Patient Assessment Survey (PAS) 2014

Transcription

1 August 8, 2013 Dear Physician Group: We are writing to invite your physician group s participation in the 2014 California Patient Assessment Survey (PAS) project, a statewide effort to produce comparative performance information on patient experience. This year, the registration period will run from August 12 through August 30, Medical group fees for the PAS group survey are unchanged from last year. This no fee increase was accomplished largely through efficiencies in the surveying process that offset other slightly higher expenses. There are small increases in fees for alternative language surveying and participation in the doctor survey. In addition, groups may register for surveying, and in return a portion of the associated savings are shared with the groups. In the 2013 PAS, nine groups participated in this option. The PAS project is now nested within the governance of the California Healthcare Performance Information System (CHPI). Accordingly, the PAS Participation Agreements for 2014 are between the medical group and CHPI. Each medical group continues to own its own data. CHPI owns the PAS results and has the authority to enter into any third-party agreements to use the PAS results. The PAS Committee evaluates any such third-party data use requests. The PAS Committee also is responsible for the survey instrument and scoring and reporting methods. With the 2014 PAS, we expect to return to reporting two-year trends in PAS results. (Due to the transition to CG- CAHPS in 2013, only the global rating questions could be trended.) This year also will mark a new public reporting opportunity, as the 2013 PAS results will be published in a California-specific insert of Consumer Reports to be released in early The Pacific Business Group on Health (PBGH) continues to manage the PAS, with the Center for the Study of Services (CSS) administering the survey. Existing PAS Committee members have continued to serve and provide continuity in PAS oversight. Importantly, the core surveys and processes also remain the same, as described in the remainder of this letter. PAS Group Survey. The PAS Group Survey, first reported in 2005, is a statewide collaborative of health plans, provider organizations, and purchasers who work together to measure and report patient experience at the physician group-level. The survey is open to all groups who serve California commercially-insured, adult, managed care populations. As in past years, the seven largest California network-model health plans continue to use the results of the PAS Group Survey in their formulas for calculating financial rewards to medical groups through the IHA Pay-for-Performance (P4P) Program. Groups that do not participate in the 2014 PAS will automatically fail to qualify for the patient experience component (20%) of the P4P bonus dollars. PAS Doctor Survey. Physician groups have the option to participate in additional surveying of their individual physicians using the same methods as those applied at the group level. The Doctor Survey provides groups with physician-specific information for quality improvement, recognition, and compensation (see Attachment D). The registration process and data specifications remain the same as last year and are as follows: Registration for the 2014 PAS will occur between August 12th and August 30th, The online registration will permit groups to register for the PAS Group Survey and the PAS Doctor Survey. To register go to: The PAS project information is available at which serves as a portal to access all PAS-related participation information including the PAS Registration Site and the CSS Survey Vendor site the location at which groups upload data submissions and submit/confirm logos and medical director signatures. August 2013 Page 1 of 44

2 You must use your medical-group specific logon identifier and password to register and to submit data. This logon identifier and password is located in this transmission. A list of project requirements for various project tasks, including registration and data submissions to the vendor, is included as Attachment A to this registration package. The PAS Participation Agreements for the Group and Doctor Surveys are embedded in the online registration site and will require your group s electronic consent. Copies are included in this package for review prior to registration (Attachments E and F). Groups are required to sign a Business Associate Agreement (BAA) with the survey vendor. A copy is included in this registration package. Please refer to your invitation (or the PAS website) for an editable version of the BAA that you can complete, sign and send directly to the survey vendor the Center for the Study of Services (CSS). (Attachment G). Starting September 3, you can logon to the survey vendor s website and upload data submissions and submit/confirm logos and signatures for producing the files from which your group s patient sample is drawn. The data specifications are found in Attachment K of this registration packet. Each group will be required to complete an online survey through the survey vendor s website to provide information on medical group coding practices and physician specialty types that will inform the survey vendor s data quality assurance process. There will be three informational conference calls regarding the PAS survey process and data submission requirements. The first call will be held on Thursday, August 15 th from 11:00am- 12:00pm, and will review the 2014 project requirements and pricing. Please see Attachment H for a full list of informational calls. In addition to garnering potential financial bonuses, the PAS survey results can be used by your group to identify areas for improvement, help focus your quality improvement investments, examine trends in performance over time, and compare your performance to your peers. P4P participating health plans subsidize the costs of the Group Survey; as such, the cost of gathering this information is lower than it would be through an independent survey effort. Physician groups are responsible for covering all costs of surveying that are in addition to the core Group Survey (Attachment I). The PAS survey will be sent to patients in January 2014 (December 2013 for groups that elect surveying). Results are reported to participating provider groups in June 2014 (see Attachment J for detailed project timeline). Please contact me at aklein@pbgh.org ( ) with any questions you may have about the registration process. We look forward to your participation in the PAS 2014 project. Ariel Klein Senior Manager, Performance Information, Pacific Business Group on Health August 2013 Page 2 of 44

