I. Finding and Using Healthcare Data

13. How can I use the VA fee basis files to find the cost of health care provided by private providers under contract with VA?

The Fee Basis files include information on care provided to VA patients by contract providers under the Fee Basis program.  Federal law established the Fee Basis program to enable VA to pay for care that the Agency cannot provide in a timely fashion, or when VA determines through an analysis that it would be cost-efficient to provide care through on contract.  Other types of contractual arrangements, such as with state veterans' homes or sharing agreements with affiliate medical schools, are not covered under the Fee Basis program and do not appear in the Fee Basis files.  

The Fee Basis files overlap with other VA utilization data in two areas.  Because Fee Basis data represent invoices rather than discrete stays, ongoing inpatient stays appear in Fee Basis data once the provider has begun to invoice VA.  After the stay has completed, a discharge record (covering the entire stay) is added to the Patient Treatment File (PTF) Non-VA Hospitalization (NVH) file.  In addition, community nursing home stays are recorded in both the PTF for extended care (distinguished by STATYPE = "42") and as outpatient records in the Decision Support System (DSS) National Data Extracts.

Below we provide some basic information about Fee Basis files.  Additional detail can be found in HERC Technical Report #18, "Fee Basis Data: A Guide for Researchers," (downloads section)

Names and coverage of Fee Basis files

Data from the VA fee basis system input in SAS files at the VA Austin Automation Center. The files that contain Fee Basis are named in the form:

MDPPRD.MDP.SAS.FEN.FYyy where yy is the last two digits of the year in which the payment was processed.

Hospital stay:
MDPPRD.MDP.SAS.FEN.FYyy.INPT

Ancillary services provided to inpatients:
MDPPRD.MDP.SAS.FEN.FYyy.INPT.ANCIL
Acute hospital and community nursing home care is found in the inpatient file (INPT). This file has places to record 5 diagnosis codes, 5 procedure codes, and the "Pricer DRG", although there are many blank values.

Outpatient services:
MDPPRD.MDP.SAS.FEN.FYyy.MED
This file contains one diagnosis code and 1 CPT procedure code. It contains information on home health care.

Travel expenses :
MDPPRD.MDP.SAS.FEN.FYyy.TVL

Payments to pharmacies:
MDPPRD.MDP.SAS.FEN.FYyy.PHR

Pharmacy vendors:
MDPPRD.MDP.SAS.FEN.FYyy.PHARVEN

All other vendors:
MDPPRD.MDP.SAS.FEN.FYyy.VEN
The two vendor files are for medical (VEN) and pharmacy (PHARVEN) vendors. The field "amount of treatment" is the amount paid to vendors; this should equal the amount in the payment files.

Veterans receiving long-term fee basis care:
MDPPRD.MDP.SAS.FEN.FYyy.VET
The VET file lists individuals who've received fee basis long-term care.

Selected fields

DISAMT (FMS Disbursed Amount). This is the actual amount paid to the contractor.

AMOUNT (Payment Amount). These are amounts of payment originally requested by contractors.

In past years, DISAMT was almost exactly 100 times AMOUNT. Once this is considered, most records have identical amounts for each of these variables. For most claims, the "amount" plus "interest" equals the FMS disbursed amount. The exception is claims that were cancelled or backed-out. Cancelled and backed-out claims can be identified by having "blank" as the value for the FMS payment date and FMS disbursed amount. These claims still have the original "amount", which was the amount of payment that was originally requested.

FMS CHECK/EFT NO. This is the electronic funds transfer number (EFT) that identifies the disbursement.

FMS Payment type. There are 10 to 15 or more FMS payment types. These include FV (fee voucher) and PV (payment voucher).

SSNUF. This is the 10th digit of the social security number, and may be a letter rather than a number.

VENDID. This is a unit vendor identification number; the same number is used by all medical centers. The same number appears in both the payment and vendor files.

VENSUF. This is used by pharmacies, which have vendor identification numbers with 4 more digits than non-pharmacy vendors.

ZIP. This is the zip code of the vendor.

DHCP. This field has the internal control numbers that identify the transaction number in the local hospital computer system; this allows Austin to update the database with information that the claim has been paid. DHCP stands for "Decentralized Hospital Computer System," the former name of the VA hospital computer system now called VISTA.

Non-VA Care Cube

There is an alternative method for accessing summaries of Fee Basis expenditure data, one that does not require an AAC time-share account. A "Non-VA Care Cube" has been created as part of the national Financial and Clinical Data Mart.  The data cube shows combined payments from the four central Fee Basis files: Inpatient, Outpatient, Inpatient Ancillary, and Pharmacy. One can view and download a series of standard reports or create a unique "view". The data cube does not present individual encounter records. Rather, it shows payment totals summed within category (Purpose of Visit) and time period (month or fiscal year).  The data cube is accessed through the VISN Support Services Center (VSSC) web site, also known as the KLFMenu.  The site is accessible only through the VA intranet.

To ensure the protection of VA information, we have restricted access to certain files (denoted by the "lock" icon). Contact HERC to download these restricted files.

• Fee Basis Data: A Guide for Researchers

  Date: 11/6/2007 | Size: 701Kb