Health Economics Spotlight

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

July 2024

In This Issue

1. Identifying the Cost of a Hospitalization using CDS Data
2. VHA Data Portal: Risk Adjustment
3. VHA Data Portal: Closing a Research Project
4. MCA Cost Data and the Cerner Transition
5. HERC Author Receives HSR's Best Paper of the Year
6. HSR Special Recognition Award Winner
7. HERC is on LinkedIn

Spotlight

Identifying the Cost of a Hospitalization using CDS Data

A new page describing Integrated Veteran Care Consolidated Data Sets (IVC CDS) cost data is now available on the HERC website. The page provides an overview of cost data in CDS and presents one method for identifying the cost of an inpatient hospital stay using CDS data. Sample SQL code for identifying the total cost of a stay is available on the website and on VA's Enterprise GitHub (VA intranet only). Investigations into outpatient cost data are underway.

IVC CDS Data Overview and Availability

IVC CDS is the primary source for VA community care data. IVC CDS contains referrals, claims, and eventually payment data from Community Care Reimbursement System (CCRS), Electronic Claims Adjudication Management System (eCAMS), Fee Basis Claims System (FBCS), Plexis Claims Manager (PCM), and VistA Fee Basis Package (Fee).

Data is available for claims processed on or after October 1, 2018. Projects looking to include community care data before FY 2019 will need to include additional data sources.

Developing the Algorithm and SQL Code

To determine which IVC CDS cost variable reflected the actual VA payment, we compared costs in IVC CDS to those in Fee Basis data for a select cohort with records in both systems. We also compared costs within CDS at the header and line levels and consulted with the Access and Community Care Engagement Network Team (ACCENT). We recommend using Claim_Total_Amount as the total VA payment amount. In many (but not all) cases, Amount_Allowed will be equal to Claim_Total_Amount, but in cases where the values are not equal, we found that Amount_Allowed does not include adjustments to the final paid amount.

Due to resubmission of claims and claims from multiple source systems, we found many duplicate claims in the data. Users should always de-duplicate when the same claim appears in both FBCS and VistA (Fee) source systems; we recommend keeping claims from FBCS since they're generally more complete.

We also found paid claims that appear to be duplicates originating from other systems or within the same system. While data users looking at utilization would likely deduplicate these claims, the question of deduplicating is less clear for costs. Imagine a scenario where a provider submits a claim, and VA pays X dollars. The provider thinks X is too low and resubmits the claim, and then VA pays an additional Y dollars. If you deduplicate these claims and keep only the most recent submission, you would think Y was the final cost, when the final cost could be X+Y.

Given our limited experience with IVC CDS data, we do not definitively know whether these duplicates should be summed or dropped; at this time, we’re unable to definitively determine if duplicate sets of claims were actually paid (perhaps erroneously).

The code we’ve provided calculates the min, mean, max, and sum of Claim_Total_Amount for paid records with the same Original_ClaimID; researchers can use these summary statistics to inform their final decision.

The inpatient costs algorithm on the HERC website serves as a starting point for data users conducting their own evaluations. We encourage those using this SQL code to monitor their output after each step for any incorrect or unexpected values.

Select IVC CDS Data Resources

• IVC CDS Cost Data on the HERC website: guidance on cost data and sample SQL code for identifying the cost of an inpatient stay.
• ACCENT website: multiple resources for working with IVC CDS data including Finding Hospital Inpatient Stays in CDS.
• IVC CDS on the VHA Data Portal (VA intranet only): information on content, requesting access, and additional resources.

Resources

VHA Data Portal: Risk Adjustment

Risk adjustment is one way of adjusting for inherent differences in patients' underlying clinical needs when comparing groups of patients or hospitals. A new page on the VHA Data Portal (VA intranet only) provides an overview of risk adjustment measures available to VA data users. Lean about VA-specific risk adjustment measures (such as Nosos) as well as general measures that can be calculated using VA data. Visitors will also find information on accessing and resources for using the different measures.

Risk Adjustment available on the VHA Data Portal. Note: this page is only available within the VA intranet.

VHA Data Portal: Closing a Research Project

Once a study is complete, researchers should begin the process of closing their project. The new Closing a Research Project page on the VHA Data Portal (VA intranet only) outlines the steps for closing a research project and provides an overview of VA records retention policy. 

Data Q&A

Will MCA data be available for sites that transition to Cerner?

We have received questions from researchers submitting grant proposals about whether MCA cost data will be available for Cerner sites. Yes, MCAO is computing costs for sites that have transitioned, but our answer is qualified as we have not yet used these data, so we don’t have any experience with how these data compare to non-Cerner medical centers.

Researchers may need to adjust how they define and identify care from Cerner sites as variables such as stop code are assigned differently.

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.

In the Literature

HERC Author Receives HSR's Best Paper of the Year

 
David Chan, MD, PhD
Investigator, HERC and Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System
Associate Professor of Health Policy, Stanford School of Medicine

HERC investigator David Chan won the 2023 HSR Best Research Paper of the Year Award with the paper, "Is There a VA Advantage? Evidence from Dually Eligible Veterans." This paper focuses on a question central to VA’s mission: Does the VA deliver better outcomes for Veterans—and at what cost—relative to the private sector?

Using an approach in which Veterans are as good as randomly assigned by ambulance to VA or non-VA hospitals, the authors found that VA reduces 28-day mortality by 46%. This survival benefit persisted at 1 year, indicating that these deaths were prevented rather than delayed. They also found that VA reduces 28-day spending by 21% with striking differences in the services provided: VA provided more low-cost services, such as telephone calls; non-VA hospitals performed more high-cost services and may have “upcoded” their services.

This is a highly competitive national award was selected from all health services papers published papers in 2023. View the full announcement on the HSR website.

The paper, published in American Economic Review is available online.

***Save the date*** Learn more about Dr. Chan’s research in the September 18, 2024 HERC health economics cyberseminar. 2pm ET. Registration link coming soon.

Interested in learning more about VA and Non-VA cost comparisons? Visit the page Comparing VA Versus Non-VA Costs on the HERC website for information about comparing costs and evidence from existing cost comparisons.

HERC News

HSR Special Recognition Award Winner

 
Carla Garcia, MPH
Research Associate
HERC, VA Palo Alto Health Care System

HERC project manager Carla Garcia received an HSR Staff Special Recognition Award along with Ci2i project manager Cindie Slightam for their work creating the health services research internship program for community college students from historically excluded groups. They designed the internship to expose students to research, inspire and aid students’ academic and professional careers, and provide an opportunity for students to envision themselves in research settings at VA.

Learn about the internship in the seminar, “How to Create and Pilot a Successful VA Internship Program for Students from Historically Excluded Groups in Under a Year,” available online.

HERC is on LinkedIn

HERC is now on LinkedIn. Follow us for all the latest HERC news including updates on upcoming seminars, new research, and other resources for determining costs and efficiency of care.