New Economic Datase

Todd Wagner Todd Wagner

Jean Yoon

Ciaran Phibbs
O i utl ne

 HERC d t t HERC datasets

– HERC DSS discharge dataset with subtotals– HERC DSS station HERC DSS station-level dataset level dataset

– Medicare Wage Index

 DSS Data

– IPD (Intermediate Product Department)– ALB (Account Level Budgeter)

Great when yMore details

– Changes to tracking nursing labor– Other NDEs

 F Bi eeas s PAID
HERC DSS Discharge D
HERC DSS Discharge Dataset 

HERC DSS Discharge Dataset 

Subtotals

 Existing DSS Inpat dataset

– Care of patients discharged in fiscal year Care of patients discharged in fiscal year– One record per discharge – Includes cost incurred in prior fiscal years Includes cost incurred in prior fiscal years– Product subtotals: nursing, lab, pharmacy, etc.

 T f bt rans

fers 

b

e

tween b d ti e

dsections are not id t

t ident

– A patient transferred from inpatient psyc

medicine is one recor

d

– Medicare would treat this as two se

p 

arate 
HERC DSS Discharge Dataset 

HERC DSS Discharge Dataset 

Subtotals

 New HERC DISCH file with 11 subtotals

 Acute medicine, psychiatry, nursing home, etc.  Cost and length of stay for each subtotal

 Subtotals obtained from treatin

gp y s

pecialt

y fi

 Functionally identical to the DSS DISCH N

Functionally identical to the DSS DISCH N
Documentation on HERC we

www.herc.research.va.gov/publications/guidebooks.asp
HERC Station-Level Da
HERC DSS Station-Level Dat

 Aggregated, station-level (STA3N) costs Annual costs and total utilization (inpatient 

Annual costs and total utilization (inpatient 

outpatient visits) 

 HERC

-designated categories designated categories

– 13 inpatient categories– 12 outpatient categories 12 outpatient categories

 One record per service per station (STA3N) 

year

 FY2000-2007
Documentation on HERC we

www.herc.research.va.gov/publications/guidebooks.asp
VA Medicare Wage Ind
Wages

 DSS costs are based on local factor inputs Wages are a factor input and vary considera

Wages are a factor input and vary considera

location

 St ti ti l l di l t 

Statistical analyses across medical centers s

control for wage variability

 Options:

– Dummy variables for each station– Medicare Wage index
VA Medicare Wage Ind

 Medicare calculates the wage inde

on th “ k t” d thi i i l d 

the 

“mar

k

et” an

d this 

is 

inc

l

u

d

e

the Medicare Im

pact Files

 VA is not included in the Impact F We merged the Impact Files with 

facility information from PSSG facility information from PSSG
VA Medicare Wage Ind

 Dataset is based on public use dat

i l d PHI inc

l

u

des no PHI

 Available upon request Available upon request FY2000-2009 Dataset includes STA3N and STA
Documentation on HERC we

www.herc.research.va.gov/publications/guidebooks.asp
DSS IPD Data
DSS Intermediate Product DSS Intermediate Product

Department (IPD) Files

 IPD inpatient and outpatient files beginning  Product department indicates both type and 

of care

– E.g. inpatient units, primary care clinic te

 Often multiple product departments per enc

Often multiple product departments per enc

 Cost incurred in each product department 

– Fixed direct, fixed indirect, variable direc
DSS Intermediate Product DSS Intermediate Product

Department (IPD) Files

 Inpatient: monthly record per pati

i ti t d t d t t inpatien

t pro

duc

t

depar

tmen

t

 Outpatient: one record per patient 

Outpatient: one record per patient 

outpatient product department

 No clinical information (ICD-9 or 

but can be linked to utilization filebut can be linked to utilization file
Example of IPD-TRT Recor

Patient TRTIN TRTOUT IPD NUM 

_

A 06-07-22 06-07-27 psychiatry MD bedday A 06-07-22 06-07-27 psychology & 

neuropsychology lab

A 06-07-22 06-07-27 occupational therapy 
Documentation on HERC we

www.herc.research.va.gov/publications/guidebooks.asp
DSS ALB Data
ALB Uses

 ALB has several uses

– Find labor costs and hours by departmen

ind labor costs and hours by departmen

– Find overhead (indirect) costs by type 

 ALB extract does not contain

– Patient-level data– Product-level data (e g costs of individu

level data (e.g., costs of individu

supplies)
ALB Data Elements

 ALBCC code has 3 components

– Leadin

g, , ( ) 8, column, 1 

(omit

)

– VA cost center, columns 2-4– Production unit code– Division suffix

 Example: DSS ALBCC Code 201MM1 is broken 

follows:

– VACC 201: Medicine– P d ti U it C d MM P i C Cli i Pro

duction 

U

nit

C

o

de MM: P

r

imar

y

Care Cli

n

ic 

– Division: 1 Usually Main Division of a VA medical facil
ALB Cost Data

 Cost are divided into elements

– Fixed direct (does not vary with volume) direct (does not vary with volume)

