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May 28 -- The National Center for Health Statistics (NCHS) invites public comments to OMB by July 1, 2021 on its 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, health centers (HCs, formerly referred to as community health centers) play an important role in the health care community by providing care to medically underserved populations. HCs serve approximately 29 million individuals throughout the United States.

This revision seeks approval to adjust the HC sample size. In 2021, the sample size will be reduced to 50 HCs, and in 2022 allocated funds will cover a sample size of 110 HCs. In 2023 the sample size will increase to 115 HCs. Additionally, in the 2021 survey year we will not include the supplemental sample of physicians from which visit data are collected through submission of EHRs, with the approved 2019 sample size. These physicians will be included in subsequent survey years when deemed necessary. The annualized 2021-2023 NAMCS sample size is projected to be 5,000 office-based physicians and 92 HCs. Questions on the traditional office-base physician survey will be modified for clarification and to keep current with medical practice and terminology. We are also seeking to include the potential for experiments involving physician incentives for some office-based physicians.   

Beginning in the 2021 survey year, data collection for HCs will transition from manual abstraction to be transmitted through EHRs. A set-up fee will be allotted to sampled HCs to offset the cost of this new data collection method. With this transition, a new HC facility interview will be implemented. The reinterview survey will also be discontinued for HC respondents. Personally identifiable information (PII) will be collected from both the HCs, and physicians who transmit EHR visit data. For both the traditional office-based physicians and HCs, 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  
2021-23 NAMCS proposal to OMB: https://www.reginfo.gov/public/do/PRAViewICR?ref_nbr=202105-0920-006 Click IC List for forms, View Supporting Statement for technical documentation
FR notice inviting comments: https://www.federalregister.gov/documents/2021/05/28/2021-11318/agency-forms-undergoing-paperwork-reduction-act-review
 
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    

For AEA members wishing to submit comments, "A Primer on How to Respond to Calls for Comment on Federal Data Collections" is available at https://www.aeaweb.org/content/file?id=5806

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