Data Sources (cont.)

1. Data Sources(cont.) Thus, rates calculated from Version 3.0 responses are compared with benchmarks from the NCBD, 2006. The Version 4.0 responses from 2009 are compared with the 2008 NCBD and from 2010 are compared with 2009 NCBD. Because of the wholesale changes in the questionnaire, changes in rates are only meaningful when compared to changes in the relevant benchmark. In most cases, when composites are presented, in order to make responses from 2008 comparable, a composite is constructed from Version 3.0 questions to match the Version 4.0 composite. For “Getting Care Quickly” and “Getting Needed Care,” that means only two questions are used for 2008, rather than four questions as in reports based only on CAHPS 3.0. For “How Well Doctors Communicate,” only responses for beneficiaries who indicate they have a personal doctor are included. The exception is the “Customer Service” composite, where Version 4.0 questions are not comparable to Version 3.0. In that case, the original Version 3.0 composite is presented in comparison to Version 3.0 benchmarks. It should also be recognized that the general tenor of the questions supporting “Getting Needed Care” and “Customer Service” shifted between CAHPS versions 3.0 and 4.0. In CAHPS 3.0 the question was framed as “How much of a problem was it to…?”, while in CAHPS 4.0 the question was framed as “How often was it easy to…?” MHS results presented herein are comparable to the NCBD for the year and version specified. The NCBD collects CAHPS results voluntarily submitted by participating health plans and is funded by the AHRQ and administered by Westat, Inc. Both benchmarks and TRICARE results are adjusted for age and health status. Differences between the MHS and the civilian benchmark were considered significant at less than or equal to 0.05, using the normal approximation. The significance test for a change between years is based on the change in the MHS estimate minus the change in the benchmark, which is adjusted for age and health status to match MHS. T-tests measure the probability that the difference between the change in the MHS estimate and the change in the benchmark occurred by chance. If p is less than 0.05, the difference is significant. Tests are performed using a z-test and standard errors calculated using SUDAAN to account for the complex stratified sample. The HCSDB has been reviewed by an Internal Review Board (and found to be exempt) and is licensed by DoD. Beneficiaries’ health plans are identified from a combination of self-report and administrative data. Within the context of the HCSDB, Prime enrollees are defined as those enrolled at least six months. RVUs are used by Medicare and other third-party payers to determine the comparative worth of physician services based on the amount of resources involved in furnishing each service. MHS uses several different RVU measures to reflect the relative costliness of the provider effort for a particular procedure or service. In this report, we used Enhanced Work RVUs to measure both direct and purchased care outpatient workload. Enhanced Work RVUs were introduced by MHS in FY 2010 and account for units of service (e.g., 15-minute intervals of physical therapy) to better reflect the resources expended to produce an encounter. See http://www.chevents.com/navymed/downloads/analytics/21_April_Wednesday/PPS(Changes%20in%20RVUs).Funk..ppt for a more complete description of Enhanced Work RVUs. Appendix 130