HERC Bulletin - August 2017
Ask An EconomistInpatient Costs in VA and Medicare
Ask An Economist
This issue’s questions involve calculating cost and resource use with VA data and comparing VA inpatient costs to Medicare inpatient reimbursements
In the LiteratureMedicaid Enrollment has Minimal Impact on Use of VA Services
In the Literature
Enrollment in Medicaid has little impact on non-elderly VA patients’ use of VA services, according to a new study lead by HERC investigator Jean Yoon.
HERC Outpatient Average Cost Data for FY16 Now Available
HERC outpatient average cost data for the 2016 Fiscal Year are now available at VINCI.
HERC creates cost estimates for all VA inpatient and outpatient encounters. These cost estimates combine VA department-level costs, utilization data, and non-VA relative value units. The HERC outpatient average cost data contain the hypothetical Medicare reimbursement average for a VA visit. The reimbursement average is based on that visit’s Current Procedure and Terminology (CPT) Codes. Estimates are adjusted to tally to actual national VA expenditures for that type of care.
HERC Discharge Data for FY15 Now Available
HERC Discharge data for Fiscal Year 2015 are now available at VINCI.
The MCA Discharge (DISCH) National Data Extract (NDE) includes information on the entire span of an inpatient hospitalization. The HERC Discharge dataset expands on the DISCH NDE to also include cost and length of stay (LOS) subtotals for each inpatient category of care. The updated guidebook, which describes how HERC prepared the Discharge dataset, is available on the HERC website.
The Impact of Coding System on Diagnosis Prevalence Rates
In HERC Technical Report #33, authors Jean Yoon and Adam Chow compare the prevalence rates of 34 chronic conditions before and after the transition to ICD-10. Researchers and policy makers rely on diagnosis codes to identify care for different diagnoses; the purpose of this analysis was to determine whether the new coding system affected the assignment of diagnoses to VA patients. Yoon and Chow found that estimates of the prevalence of chronic disease in VA patients were largely unaffected by the shift to the new system of diagnosis codes
This technical report, “Comparing the Measurement of Chronic Conditions in ICD-9-CM and ICD-10-CM in VA Patients, FY2014-2016,” has been updated to reflect changes in ICD-10-CM. The report includes the prevalence estimates for the chronic conditions and details the authors’ methods for conducting the analysis.
Improving Quality and Access in Community Care
VA investigators Todd Wagner, Amy Rosen, and Megan Vanneman were awarded a 1.5 year HSR&D planning grant to examine Veteran use of community care through the Veterans Choice Program (Choice). This study, “Planning for a New Era in Veterans Health Care: Community Care, Information Exchange and Multi-system Use,” will provide information about the utilization and cost of Choice care. The Veterans Choice Program, which was established under the Veterans Access, Choice and Accountability Act of 2014, allows eligible Veterans to receive care from community providers to ensure that Veterans have timely access to health care. The two other planning grants were awarded to teams led by Denise Hynes and Kristin Mattocks. HERC and VIReC will be working with teams to document Choice data for others interested in this area. Stay tuned for more.
HERC Welcomes Dr. Phibbs as Associate Director
HERC welcomes Ciaran Phibbs as the new center Associate Director, as Christine Pal Chee steps down from the position to focus on research, teaching at Stanford, and life with a baby.
Dr. Phibbs’ research focuses on the hospital costs and competition. His research projects have investigated the demand for VA healthcare and how travel distance and the availability of non-VA alternatives influence use of VA care, and how nurse staffing affects patient outcomes. In addition to his role as an economist at HERC, Dr. Phibbs is Associate Director of the Women’s Health Evaluation Initiative and of the Geriatrics and Extended Care Data and Analysis Center at the Veterans Health Administration.
Dr. Phibbs has been an economist at HERC for 18 years. “I am pleased that Ciaran has agreed to take on this added role at HERC,” said Director Todd Wagner. “His extensive expertise and acumen will serve us well in the future.”