Medicare Gainsharing Demonstration Evaluation: Physician Focus Groups

Forms and Documents

Document Name	Status
Form CMS-10303 Medicare Gainsharing Demonstration Evaluation: Physician Focus Groups (CMS-10303) Form and Instruction	Modified
CMS-10303.Supporting Statement Part A and B.pdf Supporting Statement B	2011-06-14
CMS-10303.Crosswalk document.docx Supplementary Document	2011-06-14
CMS-10303.Supporting Statement Part A (9-29-11 - clean).docx Supporting Statement A	2011-09-29

IC Document Collections

IC ID	Document Title	Status
192883	Medicare Gainsharing Demonstration Evaluation: Physician Focus Groups (CMS-10303) Form and Instruction	Modified

ICR Details

OMB Control No: 0938-1103	ICR Reference No: 201107-0938-002
Status: Historical Active	Previous ICR Reference No: 201005-0938-004
Agency/Subagency: HHS/CMS	Agency Tracking No:
Title: Medicare Gainsharing Demonstration Evaluation: Physician Focus Groups
Type of Information Collection: Revision of a currently approved collection	Common Form ICR:  No
Type of Review Request: Regular
OIRA Conclusion Action: Approved with change	Conclusion Date: 10/23/2011
	Date Received in OIRA: 07/06/2011
Terms of Clearance:

	Inventory as of this Action	Requested	Previously Approved
Expiration Date	10/31/2014	36 Months From Approved	08/31/2013
Responses	288	0	77
Time Burden (Hours)	288	0	77
Cost Burden (Dollars)	0	0	0

---

Abstract: The proposed physician focus groups are part of the evaluation of the Centers for Medicare and Medicaid Services (CMS)'s Medicare Physician Hospital Collaboration Demonstration. The Congress, under Section 646 of the Medicare Modernization Act (MMA) of 2003 permitted CMS to conduct demonstrations to test methods for the provision of incentives for improving the quality and safety of care and achieving the efficient allocation of resources. The primary goal of the demonstration is to evaluate gainsharing as means to align physician and hospital incentives to improve quality and efficiency. This demonstration plans to use the physician focus group protocols approved by OMB for the DRA 5007 Gainsharing Demonstration (OCN 0938-1103).

---

Authorizing Statute(s): PL: Pub.L. 109 - 171 5007 Name of Law: Deficit Reduction Act (DRA) of 2005
   PL: Pub.L. 108 - 173 646 Name of Law: Medicare Health Care Quality Demonstration Programs
  

Citations for New Statutory Requirements: None

---

Associated Rulemaking Information
RIN:	Stage of Rulemaking:	Federal Register Citation:	Date:
	Not associated with rulemaking

---

Federal Register Notices & Comments
60-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 11248	03/01/2011
30-day Notice:	Federal Register Citation:	Citation Date:
	76 FR 31339	05/31/2011
Did the Agency receive public comments on this ICR? No

---

Number of Information Collection (IC) in this ICR: 1

IC Title	Form No.	Form Name
Medicare Gainsharing Demonstration Evaluation: Physician Focus Groups (CMS-10303)	CMS-10303	Advance Letters and Focus Group Discussion Protocols

---

ICR Summary of Burden

	Total Approved	Previously Approved	Change Due to New Statute	Change Due to Agency Discretion	Change Due to Adjustment in Estimate	Change Due to Potential Violation of the PRA
Annual Number of Responses	288	77	0	211	0	0
Annual Time Burden (Hours)	288	77	0	211	0	0
Annual Cost Burden (Dollars)	0	0	0	0	0	0

Burden increases because of Program Change due to Agency Discretion: Yes

Burden Increase Due to: Miscellaneous Actions

Burden decreases because of Program Change due to Agency Discretion: No

Burden Reduction Due to:

Short Statement: The major revisions to this collection are discussed in the attached crosswalk document.

---

Annual Cost to Federal Government: $60,000

Does this IC contain surveys, censuses, or employ statistical methods? Yes Part B of Supporting Statement

Is the Supporting Statement intended to be a Privacy Impact Assessment required by the E-Government Act of 2002? No

Is this ICR related to the Affordable Care Act [Pub. L. 111-148 & 111-152]? No

Is this ICR related to the Dodd-Frank Wall Street Reform and Consumer Protection Act, [Pub. L. 111-203]? No

Is this ICR related to the American Recovery and Reinvestment Act of 2009 (ARRA)? No

Is this ICR related to the Pandemic Response? Uncollected

---

Common Form ICR:  No

---

On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).

The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:

(a) It is necessary for the proper performance of agency functions;

(b) It avoids unnecessary duplication;

(c) It reduces burden on small entities;

(d) It uses plain, coherent, and unambiguous language that is understandable to respondents;

(e) Its implementation will be consistent and compatible with current reporting and recordkeeping practices;

(f) It indicates the retention periods for recordkeeping requirements;

(g) It informs respondents of the information called for under 5 CFR 1320.8 (b)(3) about:

(i) Why the information is being collected;

(ii) Use of information;

(iii) Burden estimate;

(iv) Nature of response (voluntary, required for a benefit, or mandatory);

(v) Nature and extent of confidentiality; and

(vi) Need to display currently valid OMB control number;

(h) It was developed by an office that has planned and allocated resources for the efficient and effective management and use of the information to be collected.

(i) It uses effective and efficient statistical survey methodology (if applicable); and

(j) It makes appropriate use of information technology.

If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.

Certification Date: 07/06/2011

---