3 Enclosures: Attachment A: Attachment B: Attachment C: Attachment D: Attachment E: Attachment F: Attachment G: Attachment H: Attachment I: Attachment J: Attachment K: Project Requirements Alternative Language Surveying for Group Survey Group Survey Information Sheet Doctor Survey Information Sheet 2014 Participation Agreement: Group Survey 2014 Participation Agreement: Doctor Survey Business Associate Agreement Schedule of Informational Calls Fee Schedule Project Timeline Data Specifications August 2013 Page 3 of 44

4 Attachment A 2014 PAS Project Requirements and Password Password PAS physician group participants will need a unique user name and password to logon and complete the registration including data submissions and logo confirmation. The unique user name and password for your physician group may be found in the body of the transmittal for this PAS registration packet. Your unique user name and password was sent to the individual on record as the primary PAS contact for your group. Please keep this username and password throughout the survey period. If you cannot locate your password, please contact Ariel Klein at aklein@pbgh.org or at Project Requirements for Physician Groups Requirement Register for the PAS Group Survey, and optionally, the PAS Doctor Survey. Electronically agree to the terms and conditions in the 2014 Participation Agreement. Submit, or confirm the physician group logo and executive signature to be printed on the survey cover letter and instrument. Complete online survey regarding the group s coding practices and provider specialties. How and When Go to August 12 August 30, 2013 Electronic sign-off is the last step in the online registration process Go to September 3 October 1, 2013 Go to September 3 October 1, 2013 Submit signed Business Associates Agreement (BAA). October 1, 2013 Submit data files comprised of eligible patients, patient visits and providers from which the survey sample will be drawn. All data submissions must meet the PAS data quality criteria. Pay participation fees for all survey options selected by the physician group upon receipt of PAS invoice. Go to to download data specifications and the data checking tool no later than November 1. Data submissions due between November 1 and November 15, 2013 Final data corrections due: November 20 th Each group s estimated fees will be calculated during the registration process. Group survey and doctor survey fees are due February 28, 2014, with the exception of fees for Chinese/Vietnamese CATI phone interviews which are due June 30, 2014 (for groups who elect this option). The physician organization is required to execute a Business Associate Agreement (BAA) with CSS, the survey vendor for the PAS project. A copy of the standard BAA can be downloaded from Groups who wish to use their own BAA will be charged a fee of $250. August 2013 Page 4 of 44

5 Attachment B Alternative Language Surveying for Group Survey For the Group Survey, groups can choose to conduct alternative language surveying in Spanish, Chinese, or Vietnamese. You may choose from the options below during the registration process. The fees listed below are in addition to the cost of participating in the Group Survey. Fees for Alternative Language Surveying Double Stuff Survey Packets Per Reporting Unit Survey mailings double stuffed to include written survey materials in both English and an alternative language (groups may designate different languages for patients seen by specific physicians). Double Stuff Survey Packets Per Patient This is the per patient fee which is in addition to the base per reporting unit fee above. Groups may purchase the double stuff service for the standard 900 patient outgo mailing or apply it to fewer or more than 900 patients. The per patient fee applies in any case. Follow up phone interviews in Spanish Follow up phone interviews in Chinese or Vietnamese $ per reporting unit $1.40 per patient No additional cost $3.35 per patient *If you elect any of the above alternative language options, please inform the IT staff at your group responsible for programming the data submission. Each group will be required to flag physicians selected for alternative language surveying in the data submission due by November 15, August 2013 Page 5 of 44

