Health Economics Spotlight

Updates on VA data, health economics research, and analytic methods

May 2024

In This Issue

1. Using VA Resource Centers through the Project Lifecycle
2. The Changing Face of Veterans and Implications for Policy: Insurance Coverage for US Veterans from 2010-2021
3. Identifying Regional Anesthesia Procedures in the EHR Using Natural Language Processing
4. Identifying the Average Cost of Care for Specific Services and Locations
5. FY23 Inpatient and Outpatient Average Cost Data Now Available 
6. Discharge Data with Inpatient Categories Available for FY23 
7. Nosos Risk Score Data Revised
8. Thank You for Participating in the Customer Needs Assessment

Spotlight: Seminar

Using VA Resource Centers through the Project Lifecycle

On Wednesday, May 22, join us for a special seminar on using VA resource centers through a project lifecycle. This seminar will introduce participants to several VA resource centers (CEIR, CIDER, CIPHER, HERC, VINCI, VIReC) and provide an overview of the resources each center offers. We will discuss the variety of resources available for research and operations projects during each phase of the project lifecycle: planning a project, conducting a project, and disseminating results. Leaders from each center will be available to answer questions about the different resource center services. 

We hope participants will leave this seminar understanding the breadth of available resources and feeling more confident navigating to those resources. 

Presenters

Center for Evaluation and Implementation Resources (CEIR)
Center for Information Dissemination and Education Resources (CIDER)
Centralized Interactive Phenomics Resource (CIPHER)
Health Economics Resource Center (HERC)
VA Informatics and Computing Infrastructure (VINCI)
VA Information Resource Center (VIReC)

Learn about resources for

• Exploring available data
• Planning your analyses 
• Requesting data
• Sharing findings
• And more!

Wednesday, May 22 at 1pm ET

Register

Target audience: New and experienced VA researchers who want to learn more about resources to support their projects (research and operations).

Seminars

The Changing Face of Veterans and Implications for Policy: Insurance Coverage for US Veterans from 2010-2021

HERC Health Economics Seminar

Wednesday, May 15 at 2pm ET

Register

Director, Health Economics Resource Center, VA Palo Alto Health Care System
Professor, Department of Surgery, Stanford University

Department of Veterans Affairs (VA) health care spending has grown in the past decade, in part due to legislative changes that expanded access to VA purchased care. We analyze three national surveys, in combination with the VA Survey of Enrollees, to understand how insurance coverage and enrollment in VA has changed between 2010 and 2021. These data provide insights into VA’s efforts to improve access, and why these efforts may have had the unintended consequence of payer shifting. Further legislative efforts to increase access, without recognizing the potential for payer shifting, may just increase costs without any corresponding improvements in health.

Identifying Regional Anesthesia Procedures in the EHR Using Natural Language Processing

HERC Health Economics Seminar

Tuesday, June 18 at 2pm ET

Register

Investigator, Health Economics Resource Center (HERC), VA Palo Alto Health Care System
Affiliate scientist, Stanford-Surgery Policy Improvement Research & Education, Stanford University

Limited guidance for defining and documenting regional anesthesia has resulted in wide variation in documentation practices, which can lead to missing and inaccurate data. This seminar will present a natural language processing (NLP)-based algorithm we developed to identify regional anesthesia within unstructured clinical notes. We compared the performance of the NLP-based algorithm to regional anesthesia documentation in CDW and identified more than twice as many regional anesthesia cases using the NLP-based algorithm. Findings have implications for regional anesthesia practice, research, and quality improvement efforts.

Target audience: Researchers, clinicians, and administrators involved in anesthesia and researchers interested in NLP techniques.

Data Q&A

Identifying the Average Cost of Care for Specific Services and Locations

Where can I find the average cost of care for a specific service (e.g., physical therapy) in a specific location (e.g., Palo Alto, CA)?

The Managerial Cost Accounting (MCA) report “Cost and Workload for Selected DSS Clinic Stop/Credit Stop” includes average costs by stop code at the national, station, and facility level by fiscal year. The report also includes useful information such as total encounters by stop code, total costs by stop code, and cost components including variable and fixed costs. This report is available to VA data users through the MCA report generator (VA intranet only) page.

Information about requesting access to MCA reports for research and operations is available on the VHA Data Portal (VA intranet only).

If you end up publishing or releasing this information, make sure to only release values in aggregate (such as average costs); you should not release unaggregated costs that could be used to disadvantage VA in negotiations.

Looking for the average daily cost of inpatient stays? Estimates by categories of care are available on the HERC website.

Do you have a question about using VA cost data? We offer consultations to VA data users on a variety of health economics and data topics. Visit the HERC website to learn more about our consulting service.

Data

FY23 Inpatient and Outpatient Average Cost Data Now Available

HERC Inpatient and Outpatient Average Cost data are updated for FY23 and available on VINCI. These data are estimates of encounter level costs for VA care. Data include estimates for 12 types of outpatient care and 11 types of inpatient care.

An overview of Inpatient and Outpatient Average Cost data is available on the HERC website. Guidebooks provide detailed descriptions of the methods used to prepare the estimates and a user's guide for working with the data.

Information about accessing HERC Average Cost Data is available on the VHA Data Portal (VA intranet only).

Overviews:

• Inpatient Average Cost Data webpage
• Outpatient Average Cost Data webpage

Guidebooks:

• HERC's Average Cost Datasets for VA Inpatient Care
• HERC's Outpatient Average Cost Dataset for VA Care (VA intranet only)

Discharge Data with Inpatient Categories Available for FY23

HERC creates a dataset identical to the MCA discharge NDE with additional information on cost and length of stay (LOS) subtotals for inpatient categories of care.

The MCA discharge NDE includes information on the entire span of an inpatient hospitalization. While it includes the discharge bed section, it doesn’t have details on other treating specialties used during an inpatient stay. The HERC Discharge Dataset includes additional fields containing cost and length of stay subtotals for 11 categories of care.

The HERC Discharge Dataset is useful to researchers interested in specific treating specialty segments of an inpatient stay (e.g., surgery or ICU). The dataset, available for VA research and operations access, has been updated for FY23. More information is available in the guidebook HERC's MCA Discharge Dataset with Subtotals for Inpatient Categories of Care.

Nosos Risk Score Data Revised

Nosos risk score data for FY2006-FY2023 are available in CDW. Previously, Nosos data were generated for each quarter of the fiscal year, using a rolling 4-quarters of data. Beginning in FY23, we will only create annual Nosos scores, and we have dropped the quarterly data.

Nosos data use scrambled social security number (SCRSSN) as the patient identifier. Researchers who wish to use Nosos risk scores must request IRB approval to use SCRSSN before requesting Nosos risk score data through the Data Access Request Tracker (DART). Information about the DART research request process (VA intranet only) is available on the VHA Data Portal.

For details on the Nosos risk score, see the HERC's Guide to the Nosos Risk Adjustment Score.The Nosos variable list with descriptions is available in Appendix A.

Thank you for Participating in the Customer Needs Assessment

Thank you to everyone who participated in the annual needs assessment for ORD research resource centers. Your input is truly valuable to us, and we use the feedback you provide to plan future products and services. VA researchers: if you did not have a chance to participate and would like to provide feedback on our products and services, we welcome feedback at herc@va.gov.