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

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

• Todd Wagner

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VA Cost Distribution Report
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CDR

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

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Time Frame

• Costs represent dollars expended during the
  report month
• Annual Reconciled Report

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CDR Costs

• Costs include reconciliations

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Variables

• STA3N
• STA5
• Cost Center
• Acctno
• Costs
• FTE

Use for linking data
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File Display
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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

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

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Units and Unit Costs

• Our advice dont 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

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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

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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/Cos
  tData_Files/CDR_Handbook.PDF
• References
• Swindle, Beattie, Barnett (1996) Medical Care
  34(3)MS83-90
• Ended in FY04 replaced by MPCR for FY05 onward

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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
  200120(4)169-175.
• Chen S, Smith MW, Wagner TH, Barnett PG. Health
  Affairs 200322(6)256-263

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CDR Trend Monitoring
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Monthly Program Cost Report (MPCR)
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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 (dont use)
• MPCR is created monthly, not reconciled.

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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

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Access

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

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Cost Categories
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Indirect Costs

• Uses FMS definition of direct/indirect cost.
  Assigns indirect costs to each activity account.
• Cant separately identify subcomponents of
  indirect cost (e.g., research and education), as
  was possible in CDR.

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Advantages and Disadvantages

• Workload
• MPCR uses DSS workload to distribute costs.
• Timely, however, users cant override problems in
  errant workload
• DSS does not reconcile MPCR to FMS 830 Reports
  (monthly VAMC cost report)

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MPCR vs CDR
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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

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Questions on MPCR?
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NDE Summary
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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

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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

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Disadvantages

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

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Inpatient NDE Costs
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Inpatient NDE Days
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NDE Summary vs CDR
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HERC Person-Level Data
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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

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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

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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.

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Questions on HERC Person-level Data?