6 Attachment C Group Survey Information Sheet 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 2013, eight major California health plans,131 unique physician organizations (reporting on 173 units), and the 50 purchasers of care represented by the Pacific Business Group on Health (PBGH) collaborated on the PAS project. The 2013 participating groups served 9.9 million commercially insured HMO and POS patients, or almost 95% of the total HMO/POS commercial population in California. The participating health plans in 2013 were: Aetna, Anthem Blue Cross, Blue Shield, CIGNA, Health Net, Kaiser Foundation Health Plan, UnitedHealthcare, 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 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 is 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 core performance domains 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. August 2013 Page 6 of 44

7 Supplemental Survey Options In addition to the core PAS Group Survey, groups can elect supplemental survey options: surveying, in which patients are sent an invitation to respond to the survey prior to the mailing of the paper survey. Patients who respond to the survey are removed from the list of patients who receive the mailed survey. surveying can help to increase a group s response rate, and use of this option also produces small savings which are passed along to the group and to the sponsoring health plans. 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 Englishlanguage 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 2013, 23 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 2014 Patient Assessment Survey begins August 12 and closes August 30. Register to participate at no later than August 30, 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. Sampling Register to participate via no later than August 30, 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 1, Download, sign and mail the Business Associates Agreement (BAA) to survey vendor by October 1, Provide information on the group's coding practices and provider specialties, as requested in survey vendor hosted questionnaire, by October 1, Submit data files on all eligible patients, patient visits and providers, from which the patient sample will be drawn, by November 15, 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 February 28, After final approval of the data files submitted by each group, the survey vendor draws a random 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). For the primary care sample, the survey vendor assigns patients 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. August 2013 Page 7 of 44

8 Survey Fielding The standard survey protocol consists of two survey mailings. 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, merges the response data with the original sample data, and conducts 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 removed. Analysis of the Survey Data Each medical group s results are adjusted to control for differences across physician groups. In 2013, the case-mix adjustment model controlled for: Age Gender Education level Race/ethnicity-primary language of respondent Single item physical health status Single item mental health status Specialty type of physician that patient rated Survey response mode (mail/internet, or phone) Language in which survey was completed Obesity (derived from body mass index) 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, trending, PCP/Specialist scores, and a comparison of provider groups question and composite level scores within geographic region) Provider Group Response-level Report (Excel dataset contains de-identified patient-level records for Provider Group s patients only; records include physician identifier) Additionally, the physician group-level survey results may be reported online or in consumer publications by entities that have executed a Data Use Agreement with CHPI. Performance results will not be publicly reported without the group s consent for any topic whose reliability is less than August 2013 Page 8 of 44

9 Key Dates (visit the PAS website at for detailed timeline) August 12, 2013: Registration site live. October 14, 2013: Data checking tool available on the survey vendor s website. August 30, 2013: Registration deadline. Participation agreement due (via electronic consent during the registration process). October 1, 2013: Deadline for groups to submit/confirm group logos/signatures, complete online survey on coding practices and physician specialties and mail signed BAA. November 15, 2013: Data files and attestation due to survey vendor. December 2013-April 2014: Survey fielding. May 2014: Results for P4P items to groups, plans, and IHA. June 2014: Medical group report including all survey items, comparative results, and raw data to medical groups. June 2014: Individual doctor report including all survey items, comparative results, and raw data to medical groups. For More Information Go to or contact Ariel Klein aklein@pbgh.org or at August 2013 Page 9 of 44

