (PII) will be collected from both the CHCs, and physicians who submit EHR data. For both the traditional office-based physicians and CHCs, we will continue COVID-19 questions in 2021 and for subsequent data years where information is pertinent. We will also begin to conduct methodological work to improve upon the survey.  
  
NAMCS website: https://www.cdc.gov/nchs/ahcd/index.htm  
Draft survey forms and supporting statement: https://www.dropbox.com/sh/e15v9fesdv64hn0/AAAEYzQfsnsNlHAupgME1h6Ua?dl=0
FR notice inviting comments: https://www.federalregister.gov/documents/2021/01/28/2021-01691/proposed-data-collection-submitted-for-public-comment-and-recommendations
 
Point of contact: Sonja Williams, M.P.H., Acting Team Lead, Ambulatory Care Team, Ambulatory and Hospital Care Statistics Branch, Division of Health Care Statistics, National Center for Health Statistics/CDC 301-458-4774 iwn2@cdc.gov

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