1. National Health Care Surveys 2007-2012 Budget Update/Options NCHS Board of Scientific Counselors April 24, 2008 Jane E. Sisk Centers for Disease Control and Prevention National Center for Health Statistics

2. National Health Care Surveys Long-Term Care National Nursing Home Survey (NNHS) National Nursing Home Survey (NNHS) 2004: National Nursing Assistants Survey (NNAS) National Home and Hospice Care Survey National Home and Hospice Care Survey 2007: National Home Health Aide Survey (NHHAS) National Survey of Residential Care Facilities (NSRCF) National Survey of Residential Care Facilities (NSRCF) Hospital and Ambulatory Care National Ambulatory Medical Care Survey (NAMCS) National Ambulatory Medical Care Survey (NAMCS) Physicians in offices National Hospital Ambulatory Medical Care Survey (NHAMCS) National Hospital Ambulatory Medical Care Survey (NHAMCS) Hospital emergency and outpatient departments National Survey of Ambulatory Surgery (NSAS) National Survey of Ambulatory Surgery (NSAS) National Hospital Discharge Survey (NHDS) National Hospital Discharge Survey (NHDS)

3. Annual Average Expected Cost of Surveys millions of dollars National Nursing Home Survey$4.5 National Home and Hospice Care Survey 5.0 National Survey of Residential Care Facilities 3.5 National Ambulatory Medical Care Survey 3.9 National Hospital Ambulatory Medical Care Survey 4.7 National Hospital Discharge Survey 2.0 Redesigned National Hospital Discharge Survey 3.0 National Survey of Ambulatory Surgery (if separate) 5.0

4. National Health Care Surveys, 1992-2012 NNHS NHHCS NHAMCS NAMCS NHDS NSRCF 92 93 94 95 96 97 98 99 00 01 02 03 04 05 06 07 08 09 10 11 12 NSAS Redesigned Little change Continually updated

5. National Health Care Surveys 2007-2012

6. National Health Care Surveys Funding 2007-2012 200720082009201020112012 $s in millions $s in millions NCHS Funds $ 9.6$10.5$10.5$10.5$10.5$10.5 Reimbursables $ 2.1$ 2.2$ 2.0$ 0.8$ 0.4$ 0.4 Total Revenue $11.7$12.7$12.5$11.3$10.9$10.9 Expenses $11.7$12.7$14.1$16.1$16.9$16.2 Deficit $0$0-$1.6-$4.8-$6.0-$5.3

7. Option: Delay Nursing Home Survey Cost savings $2 million FY 2009 Cost savings $2 million FY 2009 2.5 million FY 2010 2.5 million FY 2010 Pro Pro Avoid deficit Would not disrupt current operations Con Con Extend period between nursing home surveys Survey last conducted in 2004

8. Option: Delay Updating Ambulatory Survey Samples Cost savings$2 million FY 10 Cost savings$2 million FY 10 4 million FY 11 4 million FY 11 Pro Pro Avoid deficit Con Con Continued likelihood of estimates’ not accurately reflecting the current demographics of health care providers and patients Continued likelihood of estimates’ not accurately reflecting the current demographics of health care providers and patients Last sample of PSUs drawn from 1980 Census

9. Option: Delay Home and Hospice Care Survey Cost savings$1 million FY 11 Cost savings$1 million FY 11 4 million FY 12 4 million FY 12 Pro Pro Avoid deficit Would not disrupt current operations Con Con Extend period between home and hospice care surveys Survey conducted in 2007

10. Option: Suspend Hospital and/or Ambulatory Care Surveys Cost savings$2 to $10.5 million depending on Cost savings$2 to $10.5 million depending on whether 1, 2, or 3 surveys were whether 1, 2, or 3 surveys weresuspended Pro Pro Substantial savings Cons Cons Removing crucial data sources at a time of health system transformation Commitments made and funds already received and spent to collect certain data