Appendix Exhibit 2.

Description of CAHPS survey items and claims-based measures of utilization and spending

		High-Priced TINs (n=17,130 patients)		Low-Priced TINs (n=14,137 patients)
Domain/Item	Scale†	% Non-Applicable	% Applicable but Missing‡	% Non-Applicable	% Applicable but Missing‡
Experiences with Care
Overall Ratings of Care and Physicians
Rating of health care	0–10	0%	11.4%	0%	11.9%
Rating of primary physician	0–10	1.9%	13.2%	1.8%	12.5%
Rating of specialist	0–10	35.1%	3.9%	34.9%	4.7%
Timely Access to Care
Timely access to care (3-item composite):
In the past 6 months:
When you needed care right away for an illness, injury, or condition, how often did you get care as soon as you thought you needed it?	1–4	59.4%	3.7%	59.1%	3.7%
How often did you get an appointment for your health care at a doctor’s office or clinic as soon as you thought you needed it (not counting the times you needed care right away)?	1–4	12.1%	3.9%	11.9%	4.3%
How often was it easy to get appointments with specialists?	1–4	33.8%	14.8%	33.6%	15.1%
Waiting time in the office	1–4	0%	12.6%	0%	13.2%
Interactions with Primary Physician
Interactions with primary physician (4-item composite):
In the past 6 months, how often did your personal doctor:
Explain things in a way that was easy to understand?	1–4	1.9%	13.2%	1.8%	12.3%
Listen carefully to you?	1–4	1.9%	13.1%	1.8%	12.3%
Show respect for what you had to say?	1–4	1.9%	13.2%	1.8%	12.3%
Spend enough time with you?	1–4	1.9%	13.2%	1.8%	12.3%
Care Coordination and Management
Primary physician informed about specialty care	1–4	35.1%	10.1%	34.9%	10.8%
Patient care information available to primary physician	1–4	1.9%	13.2%	1.8%	12.4%
Medication review	1–4	3.7%	13.5%	3.8%	12.8%
Patients’ access to visit notes	Yes/No	1.9%	15.3%	1.8%	14.9%
Care management from physician’s practice	1–3	66.7%	16.3%	67.2%	16.0%
Communication of test results (2-item composite):
In the past 6 months, when personal doctor ordered a blood test, x-ray, or other test:
How often did someone from your personal doctor’s office follow up to give you those results?	1–4	11.1%	14.2%	11.4%	13.7%
How often did you get those results as soon as you needed them?	1–4	11.1%	17.3%	11.4%	17.6%
Use of Preventive Services
Influenza vaccine in last 1 year	Yes/No	0%	4.0%	0%	4.4%
Pneumococcal vaccine (ever)	Yes/No	0%	8.5%	0%	9.2%
Preventive services for diabetes¶
Glycated hemoglobin testing in last 1 year	Binary	71.5%	–	69.2%	–
Low-density lipoprotein testing in last 1 year	Binary	71.5%	–	69.2%	–
Diabetic retinal examination in last 2 years	Binary	71.5%	–	69.2%	–
Breast cancer screening (mammogram in last 2 years) ˆ	Binary	85.8%	–	85.6%	–
Utilization and Spending
Emergency department visits not related to inpatient admissions	Count	0%	–	0%	–
Acute hospitalizations	Count	0%	–	0%	–
Hospitalizations for Ambulatory Care-Sensitive Conditions	Count	0%	–	0%	–
Total Annual Spending, $	$ 2012	0%	–	0%	–

^†For numeric scores, scales range from 0 (worst) to 10 (best); from 1 (never) to 4 (always); or have values of 1 (no), 2 (yes, somewhat), or 3 (yes, definitely). Prior to analysis, numeric scores were converted to a consistent 0–10 scale. For items that are part of composite scores, we first subtracted the overall mean for the item and then calculated a patient-level composite score as an equally weighted average of all items for which a patient provided a valid response.

^‡Assessed from responses to the CAHPS survey. CAHPS denotes the Consumer Assessment of Healthcare Providers and Systems survey.

^¶For diabetes preventive services, the population assessed consisted of eligible CAHPS respondents who had a diagnosis of diabetes by the beginning of 2011 based on the Medicare Chronic Conditions Data Warehouse.

^ˆAmong women 65–69 years old.

^§Assessed from 2012 Medicare fee-for-service claims. Includes all spending except for rehabilitation facility and long-term acute care facility spending.

Source: Authors’ analyses of CAHPS survey data, linked fee-for-service Medicare claims, and commercial insurer prices from FAIR Health.