10 Attachment D Doctor Survey Information Sheet Physician groups have the option of surveying additional patients to produce doctor-level results using the PAS survey. Groups can choose among three surveys to evaluate patients experiences of care with primary care practitioners, specialists, or pediatricians. Physician groups use the doctor-level results for quality improvement, compensation and other recognition activities. For the Doctor Survey, the group designates the physicians for whom patient samples will be drawn. Groups can survey across a broad range of physician specialties. The survey instrument used will depend on the physicians whose patients are surveyed: PCP Survey: Family practitioners and internal medicine physicians who are providing primary care Specialist Survey: specialists who treat adults, excluding hospital-based physicians and urgent care physicians Child Survey: Pediatricians for children under the age of 12 The survey is administered using a two-survey mailings protocol (no phone follow-up). Eligible patients are those who have had a visit with the doctor that the medical group has included in the doctor-level survey. A three-survey mailings protocol will be used for pediatric patients given the lower response rates for this population; the pediatric survey cost is higher due to this extra mailing. Distinct from the Group Survey, the Doctor Survey can be used with physicians serving members in any product line (HMO, POS, PPO, commercial or Medicare). Special arrangements are made if a group wishes to create a unique sample of Medicare-only patients. For each participating physician a sample of 100 patients is selected. A mail-out sample size of 100 patients per doctor typically yields between 30 and 35 survey responses per physician, averaged across all medical groups. However, response rates for individual doctors can range substantially. Historically, the number of responses per doctor has ranged from a low of 10 to a high of 50+. There is some indication that physicians who serve patients of diverse cultures/language see lower response rates. To increase the likelihood of receiving a threshold number of responses per doctor, groups have the option to increase the number of patients in the mail sample to 135 per doctor. The group has the option of designating a subset of select doctors to have a larger patient sample. This option does entail an additional fee (see below). In considering an increase in the mailed sample size from 100 to 135 for select physicians a group may wish to weigh the following: The group s use of the survey results. If results are used as a component of physician compensation, we recommend a minimum of responses per doctor. Your group s historical experience with physician level survey efforts. Groups who have participated in past years may wish to consider the 135 patient sample size for select physicians who have historically experienced low response rates. Groups without historic information may wish to choose the standard sample size of 100 for this year and make adjustments in future years as necessary. Some physicians may not have 100 patients that meet the eligibility criteria for inclusion in the survey sample. As an interim step in the project, the survey vendor will apprise the group of each doctor's sample size after receiving the data submission. Groups can remove doctors from the doctor-level survey for any reason including if the eligible patient sample is fewer than 100. Likewise, if a physician was targeted for a 135 sample size, but the data submission shows that they do not have enough eligible patients to meet this mark, the group can choose to transfer the doctor to the 100 sample size option. Fees for the Doctor Survey are detailed below. The Doctor Survey fees are estimates only; the actual fees will be provided once the number of Doctor Survey groups and participating physicians is finalized. Each group's total fees (based on the number of participating doctors) will not be finalized until the patient samples are created and the group has reviewed the available patient sample sizes for each physician. The group must flag the physicians selected for inclusion in the Doctor Survey as part of the group's data submission due by November 15, August 2013 Page 10 of 44

11 Doctor Survey Fees Fixed fee for each reporting unit (A) Per practitioner (non-pediatrician) fee for a sample size of 100 (B) Per pediatrician fee for a sample size of 100 $2, per reporting unit $ per doctor (nonpediatrician) $ per pediatrician (C) Per practitioner fee for a sample size of 135* $ per doctor (patient oversample of 135 patients) *Optional larger sample size for physicians with historically lower survey response rates Alternative Language Surveying in the Doctor Survey The group can choose to conduct alternative language surveying at the physician-level in Spanish, Chinese or Vietnamese. The group may select all of the designated Doctor-Survey physicians or a subset of these providers to include in the alternative language surveying. Patients of these physicians will receive survey packets with two copies of the survey: an English-language version and an alternative language version. The group must flag physicians selected for alternative language surveying in the physician group's data submission due by November Doctor Survey Alternative Language Fees Survey mailings double stuffed to include written survey materials in both English and one alternative language among the above listed options. (The Child Survey is not available in Chinese, or Vietnamese) (A) Per patient (non-pediatric patients) (B) Per patient (pediatric patients) $1.40 per patient $1.70 per patient August 2013 Page 11 of 44

