Community Care Data Overview
As VA has expanded access to community care with the passage of the Veterans Access, Choice, and Accountability (VACAA; also called “Choice”) Program (FY 2015-2017) and the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act (FY2019-present), the types and content of community care data available has also grown.* Here, we focus on documenting three new sources of community care utilization data: Third Party Administrator (TPA) Monthly Choice tables, Fee Basis Claims System (FBCS) Data, and the Program Integrity Tool (PIT).
Investigations into these data sources, particularly PIT, are still in their early stages, and as such, documentation is being updated regularly as HERC and other HSR investigators learn more. We encourage those looking for updated information on community care to check the VHA Office of Community Care website (VA intranet only: https://vaww.va.gov/communitycare/).
Available Community Care Data Sources
Program Integrity Tool (PIT): PIT, which was created to check for fraud, waste, and abuse, provides comprehensive data on all Choice utilization. These data are available on CDW.
Third Party Administrator (TPA) Monthly Choice tables: Those interested in evaluating the administrative process, such as clinic wait times, can find detailed records in the TPA Monthly Choice tables, which can be found within the VACAA schema in CDW Raw. The VACAA tables are “live,” which means that the data are constantly updated. The TPA tables do not contain clinical information, such as diagnosis and procedure codes.
Fee Basis Claims System (FBCS): Data FBCS is a nationwide claims management system. The FBCS schema is available as CDW raw data, meaning that users will need to plan for additional time for cleaning the data. Researchers looking for clinical data can use the “obligation number” variable to identify care related to the Veterans Choice Program in the Fee Basis or FBCS Data. NOTE: Starting January 1, 2020, the FBCS application will no longer be used. Claims and other FBCS data will be found in PIT or Community Care Referral & Authorization domains. See the FBCS page (CDW Raw) on the CDW SharePoint site (intranet only https://vaww.cdw.va.gov/bisl/Database/SitePages/Raw%20Extractor.aspx) for more information.
Data Access
Operations users can request access to data using the VHA NDS Access for Health Operations ePAS Form. Researchers can request data through the DART research request process. For more information, visit the VHA Data Portal (VA intranet only: http://vaww.vhadataportal.med.va.gov/).
Community Care Data Q&A
Originally from the January 24, 2018 cyberseminar “HERC Q&A: Trying to Understand Choice Data.”
Q: Is there a way to see if patients have been referred but have not yet seen the provider?
A: Researchers can look at referrals in the VACAA tables; however, it is difficult to link referrals to visits, one to one. Researchers should give themselves a reasonable amount of time for the patient to have received care. There is no variable that specifically indicates a patient received care.
Q: Are you aware of any nationally available data to track success metrics?
A: The Office of Community Care has rolled out several tools to aid with care coordination and evaluate quality. These evaluations are in the early stages, so they are just developing the metrics now, and data is not yet available. Visit the Office of Community Care intranet site (https://vaww.va.gov/communitycare/) to learn more about their programs.
Q: Are the Choice data available on CDW raw or production servers?
A: The VACAA tables and the FBCS data are available on the CDW raw server (A06). PIT data are available on CDW production servers.
Q: Can a researcher determine whether a Veteran qualified for Choice due to mileage vs wait time?
A: Determining how a Veteran qualified for Choice can be complicated. In Dr. Vanneman’s project, she used patient level information in the VACAA tables, and linked the VACAA patient level data to the visit data. Investigators should remember that the VACAA tables are on the raw server, so the information is constantly updated. This means that researchers will only see the reason a Veteran is currently eligible for Choice and will not know if the Veteran was originally eligible for a different reason.
See the 2017 paper by Vanneman et al, published in Medical Care, for more information on Dr. Vanneman’s methods: Vanneman ME, Harris AHS, Asch SM, et al. Iraq and Afghanistan Veterans' Use of Veterans Health Administration and Purchased Care Before and After Veterans Choice Program Implementation. Med Care, 2017. 55 (Suppl 7 Suppl 1): S37-S44.
Q: Is Fee Basis data distinct from FBCS data?
Fee Basis (formally known as Purchased Care or SAS Fee) and FBCS are two distinct schemas within CDW, although they have many similarities. Both Fee and FBCS were developed to track VA’s purchased care and contain much of the clinical and payment data typically in administrative claims datasets. The schemas also have many overlapping variables. However, the way information gets into the schemas and how they are updated is different. Fee data are local and entered through VistA. FBCS is a national system, which means that there are over 30 SQL servers aggregated into FBCS on CDW. Fee Basis data are static, meaning that the datasets are updated annually, and data is available for each fiscal year. Fee Basis data live on the CDW production servers. FBCS has live data, which means that the data are updated frequently, and datasets can change. In addition, live datasets, which are available on the CDW raw server, can be difficult to analyze since they have not been cleaned by the CDW team.
Q: Are data dictionaries available for Choice data?
A: VIReC and HERC are in the process of developing data dictionaries. Due to the considerable interest in Choice data, the resource centers are working to develop resources that can be released faster than a traditional guidebook. No data dictionaries exist right now, which is why crowd sourcing and input from other investigators working with Choice data is so important.
VHA Community Care Data: Slides from the 2019 HSR/QUERI National Meeting Workshop
Understanding community care use has become central to many VA research studies. At the HSR/QUERI 2019 National Conference, HSR researchers Todd Wagner, Erin Beilstein-Wedel, and Warren Pettey led a workshop with the objectives of (1) explaining how to use PIT data through specific examples from their research, and (2) building a community of VA users who are interested in learning to use community care data for research. The slides from this workshop are available on the VA Intranet (https://vaww.herc.research.va.gov/include/page.asp?id=using-choice-data-research).
If you are working with Choice data, please email herc@va.gov. This will help the team build a community of colleagues who can share information and grow the Community Care data knowledge base.
*Prior to Fiscal Year 2015, the primary source of community care data was known as Fee Basis Data or Purchased Care data. These data are available to researchers and operations users in CDW as “Purchased Care” or “SAS Fee.” As of June 2019, the SAS Fee database is no longer being updated.
Last updated: February 14, 2020
