VA Economic Data Sets: CDR, MPCR, Person-level cost

1. VA Economic Data Sets: CDR, MPCR, Person-level cost Todd Wagner

2. VA Cost Distribution Report

3. CDR • Financial database that records costs at a functional or organizational level • Medical Service • Surgical Service • Sanitation Operations • No encounter or patient level costs

4. Time Frame • Costs represent dollars expended during the report month • Annual Reconciled Report

5. Variable Obs Mean Min Max totcost 136575 156039.7 -2.68e+08 2.67e+08 pscost 136575 85667.72 -331555.8 5.77e+07 othcost 136575 70371.98 -2.68e+08 2.61e+08 Source: 2001 CDR CDR Costs • Costs include reconciliations

6. Variables • STA3N • STA5 • Cost Center • Acctno • Costs • FTE Use for linking data

7. File Display

8. Cost Center • Category Account Series • 2xx Direct Medical • 3xx Contract and Fee care • 4xx Administration • 5xx Engineering • 6xx Miscellaneous Benefits & Services • 9xx Medical Care Cost Recovery

9. Account Number X X X X. x x Major Cost Category (e.g., 1=inpatient, 2=outpatient) Indirect Accounts Department

10. Costs and FTE • Costs & FTE are available for each account number • Costs include personnel, other and total • FTE data come from FMS. Calculated on a basis of 80 hours per pay period regardless of how much time is actually worked.

11. Units and Unit Costs • Our advice: don’t rely on these fields • It is more reasonable to find average costs using utilization from PTF and OPC • National average daily cost and average visits costs available from HERC for 1993-2004

12. Allocations • Allocations based on service chief estimates of activity • Uncertain accuracy of service chief allocation • Past incentive to misreport costs • Past activity reports carried forward as default

13. Using the CDR • Flat file that must be read into SAS • Exclude 9000 series accounts • Documentation • 1996 CDR handbook www.herc.research.med.va.gov/CostData_Files/CDR_Handbook.PDF • References • Swindle, Beattie, Barnett (1996) Medical Care 34(3):MS83-90 • Ended in FY04; replaced by MPCR for FY05 onward

14. Applications of CDR • Useful to find average cost • Average cost per day of stay in long-term care • Average cost per psychiatric visit • Monitor trends in VA expenditures by program • Chen S, Wagner TH, Barnett PG. Health Affairs 2001;20(4):169-175. • Chen S, Smith MW, Wagner TH, Barnett PG. Health Affairs 2003;22(6):256-263

15. CDR: Trend Monitoring

16. Monthly Program Cost Report (MPCR)

17. File History • New DSS financial dataset for FY04- • Replaced the Cost Distribution Report. Last CDR year was FY04. • Both CDR and MPCR are available in FY04. • FY03 MPCR is a test case (don’t use) • MPCR is created monthly, not reconciled.

18. File Construction • Costs are from FMS • Costs are distributed to Cost Distribution Accounts (same as in CDR) • Facility is tracked by STA3N • No longer are substations being tracked

19. Access • KLF Menu • Austin • CD-ROM via chief of fiscal service

20. Cost Categories

21. Indirect Costs • Uses FMS definition of direct/indirect cost. Assigns indirect costs to each activity account. • Can’t separately identify subcomponents of indirect cost (e.g., research and education), as was possible in CDR.

22. Advantages and Disadvantages • Workload • MPCR uses DSS workload to distribute costs. • Timely, however, users can’t override problems in errant workload • DSS does not reconcile MPCR to FMS 830 Reports (monthly VAMC cost report)

23. MPCR vs CDR

24. MPCR for Research • Result: MPCR is a report for Congress that projects workload and costs. It is not reconciled later (although ARC conducts reconciliations) • Conclusion: Use it cautiously for research • Look for upcoming HERC guidebook • Also: HERC is creating a department-level cost dataset based on NDE

25. Questions on MPCR?

26. NDE Summary

27. NDE Summary • Created a department-level cost dataset from the DSS NDE extracts. • Inpatient FY01-04 • Outpatient FY04 • HERC is using this summary to create the Average Cost file for FY04 onwards

28. Benefits • Reconciles with the NDE extracts • Allows people to compare HERC to DSS more directly • Same total costs • Different RVUs • Researchers can go back in time to track spending patterns

29. Disadvantages • Cost totals by STA3N by HERC category • No subtotals for indirect costs • Limited to HERC categories • Available after DSS NDEs are released

30. Inpatient NDE Costs

31. Inpatient NDE Days

32. NDE Summary vs CDR

33. HERC Person-Level Data

34. HERC Person-Level Data: Inpatient • Costs and LOS summed across all stays • Costs and LOS summed within five categories: - Medical / Surgical - Behavioral - Long-Term Care - Residential / Domiciliary - Other

35. HERC Person-Level Data: Outpatient • Costs summed across all visits • Costs summed within four categories: • Medical / Surgical • Behavioral • Diagnostic • Other • Separate total for all DSS pharmacy costs

36. HERC Person-Level Data: Access • AAC files in SAS format: RMTPRD.HERC.SAS.PLCOSTyy • Years available to date: FY98-FY03 • Reference guide on HERC web site: Hill A, Yu W. Guidebook for the HERC Person Level Cost Data Sets. HERC Technical Report #16. 2004.

37. Questions on HERC Person-level Data?