12 Attachment E Provider Group Participation Agreement 2014 PAS Group Survey *Acceptance of Agreement to be provided electronically during online registration* This Provider Group Participation Agreement (the Agreement ) is by and between The [insert legal name of Medical Group] (hereinafter referred to as Provider Group ) and the California Healthcare Performance Information System (hereinafter referred to as CHPI ) in connection with the collection and public reporting of certain healthcare provision performance data through the 2014 Patient Assessment Survey project (hereinafter referred to as PAS ). CHPI has contracted with the Pacific Business Group on Health (hereinafter referred to as Program Administrator ) to administer the PAS program and the Center for the Study of Services (hereinafter referred to as Survey Vendor ) to collect, score and report the PAS results. The CHPI PAS Committee is responsible for the PAS survey instrument and the accompanying scoring and reporting methods. PAS is a version of the Clinician-Group CAHPS Survey (CG-CAHPS ) developed by the Agency for Healthcare Research and Quality ( AHRQ ) and endorsed by the National Quality Forum. The survey concerns data collection and public reporting of results for the adult (ages 18 and older), Commercial HMO and POS population only. Information will be collected on those patients who have had an encounter between January 1 and October 31, Provider Group and CHPI agree to the following: 1. Provider Group shall produce and submit patient and provider-level data files (the Sample Frame ) to the Survey Vendor for the purposes of drawing a random sample of 900 patients based on the PAS data specifications, included in Attachment K of the Registration Packet located at (the Data Specifications ) in accordance with the timetable set forth in Attachment J to the Registration Packet (the Project Timeline ). The Provider Group shall provide the Survey Vendor a copy of its Provider Group logo and the name and signature of the medical director for the sole purpose of producing customized patient survey packets. The Provider Group shall provide accurate information on medical group enrollment, coding practices and number of physicians by specialty type as set forth in the Data Specifications as required by the Project Timeline. 2. The Survey Vendor shall apply a set of data quality checks to the Sample Frame. If the Sample Frame does not conform to the Data Specifications, the Provider Group will make the necessary corrections and resubmit the file to Survey Vendor. If at the close of the data submission period set forth in the Project Timeline, the Survey Vendor determines that Provider Group s Sample Frame is compromised substantially such that it would likely introduce bias by having a non-comparable patient population (e.g., too few records relative to size of enrolled HMO adult population), the Provider Group will be deemed ineligible for the PAS project and there will be no results for the Provider Group (i.e., no data will be collected for public reporting or for use by the IHA Pay-for- Performance program). 3. The PAS survey responses shall be collected and scored by the Survey Vendor.. The only condition in which a Provider Group results will not be publicly published as set forth in this Agreement is if the reportable result s reliability is less than Should a Provider Group s reliability fall below 0.70 for any overall rating or composite measure, that Provider Group s result will be included in the PAS internal reports to be shared with all participating groups and plans (with a symbol denoting that the reliability is less than 0.70) but it will not be publicly reported. 4. If Provider Group s survey response rates historically have been lower than 25%, then Provider Group shall be required to have and pay for an outgo sample that is larger than the standard 900 patient sample as a means to improve the reliability of its results. 5. Provider Group shall designate a primary contact person ( Provider Contact ) who is responsible for interfacing with the Program Administrator in the conduct of the project. The Provider Contact shall have final and binding authority for the Provider Group. The Provider Contact shall be responsible for communicating updates and issues related to the 2014 PAS to other interested parties within Provider Group. 6. Provider Group shall pay a participation fee in accordance with the fee schedule set forth in Attachment I to the Registration Package (the Participation Fee ). Provider Group must pay its Participation Fee if any of its patients are surveyed, even in the event the Provider Group s results are excluded from the public or internal reports (i.e. August 2013 Page 12 of 44

