The Patient Assessment Survey (PAS) - Group Survey
Background
Since 2005, the PAS project, a statewide collaborative of health plans, provider organizations, and purchasers, has conducted an annual survey to assess patient experience of care delivered by the patient's medical group. This statewide survey initiative produces a common set of performance information for all Californians.
In 2012, eight major California health plans, 139 unique physician organizations (reporting on 178 units), and the 50 purchasers of care represented by the Pacific Business Group on Health (PBGH) collaborated on the PAS project. The 2012 participating groups served 11.6 million commercially insured HMO and POS patients, or almost 95% of the total HMO/POS commercial population in California. The participating health plans in 2012 were Aetna, Anthem Blue Cross, Blue Shield, CIGNA Health Net, Kaiser Foundation Health Plan, United Healthcare, and Western Health Advantage.
PAS in the IHA Pay for Performance Program
Each year a subset of questions from the PAS survey are selected for inclusion in the IHA Pay-for-Performance (P4P) program. Like other P4P measurement domains, IHA seeks public comment on the potential measures it will include from the PAS. The P4P Steering Committee approves all final measures included in the P4P measurement set with significant input from the Technical Measurement Committee and stakeholders during the public comment period. The PAS measures used in the P4P program and their associated questions and weights are available on the IHA website at www.iha.org.
Physician Group Eligibility
All physician groups that serve commercially-insured, HMO and POS patients are eligible to participate in PAS.
Unit of Analysis
The physician group is the unit of analysis. Some physician groups elect to survey geographic or other subunits and these subunits are included as units of analysis.
Survey Instrument
Beginning with 2013 PAS, the core survey will be the same as the Clinician and Group CAHPS™ survey. (CG-CAHPS™). Additional supplemental CAHPS questions and test questions also are included in the PAS survey.
Performance Domains
The PAS key performance are:
- Access to care;
- Coordination of care;
- Doctor-patient interactions;
- Office staff helpfulness;
- Health promotion;
- Overall rating of doctor; and
- Overall rating of care.
Patient Population Surveyed
The survey vendor draws a random sample of 900 patients for each group. These are adult, commercially-insured HMO and POS patients who: 1) have had at least one visit between January and October of the measurement year; and 2) are enrolled in the medical group as of October 31 of the measurement year. The sample is stratified: 450 of the patients visited a primary care physician and the other 450 patients visited a specialist.
Supplemental Survey Options
In addition to the core PAS Group Survey, groups can elect supplemental survey options:
- Geographic or other sub-unit surveying to obtain information on more discrete populations within the physician group.
- Alternative language surveying, in which the patient survey packages include two survey copies: an English-language version and a version in an alternative language (Spanish, Chinese, or Vietnamese). Double stuffing improves patient response rates among populations who may not be fluent in English.
- Doctor-level surveying, to measure patient experience at the individual physician level using the PAS survey. Physician groups use the doctor-level results for quality improvement, compensation and other recognition activities. Pediatricians may be included in the doctor-level survey. In 2012, 29 physician groups elected to participate in the Doctor Survey in addition to the Group Survey.
Physician Group Registration
PAS registration invitations were sent to all California physician groups that have at least 1,000 managed care enrollees.
Registration for the 2013 Patient Assessment Survey begins September 16th and closes September 28th.
Register to participate at http://www.cchri.org/pas_registration/ no later than September 28, 2012.
To participate in PAS, groups must adhere to the following requirements. Failure to meet the deadlines will forfeit the group's participation in the PAS and eligibility for P4P bonus dollars associated with the PAS patient experience measures.
Execute the Participation Agreement at the time of registration.
Submit (or confirm) the physician group logo and executive signature, to be printed on the survey cover letter and survey by October 15, 2012 here.
Download, sign and return the Business Associates Agreement (BAA) by October 15, 2012. The survey vendor BAA may be found here.
Provide information on the group's coding practices and provider specialties, as requested in survey vendor hosted questionnaire by October 15, 2012 here.
Submit data files on all eligible patients, patient visits and providers, from which the patient sample will be drawn by November 19, 2012 here. All data submissions must meet the PAS data quality criteria. Failure to meet the defined criteria will forfeit a group's participation in PAS.
Pay PAS participation fees by January 6, 2013.
