The TEP weighed the strengths and limitations of three data sources for monitoring provider reports of access, including the National Ambulatory Medical Care Survey (NAMCS), the National Ambulatory Medical Care Survey - Electronic Medical Records/Electronic Health Records Mail Survey (NAMCS-EMR), and the SK&A provider survey. (Additional detail on these data sources is included in Appendix B.) Given current designs and limited understanding of the design and methods of the SK&A survey, the NAMCS and NAMCS-EMR emerged as the recommended datasets for measuring provider reports of access for the Medicaid population.
Conducted annually by NCHS, NAMCS gathers data from office-based physicians to provide information on the provision and use of ambulatory medical care services in the U.S. The main advantage of NAMCS is that it includes several provider-reported items on access to care for Medicaid patients, including whether the provider is accepting new patients and new Medicaid patients, policies for same-day appointments, and the percent of provider revenue from Medicaid. Additionally, the survey includes items on the use of mid-level providers such as physician assistants and nurse practitioners. The main limitations of NAMCS are the limited sample size (although it was increased to 15,590 office-based physicians and 6,336 community health center providers in 2012) and that data are restricted with state identifiers only available through the NCHS RDC. State-level estimates are only available for the thirty-four largest states in 2012 and 2013. For previous years and for smaller states, a potential solution is to use two- or three-year averages.
Funded by the Office of the National Coordinator for Health Information Technology (ONC) and conducted by NCHS, NAMCS-EMR is a supplemental mail survey to the NAMCS that explores the adoption of electronic medical records (EMRs) or electronic health records (EHRs) among providers. Since 2008, the NAMCS-EMR has been mailed to physicians who are eligible for NAMCS but who were not selected in the regular NAMCS sample. Beginning in 2010, the sample was designed to produce state-level estimates and the sample size was increased to 10,301. The NAMCS-EMR includes several of the same access measures as the NAMCS. Like NAMCS, data use is restricted, with state identifiers only available through the NCHS RDC.
The company SK&A manages a database with information on over two million healthcare practitioners. Every six months, SK&A's full time, in-house research associates make calls to providers to verify names, titles, phone numbers, and fax numbers. Supplemental information is gathered, including items on access, such as whether the physician is accepting new patients with varying types of insurance. The potential advantages of the SK&A data are the timeliness of data (six month data collection cycles and monthly data updates) and the large sample size used to generate state-level estimates. However, access to the data is limited by cost, and public documentation does not allow researchers to fully assess the survey methods and full questionnaire. The TEP members were largely unaware of the survey and unable to assess its suitability for HHS's needs.