13 because of data incomparability or incompleteness). In addition, Provider Group shall be financially responsible for any costs (time or materials) incurred by the Survey Vendor that are related to submission of Provider Group information (e.g. data files, medical group logos and signatures) after the PAS deadline, or that is related to correction of errors made by the Provider Group. The Provider Group also shall be financially responsible for any Provider Group requested customized data runs or analyses; provided that the Survey Vendor has the right to refuse any such request in its sole discretion. Payment shall be made within 30 days of receipt of invoice. 7. Provider Group acknowledges that neither CHPI nor the Project Administrator will receive, handle, process or store any protected health information, as that term is defined in the Health Insurance Portability and Accountability Act of 1996, as amended ( HIPAA ). CHPI will contractually require the Survey Vendor to treat all such protected health information ( PHI ) as required by applicable laws and regulations, including without limitation the provisions of HIPAA, and the applicable requirements of HIPAA s implementing regulations issued by the U.S. Department of Health and Human Services, Title 45 of the Code of Federal Regulations Parts , the Health Information Technology for Economic and Clinical Health Act, as incorporated in the American Recovery and Reinvestment Act of 2009 and the regulations issued thereunder, Cal. Civil Code 56 et seq., Cal. Civil Code et seq. and Cal. Ins. Code 791 et seq., as each may be amended from time to time. 8. To protect any PHI provided as part of Provider Data, Provider Group shall execute a Business Associate Agreement ( BAA ) with the Survey Vendor substantially in the form of template BAA which is included in Attachment G of the Registration Packet. A Provider Group that wishes to use a BAA other than the Survey Vendor s standard BAA may do so for a fee as provided for in the Fee Schedule set forth in Attachment I of the Registration Packet. 9. The Sample Frame shall remain proprietary information of Provider Group. Provider Group agrees that CHPI may use the Sample Frame as incorporated in the 2014 PAS results in accordance with this Agreement. CHPI will require the Survey Vendor to take all appropriate steps to safeguard, and not to reproduce or disclose the Sample Frame or any other information about individual patients, individual physicians, individual physician groups or health plans which it receives in the course of performing its services to any other party without prior written authorization from CHPI, other than its employees or subcontractors authorized under this Agreement. CHPI will require the Survey Vendor to take appropriate steps to ensure the confidentiality of the survey participants responses, and that any and all patient name and address data, whether physical or electronic addresses, that Survey Vendor receives from Provider Group will be used only for the survey and will not be released to any organizations or persons other than to Survey Vendor s employees, agents, or contractors assisting in performing the survey. 10. Subject to Provider Group s interest in the Sample Frame, Provider Group acknowledges and agrees that, as between Provider Group and CHPI, CHPI shall own all right, title and interest in and to the 2014 PAS, including without limitation the survey instruments, the survey results, the coding and scoring methodologies and any and all public and private reports produced by CHPI based on the 2014 PAS results. CHPI agrees that Provider Group may use the 2014 PAS results for any lawful purpose, except that Provider Group may not use the results relating to any other participating provider group or health plan for any commercial or promotional purpose (such as utilizing comparative ratings in an advertising or marketing communication). 11. CHPI shall produce and distribute the following products to Provider Group: Provider Group Summary PAS P4P Report (question and composite level scores) PAS Provider Group Report (group detailed results including benchmarks, trending, PCP/Specialist scores, and a comparison of provider groups question and composite level scores within geographic region) Provider Group Response-level Report (Excel dataset contains de-identified patient-level records for Provider Group s patients only; records include physician identifier) 12. CHPI shall produce and distribute the following products to each participating health plan: PAS Project-wide Report (provider group-specific results statewide) PAS Project-wide Aggregate Report (project-level report including benchmarks) Health Plan Response-level Report (Excel dataset containing de-identified patient-level records for the Provider Groups with which health plan contracts. To support plan-specific enrollee analyses, patient-level data identifies the health plan s own enrollees with a health plan identification variable August 2013 Page 13 of 44

14 (e.g., plan= U.S. Health ) patients who are enrolled in all other plans are plan de-identified (e.g., plan= other ). 13. Provider Group authorizes CHPI to provide the 2014 PAS results for public reporting to entities that have executed a Data Use Agreement ( DUA ) with CHPI. Such DUAs shall require that the public reporting data shall be deidentified by removing all patient, physician/practitioner, and health plan identifiable information, with the only identifiable information included being the name of the provider group to which a specific measure is attributable. The PAS Committee shall review and CHPI shall approve all such DUAs. 14. Provider Group authorizes CHPI to provide the 2014 PAS results to third parties engaged in bona-fide healthcare performance data research that have executed a Data Use Agreement ( DUA ) with CHPI, including without limitation AHRQ and its grantees for the purpose of the development of CAHPS-related survey tools and methods. Such DUAs shall require that the dataset shall be de-identified by removing all patient, Provider Group, and health plan identifiable information.. In addition, pursuant to the CHPI-AHRQ DUA, CHPI shall be authorized to provide a PAS de-identified, patient-level dataset to the National CAHPS Benchmarking Database. The PAS Committee shall review and CHPI shall approve all such DUAs. 15. Provider Group authorizes CHPI to provide the 2014 PAS results to the Integrated Healthcare Association ( IHA ) pursuant to a CHPI-IHA DUA. The IHA use concerns integrating the PAS results into its Pay-for-Performance formula for use by health plans in determining bonus payments to Provider Groups. 16. CHPI warrants that the PAS survey shall be conducted in a professional manner. Each party warrants that it will comply with all applicable laws and regulations in the performance of its obligations or exercise of rights granted hereunder. Except for the express warranty set forth in this Section 16, neither party makes any and hereby disclaims all other warranties in connection with this Agreement or the PAS survey, whether express, implied, statutory or otherwise. 17. In no event will CHPI be liable to Provider Group for any consequential, indirect, incidental or special damages in connection with or arising under this Agreement. 18. This Agreement shall be construed and interpreted in accordance with the laws of the State of California. Any controversy or claim arising out of or relating to this Agreement or breach hereof shall be resolved by arbitration with one arbitrator in San Francisco, California, in accordance with the rules of the American Arbitration Association then existing. The decision of the arbitrator shall be final and binding, and judgment on the arbitration award may be entered in any court having jurisdiction over the subject matter of the controversy. Arbitration shall be the exclusive final remedy for any dispute between the parties. The costs of any arbitration shall be divided equally between the parties, and each party will bear its own costs and attorneys fees in connection with the arbitration. August 2013 Page 14 of 44