Sampling
After final approval of the data files submitted by each group, the survey vendor draws a sample of 900 patients for each group reporting unit. The sample is stratified by visits to Primary Care Physicians (n=450 PCP visits) and Specialty Care Physicians (n=450 specialist visits), and within strata, patients are randomly selected. For patients with an assigned PCP, the visit must be with the assigned PCP. Patients without assigned PCPs are "assigned" by the survey vendor to the most frequently visited PCP. In drawing the sample of patients, only one eligible adult from each household is included.
To increase the likelihood of patient response, sampling is prioritized by the most recent visit date. Patient visits are grouped into three periods: January-April, May-July and August-October. Starting with the most recent period (August-October) visits are randomly selected from the enrollment files of each group.
Survey Fielding
The standard survey protocol consists of two survey mailings and a phone follow-up to non-respondents. The cover letter invites patients to complete the survey online or to use the enclosed print version. The cover letter is printed using the logo of the patient's physician group and signed by the group's medical director. The first mailing occurs in late January. The second occurs in late February and is sent only to those patients who did not respond to the initial survey. Those patients who do not respond after the second mailing are called as a final effort to complete the survey via a phone interview. Mail, web and phone interviews are available in English and Spanish for all patients. The survey cover letter includes a message in Spanish inviting patients to request a Spanish version of the survey via a toll-free number. Groups also have the option to field the survey in an alternative language (Chinese, Spanish, or Vietnamese). Patients receiving the alternative language survey receive a cover letter in English with a translation in the alternative language printed on the back of the letter, in addition to copies of the survey instrument in the alternative language and English.
Response File Preparation
Upon completion of the survey fielding, the survey vendor cleans the data including removing duplicate interviews, merging the response data with the original sample data, and conducting consistency checks between questions. Cases with out-of-bound ages (<18) are removed. To be deemed a usable response the patient either confirms the physician visit or, for PCP patients, provides the name of another PCP in the physician group and confirms that they had a visit with that physician in the past year. If the respondent indicates a physician that cannot be matched to the physician group's provider file, then the respondent's survey is dropped from analysis.
Analysis of the Survey Data
Each medical group's results are adjusted for patient case-mix to control for differences across physician groups. In 2012, the case-mix adjustment model controlled for:
- Age
- Gender
- Education level
- Race/ethnicity-primary language of respondent
- Presence of chronic conditions
- Single item physical health status
- Single item mental health status
- Specialty type of physician that patient rated (44 categories)
- Survey response mode (mail, internet, or phone)
- Language in which survey was completed
- Body Mass Index (BMI)
Reports
Groups receive the following PAS reports:
- Provider Group Summary PAS P4P Report (question and composite level scores)
- PAS Provider Group Report (group detailed results including benchmarks)
- PAS Provider Group Supplemental Report (group trending and PCP/Specialist scores)
- Provider Group Response-level Report (Excel dataset contains de-identified patient-level records for Provider Group’s patients only; records include physician identifier)
- Regional Comparison Report (compares provider groups’ question and composite level scores within geographic region)
Additionally, the results of the survey are made publicly available for use by consumers through the California Department of Managed Health Care's Office of the Patient Advocate consumer website (www.opa.ca.gov/report_card) each October. Performance results will not be publicly reported for any overall rating question or composite whose reliability is less than 0.70.
Key Timelines
- September 16, 2012: Registration site live.
- September 16, 2012: Data checking tool available on the survey vendor's website via the CCHRI website.
- September 28, 2012: Registration deadline. Participation agreement due (via electronic consent during the registration process).
- October 15, 2012: Deadline for groups to submit/confirm group logos/signatures, complete online survey on coding practices and physician specialties and mail signed BAS.
- November 19, 2012: Data files and attestation due to survey vendor.
- January-April, 2013: Survey fielding.
- May 2013: Results for P4P items to groups, plans, and IHA.
- June 2013: Medical group report including all survey items, comparative results, and raw data to medical groups.
- July 2013: Individual doctor report including all survey items, comparative results, and raw data to medical groups.
For More Information
Go to www.cchri.org/programs/programs_pas.html or contact Lydia Paull-Flores at lpaullflores@pbgh.org or at 415.615.6338.
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