The HERC outpatient file estimates represent the hypothetical Medicare reimbursement average given the Current Procedure and Terminology Codes assigned to the VA visit. Estimates are adjusted so that the estimates tally to actual national VA expenditures for that type of care.
Data location: on VINCI (\\vhacdwsasrds01.vha.med.va.gov\HERC) or on the SAS 9.4 Grid (on the server VHACDWSASGSUB2.VHA.MED.VA.GOV at /data/prod/HERC).
- HERC's Average Cost Methods
- Register to Use HERC's Average Cost Data
- Guidebook: HERC's Outpatient Average Cost Dataset for VA Care: Fiscal Year 2013 Update (Intranet only)
- Table 3.1 Medicare Conversion Factors for Relative Value Units, FY1998-2013
- Table 3.2 VA Utilization by Source for Provider Component of the HERC Value, FY1998-2013
- Table 3.3 VA Utilization by Sourec for Provider Component of the HERC Value, FY2001-2013: Details of the Medicare and Ingenix Relative Value Unit Schedules
The person-level cost datasets contain total annual costs for VA care received by each individual who used the VA health care system. Currently spanning FY98-FY13, these data allow researchers to observe the annual costs of individual patients without needing to extract and summarize stay and visit level information from numerous VA databases.
The US Department of Veterans Affairs (VA) uses the Managerial Cost Accounting System (MCA), formerly Decision Support System (DSS), for fiscal management and to determine the cost of patient care. National Data Extracts (NDEs) have been created to facilitate access to workload and cost information. These extracts report costs of outpatient encounters provided by VA.
OPAT (Outpatient). This dataset includes outpatient costs per clinic stop per day. HERC has created a Guidebook for the MCA NDE. As we describe in the Guidebook, some care is needed to merge this dataset to the Medical SAS outpatient datasets (i.e., National Patient Care Database). This dataset excludes low cost records (see Out2).
OUT2. This dataset is similar to the Opat NDE, but it includes low cost outpatient records (those with cost greater than $-1 and less than $1, including zero-cost encounters). This dataset includes almost all of the outpatient care recording in the Medical SAS outpatient datasets (i.e., National Patient Care Database) that is not recorded in the MCA OPAT NDE.
The intermediate product department for each encounter for outpatient (O-IPD) care. These files provide more detailed cost information for specific types of care. Previously, MCA National Data Extracts reported costs for six broad categories -- medicine/other, laboratory, pharmacy, radiology, nursing, and surgery. These cost sub-totals were dropped from the NDE files while new IPD files were created with a richer set of cost detail. The IPD extract files are available for all fiscal years beginning in 2003.
Opat-IPD (Outpatient intermediate Product Department). This dataset has one record per MCA product department (IPD) utilized within an outpatient encounter. Intermediate products represent work performed in each department and are bundled to make up the outpatient visit.
The IPD national extract files do not contain any formatting for the product department variable (IPD_NUM), so HERC has created a permanent SAS format library for the product department names for files FY 2003 through FY 2008. HERC has made this file available at the Austin Information Technology Center for use by researchers.
The Non-VA Medical Care (Fee) files include information on covered care provided to VA patients by contract providers under the Non-VA Medical Care Program.
Data from the Non-VA Medical Care system input in SAS files at the VA Austin Information Technology Center (AITC). The files that contain Non-VA Medical Care 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.
This file contains one diagnosis code and 1 CPT procedure code. It contains information on home health care.
There is an alternative method for accessing summaries of Non-VA Medical Care expenditure data, one that does not require an AITC 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 Non-VA Medical Care 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.
|Non-VA Medical Care Data||FY00||FY01||FY02||FY03||FY04||FY05||FY06||FY07||FY08||FY09||FY10||FY11||FY12|
The VA National Patient Care Database (NPCD) has information on outpatient vists. It includes diagnosis, procedure codes, and patient demographics.
- Managerial Cost Accounting (MCA) Outpatient Identifiers With FY10 Attachments
- Outpatient Fiscal Year 2003 Managerial Cost Accounting (MCA) Identifiers
- Outpatient Fiscal Year 2000 Managerial Cost Accounting (MCA) Identifiers
- Tabulation: Outpatient National Tally of Annual Number to Each Clinic Stop FY 1998-2012
- Tabulation: Outpatient National Tally of Annual Number to Each Clinic Stop FY 1993-2000
The 12 categories are:
|32||Adult day Health|
Number 26 is a placeholder for Pharmacy, 99 is the category for unidentified clinic stops.
What is the nature of MCA National Data Extracts (NDEs) that contain low cost outpatient encounters?
The low cost outpatient NDE files contain information on outpatient encounters that were assigned low cost by MCA. "Low cost" MCA data refer to those outpatient encounters that are either not assigned costs or assigned costs between -$1 and $1. In fiscal year (FY) 2004, low cost data represented 8.2% of all MCA data containing information about outpatient care. Technical Report #23, Comparison of MCA Encounter-Level National Data Extracts and the VA National Patient Care Database: FY2004, reveals that by including low cost MCA encounters in a comparison between the MCA and NPCD databases, outpatient utilization thought to be missing from MCA was found, and almost all outpatient care was reported in MCA. The low cost files, which have supplemented MCA outpatient extracts since FY2002, are thus important in identifying VHA outpatient encounters. The low cost files are stored at the Austin Information Technology Center (AITC). To obtain the file names, please contact us.