15 Attachment F Provider Group Participation Agreement 2014 PAS Doctor Survey Project *Acceptance of Agreement to be provided electronically during online registration* This Provider Group Participation Agreement (the Agreement ) is by and between The [insert legal name of Medical Group] (hereinafter referred to as Provider Group ) and the California Healthcare Performance Information System (hereinafter referred to as CHPI ) in connection with the collection and reporting to Provider Group of physician-specific patient reported performance data through the 2014 PAS Doctor Survey Project ( Doctor Survey ). CHPI has contracted with the Pacific Business Group on Health (hereinafter referred to as Program Administrator ) to administer the Doctor Survey and the Center for the Study of Services (hereinafter referred to as Survey Vendor ) to collect, score and report the Doctor Survey results. The Doctor Survey captures patient-reported experiences of care and service with their physician. The Doctor Survey will be conducted with a sample of adult members and/or the parents/guardians of child members who are patients of physicians affiliated with the participating Provider Group. Doctor Survey results are reported to the Provider Group and, except as expressly stated herein, are not reported or disclosed to any other persons or entities. Provider Group and CHPI agree to the following: 1. Provider Group shall designate a primary contact person ( Provider Contact ) who is responsible for interfacing with the Program Administrator in the conduct of the project. The Provider Contact shall have final and binding authority for the Provider Group. The Provider Contact shall be responsible for communicating updates and issues related to the Doctor Survey to other interested parties within Provider Group. 2. Provider Group shall produce and submit patient and provider-level data files (the Sample Frame ) to Survey Vendor for the purposes of drawing a random sample of patients based on the Doctor Survey data specifications, included in Attachment K of the Registration Packet located at (the Data Specifications ) in accordance with the timetable set forth in Attachment J to the Registration Packet (the Project Timeline ). The Provider Group shall provide the Survey Vendor a copy of its Provider Group logo and the name and signature of the medical director for the sole purpose of producing customized patient survey packets. 3. Provider Group agrees to have its patient data collected, scored and reported by Survey Vendor. For purposes of this Section 3, Provider Group-specific results shall be shared with other Doctor Surveyparticipating Provider Groups only under the condition that no results shall disclose the identity of the Provider Group, any medical practice, individual physician or patient/member. 4. Provider Group shall pay a participation fee in accordance with the fee schedule set forth in Attachment I to the Registration Package (the Participation Fee ). Provider Group must pay its Participation Fee if any of its patients are surveyed, even in the event the Provider Group s results are excluded from the Doctor Survey Reports (i.e. because of data incomparability or incompleteness). In addition, Provider Group shall be financially responsible for any costs (time or materials) incurred by the Survey Vendor that are related to submission of Provider Group information (e.g. data files, medical group logos and signatures) after the Doctor Survey deadline, or that is related to correction of errors made by the Provider Group. The Provider Group also shall be financially responsible for any Provider Group requested customized data runs or analyses; provided that the Survey Vendor has the right to refuse any such request in its sole discretion. Payment shall be made within 30 days of receipt of invoice. 5. Provider Group acknowledges that neither CHPI nor the Program Administrator will receive, handle, process or store any protected health information, as that term is defined in the Health Insurance Portability and Accountability Act of 1996, as amended ( HIPAA ). CHPI will contractually require the Survey Vendor to treat all such protected health information ( PHI ) as required by applicable laws and regulations, including without limitation the provisions of HIPAA, and the applicable requirements of HIPAA s implementing regulations issued by the U.S. Department of Health and Human Services, Title 45 of the Code of Federal Regulations Parts , the Health Information Technology for Economic and Clinical Health Act, as incorporated in the American Recovery and Reinvestment Act of 2009 and the regulations issued August 2013 Page 15 of 44

