Fee Basis Roll-up Dat

Patsi Sinnott, PT, PhD, MPH Patsi Sinnott, PT, PhD, MPH

Andrea Shane, BA

Ada C ow, S m 

C

how, B

S

HERC

Dec. 7, 2011
Background

 M th 10% f th VHA b d t 

More than 10% of the VHA budget now 

purchased care, with 10-20% growth per 

 The primary vehicle for purchasing care 

Basis p g ro ram. 

 Fee Basis care is authorized when...

– VA cannot provide timely care VA cannot provide timely care– It is cost-efficient to purchase care (getting equa

outcomes)

– Under limited circumstances, the Veteran had n

payment source. payment source.
Fee Basis payment syste

Fee Basis payment syste

 Fee Basis payment scenario:

1. Veteran receives care at General Hospital (GH2. Vendors bill VA for services rendered

a. GH sends facility invoice to VAb. GH doctor(s) send professional fee invoicc. Laboratory serving GH sends invoice to Vd. Ambulance service sends invoice to VA

(often in vain)

3. VA receives electronic claims, re-enters them 

into a separate system, and processes them. 

a. >90% of claims are paid within 30 days 

of receipt by VA.
Project Goals Project Goals

 HSR&D funded HERC to create t

files:

– Summary of annual Fee Basis spend

person-level

– Encounter-level roll level roll-up of claims da

up of claims da

 total inpatient t t l t ti t total outpatient

 total
Fee Basis national file

Fee Basis national file

 F B i d t ll d i t i ht 

Fee 

Bas

is 

d

a

ta are roll

e

d up 

i

n

to e

i

ght na

files per year. Four contain paid invoice

1. Inpatient facility (INPT)2. Ancillary (inpatient professional fees, labo

other) (ANCIL)

3. Outpatient (MED)

4. Monthly total payments to pharmacies for 

medications (PHR)
Patient-level summary of a

level summary of a

Fee Basis spending

 FB costs obtained from four FB (FEN) d

– Inpatient (FENINPT), – Ancillary (FENANCIL), – Outpatient (FENMED), and – Pharmacy (FENPHR). 

 Dates of service FY00 to FY10 Fee Basi

datasets.

Rollup datasets for each 

SCRSSN n_phr_recsn_me

d_recs p

hr_sum

med su _

m

n_inpat_recs

inpat_sum outpat_total

n ancil recs n

_

ancil

_

recs inpat total inpat_total

ancil_sum FB_total
Patient-level summary of a

level summary of a

Fee Basis spending Fee Basis spending

 T i bl i th P Two new variables in the Person-L 

eve

datasets with Fee Basis information:

– FB_Total is the sum of all of an individu

Basis encounter costs for the fiscal year 

– TOTPLCST is the total of all an individu

expenditures for the year including their expenditures for the year including their 

expenditures. (total cost +FB_Total)
Questions?
Encounter-level roll level roll-up

of claims data

 To provide roll To provide roll-up of data for all inpat

up of data for all inpat

outpatient and all care at the encounter 
Definition of an encount

 Inpatient care 

 an inpatient stay an inpatient stay

 Outpatient care

 one or more services from one or more re

have the same SCRSSN,, 

 STA3N, VEN1

PAYCAT, and Date of Service (DOS). 
Encounter-level roll level roll-up 

claims data

 An inpatient encounter begins with a star

(admission to hospital) and ends with a s(discharge from hospital) (discharge from hospital)

– reported in one single record 

– or two or more records that have conti

service dates. 

 FB Pay Amount Variable was used to ca

cost.
Example Fee Basis INPT R

Ob Scrssn VEN13N Pmt cat. startdt stopdt 1 -11XX 161469571 CH 04/28/08 05/01/08 02 -14XX 721159928 CNH 11/01/99 11/04/99 03 -14XX 721159928 CNH 10/01/99 10/31/99 04 -14XX 721159928 CNH 09/01/99 09/30/99 05

-14XX 721159928 CNH 08/01/99 08/31/99 0

CNH 08/01/99 08/31/99 0

6 -18XX 3102 08/31/03 09/07/03 07

-28XX 55035705004 CH 05/24/07 05/24/07 0

55035705004 CH 05/24/07 05/24/07 0

8 -28XX 550404900 CH 02/18/07 02/22/07 0
Questions?