 Types: FDO (other), FDL (labor), FDE (equipm

(facility)

– Variable direct (varies with volume)

 Types: labor (VL), supplies (VS)

– Indirect 

 Non-clinical departments: police, building engineers, 

ad i i i li i l h dministration, clinical research, etc.
Resources

 DSS National Data Extract Technical Guide 

Product epa t e t Gu de Department Guidehttp://vaww.dss.med.va.gov/nationalrptg/nr_extrachttp://vaww dss med va gov/programdocs/pd depthttp://vaww.dss.med.va.gov/programdocs/pd_deptNote: These are internal VA Web sites and are not available 

 HERC Technical Reports 5 and 6: HERC Technical Reports 5 and 6:

– Barnett PG, Berger MS Cost of positron emissio

to og ap y: et od o dete g d ect co

mography: method for determining indirect co

– Barnett PG, Berger MS. Indirect costs of specia

mental health treatment. 2003. 
Nursing Changes Coming to D

 DSS TLU to ALB mapping

– How DSS gets labor costs into system How DSS gets labor costs into system– For each employee, labor allocated to ALBs by 

 Nurses float to other units as patient census 

– This is not directly tracked in DSS
DSS Changes, Cont.

 Good private sector systems, floating is trac Office of Nursing Services working with D

system track fl i h 

k float

ing, w

hen nurses are not p

patient care (e.g., in training session), and p

more 

data on contract nurses.
Other DSS NDEs

To date, HERC has not used the data.

vaww.dss.med.va.gov/nationalrptg/nr_extract

Note: This is an internal VA Web site and is 

available to the public.
DSS Ward NDE

 Divides all inpatient encounters into segmen

on the ward on which the patient was locateon the ward on which the patient was locate

hospitalization during the current fiscal year

– Includes date and time of admission and dischar

Includes date and time of admission and dischar

unit.

 Similar to the TRT file but wards refer to a 

Similar to the TRT file, but wards refer to a 

location

 W d d t l il bl i FY07 Ward data are only available since FY07
Surgery NDE

 Contains the cost and workload of 

surgery cases. 

 This NDE is based on the This NDE is based on the VistA S

S

package

 DSS does not cost cancelled or ab

cases but does record them cases, but does record them.
Fee Basis: Fee Basis:

Non-VA Purchase Dat
Fee Basis Program

 Pays for care at non-VA facilities when

– it is the only source available, or it is the only source available, or

– VA could save money

 Full range of services covered Nearly all outpatient care is pre-authorized

emergent care
Growth in Fee Basis

 Large growth in contract care in last 10 yea

– $556 million in FY2003 $3 1 billion in FY2009 $556 million in FY2003, $3.1 billion in FY2009– 10-20% growth per year

 Examples of growth areas

– long-term care (community NHs)– kidney dialysis– radiology
8 Fee Basis Files per Fiscal Y

 Inpatient care

– Hos

p y ( y ypy ) ital sta

ys 

(facilit

y or facilit

y

+

p

h

ysician

)

– Ancillary, physician (if billed separately)

 Outpatient care Outpatient care

– Outpatient non-pharmacy – Payments to pharmacies Payments to pharmacies

 Travel expenses T d fil ( h ll h ) Two ven

dor files 

(

p

harmacy, all ot

her

)

 Veterans with Fee Basis ID cards
Resources

 Fee Basis intranet web site 

– Record of national Fee monthly calls ecord of national Fee monthly calls

 HERC intranet web site HERC intranet web site

– Guidebook on Fee Basis data– Technical report anal ing FY2003 data echnical report analyzing FY2003 data

 Mark Smith will be presenting on Fee Basis 

Mark Smith will be presenting on Fee Basis 

July 28th Cyberseminar
PAID Data
PAID

 VA’s payroll data system PAID has many different types of data 2 parts to PAID

– History file, data from each pay period– Master file, annual file with human resources da

Master file, annual file with human resources da
PAID, cont.

 PAID History file

– Data on hours worked including hours with shi

Data on hours worked, including hours with shi

differentials

– Data on pay, including all deductions and adjus– Essentially all of the detail for generating paych
PAID, cont.

 PAID Master file

– Education/qualifications including degree dates Education/qualifications, including degree dates– Demographics– Hire date Hire date– J b d i ti /titl Job description/title
Linking to PAID

 Individual identifiers 

– SSN name SSN, name, birthdate birthdate, etc.

 W k l id tifi Wor

k

p

lace identifiers

– TLU, facility, BOC (type of employee)
Li ki PAID Linking to PAID, cont.

 Providers

– DSS PTF NPCD all have a provider ID DSS, PTF, NPCD all have a provider ID– There is a crosswalk between provider ID and S– Use SSN to pull PAID data and link to provider

Use SSN to pull PAID data and link to provider

 Nurses

– Nurse manager of each unit has own TLU

– All nurses working for that unit assigned to that 

– From DSS, can get mapping of TLUs to ALBC– This only works for nurses