16 thereunder, Cal. Civil Code 56 et seq., Cal. Civil Code et seq. and Cal. Ins. Code 791 et seq., as each may be amended from time to time. 6. To protect any PHI provided to the Survey Vendor by Provider Group, Provider Group shall execute a Business Associate Agreement ( BAA ) with the Survey Vendor substantially in the form of template BAA which is included in Attachment G of the Registration Packet. A Provider Group that wishes to use a BAA other than the Survey Vendor s standard BAA may do so for a fee as provided for in the Fee Schedule set forth in Attachment I of the Registration Packet. 7. The Sample Frame shall remain proprietary information of Provider Group. Provider Group agrees that CHPI may use the Sample Frame as incorporated in the Doctor Survey results in accordance with this Agreement. CHPI will require the Survey Vendor to take all appropriate steps to safeguard, and not to reproduce or disclose the Sample Frame or any other information about individual patients, individual physicians, individual physician groups or health plans which it receives in the course of performing its services to any other party without prior written authorization from CHPI, other than its employees or subcontractors authorized under this Agreement. CHPI will require the Survey Vendor to take appropriate steps to ensure the confidentiality of the survey participants responses, and that any and all patient name and address data, whether physical or electronic addresses, that Survey Vendor receives from Provider Group will be used only for the survey and will not be released to any organizations or persons other than to Survey Vendor s employees, agents, or contractors assisting in performing the survey. 8. Subject to Provider Group s interest in the Sample Frame, Provider Group acknowledges and agrees that, as between Provider Group and CHPI, CHPI shall own all right, title and interest in and to the Doctor Survey, including without limitation the survey instruments, the survey results, the coding and scoring methodologies. Notwithstanding the foregoing, CHPI agrees that it will not publicly distribute any Doctor Survey Results and that it may only use the Doctor Survey results for patient-experience survey research and development purposes internally and with other persons or entities who agree to similar contractual restrictions on public distribution; provided that no such results shall disclose the identity of the Provider Group, any medical practice, individual physician, or patient/member. Provider Group agrees that Provider Group may use the Doctor Survey results for any lawful internal purpose and may not publicly distribute any such results or the reports described in Section 9 or disclose such results or reports to any third party unless such third party agrees to similar contractual restrictions on public distribution.. 9. CHPI shall produce and distribute the following Doctor Survey Reports to Provider Group: Provider Group Performance Profile Report, which is the Provider Group s affiliated physician results and percentile rankings compared to other participating Provider Groups in the Doctor Survey. Summary results are provided by survey type (PCP, Pediatric, Specialist and OB-GYN). No patientlevel information (or patient personal identifying information) shall be included in this report. Physician-specific Performance Profile Reports, which are the personalized physician reports which include physician scores and percentile rankings compared to other physicians in that Provider Group and to all physicians in the Doctor Survey. No patient-level information (or patient personal identifying information) shall be included in this report. Electronic Data File Report, which is the physician-level results for the Provider Group s physicians only (Excel format). Report includes a dataset of all of the Provider Group s physician-level survey results. No patient-level information (or patient personal identifying information) shall be included in this report. The report includes reference normative results based on all of the participating provider groups. 10. The foregoing data confidentiality and non-disclosure terms shall survive the termination or expiration of this Agreement. August 2013 Page 16 of 44

17 11. CHPI warrants that the Doctor Survey shall be conducted in a professional manner. Each party warrants that it will comply with all applicable laws and regulations in the performance of its obligations or exercise of rights granted hereunder. Except for the express warranty set forth in this Section 11, neither party makes any and hereby disclaims all other warranties in connection with this Agreement or the Doctor Survey, whether express, implied, statutory or otherwise. 12. In no event will CHPI be liable to Provider Group for any consequential, indirect, incidental or special damages in connection with or arising under this Agreement. 13. This Agreement shall be construed and interpreted in accordance with the laws of the State of California. Any controversy or claim arising out of or relating to this Agreement or breach hereof shall be resolved by arbitration with one arbitrator in San Francisco, California, in accordance with the rules of the American Arbitration Association then existing. The decision of the arbitrator shall be final and binding, and judgment on the arbitration award may be entered in any court having jurisdiction over the subject matter of the controversy. Arbitration shall be the exclusive final remedy for any dispute between the parties. The costs of any arbitration shall be divided equally between the parties, and each party will bear its own costs and attorneys fees in connection with the arbitration. August 2013 Page 17 of 44