Health Economics Spotlight

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

October 2024

In This Issue

1. Guidance for Using MCA NDEs in VA Research and Operations
2. Seminar: Integrating Revealed and Stated Preference Analysis to Improve Maternal Healthcare Access in Rural Areas
3. IVC CDS Cost Data Page Update
4. Fixed vs Variable Costs
5. Join the HERC team: Research Data Analyst (Experienced) Position Open

Spotlight

Guidance for Using MCA NDEs in VA Research and Operations

A new HERC technical report offers practical guidance for using the Managerial Cost Accounting (MCA) National Data Extracts (NDEs) in a VA research or operations project. MCA data are the national source of cost information for VA, and the NDEs provide detailed cost information for all VA inpatient and outpatient encounters. The technical report provides guidance on common tasks including merging cost and utilization data for a cohort, summarizing data into meaningful time periods, and creating categories of care. Sample code for all tasks is available within VA’s Enterprise GitHub.

Merging and Summarizing Cost and Utilization Data for a Cohort

Many projects will need to summarize cost and utilization data for a cohort. Summarizing these data at the patient level allows researchers to identify the effects of an intervention on VA costs and utilization and identify trends over time. The MCA NDEs don't contain detailed clinical information such as procedures and diagnoses; therefore, researchers will need to extract the cost and utilization data separately and then merge the data files to crate their analytic dataset.

Developing the Code: Cost Analysis of a Clinical Trial

The sample code in Technical Report 44 and VA’s Enterprise GitHub was created for cost analyses conducted alongside clinical trials, although it can be applied to any study aiming to identify trends in costs using VA data. Specifically, the code the authors include is from the study Can Service Dogs Improve Activity and Quality of Life in Veterans With PTSD?. The full results of the cost analysis is available in chapter 1 of the monograph, The Economic Impact and Cost Effectiveness of Service Dogs for Veterans with Post Traumatic Stress Disorder. Summarized results are also available in the paper, Therapeutic and Economic Benefits of Service Dogs Versus Emotional Support Dogs for Veterans With PTSD.

In the study linked above, the authors wanted to understand participants’ health care use and costs for the for the 540 days (i.e., 18 months) before and after participants were paired with a dog. They summarized the data into 30-day periods by creating a long dataset with one value per person per thirty-day period for each variable. They grouped cost and utilization data into mutually exclusive categories of care using inpatient Treating Specialty or outpatient Clinic Stop codes available in the TRT and OUT/OUT2 MCA NDEs. A list of codes by category of care is available in Appendix B of the technical report. They then created cost and utilization variables for each 30-day period; a list of variables is available in Appendix A.

The SAS code that accompanies the technical report serves as a starting point for data users conducting their own evaluations. We encourage those using this code to monitor their output after each step for any incorrect or unexpected values.

Technical Report 44: Practical Guide to Using MCA NDEs in VA Research and Operations is available on the HERC website.

Seminar

Integrating Revealed and Stated Preference Analysis to Improve Maternal Healthcare Access in Rural Areas

HERC Health Economics Seminar

Wednesday, October 16 at 2pm ET

Register

 
Adriana Nunez, PhD
Master in Health Economics, Master in Healthcare Quality Management, MD.
University of California Merced. Health Services Research and Policy.

 
Paul Brown, PhD
Professor of Health Economics, University of California Merced.

Abstract: This study investigates disparities in pregnancy-related healthcare utilization between rural and urban areas, developing a predictive model that integrates findings from revealed preference analysis and a discrete choice experiment. Of the over 12.5 million discharges in California from 2016 to 2019, 15% were pregnancy related. The study revealed that rural patients not only traveled three times the distance to receive care, but also had higher odds of labor induction, and increased care costs, with more significant racial-ethnic disparities. The discrete choice experiment recruited 204 participants, encompassing 102 California rural zip codes, highlighting the higher-valued attributes of care. Integrating both models suggests that improving modifiable aspects of care in rural facilities can increase the demand for these facilities, potentially ensuring their operation.

Resources

IVC CDS Cost Data Page Update

We have made two changes to the Integrated Veteran Care Consolidated Data Sets (IVC CDS) Cost Data webpage based on input from the VHA Office of Integrated Veteran Care.

1. We now recommend filtering IsCurrent=Y. IVC has informed us that claim total amounts are not cumulative for reprocessed claims, and the most current version of a claim should represent the full amount paid on that claim.
2. We removed the 3-day payment window lookback period to be consistent with other cost data and given the unknowns in the complicated billing process.

VA data users can find the most recent version of the SQL code on VA's Enterprise GitHub: github.ec.va.gov/COIN-HSR/HERC/blob/main/HERC-sop-cost-inpatient-hospital-stay.sql (VA intranet only).

Data Q&A

Fixed vs Variable Costs

Q: What is the difference between fixed indirect, fixed direct, and variable costs?

Fixed direct costs are costs of patient care that don’t vary (within the year) in response to the volume of care provided. Examples include technology such as telehealth equipment and leased office space.

Fixed indirect costs are the overhead costs for services delivered to patients. These costs are not directly related to patient care. Examples include utilities, maintenance, and administration costs.

Variable direct costs are costs directly associated with providing patient care. These costs can change based on the volume of care provided. Examples include provider labor and supplies used during patient care.

More information is available in the MCA NDE Technical Guide, available on the MCAO SharePoint: dvagov.sharepoint.com/sites/vhamcao/SitePages/National-Data-Extracts.aspx (VA intranet only).

Do you have a question about using VA cost data? HERC offers 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.

Join the HERC Team:
Research Data Analyst (Experienced) Position Open

We are seeking a full-time experienced Research Data Analyst to join the HERC team. The Data Analyst will create, manage, and analyze large datasets for high-quality research projects designed to evaluate VA programs and policies. We are looking for candidates highly proficient in SAS and/or SQL with extensive experience working with relational databases. Candidates should have experience importing, transforming, cleaning, and merging data and conducting extensive quality/accuracy checks to ensure high-quality datasets.

Candidates must have excellent critical thinking skills, attention to detail, and good communication skills. We are looking for candidates who are self-starters and can work independently.

This position is in collaboration with the Department of Surgery at Stanford University and is open to candidates anywhere in the United States.The expected pay range for this position is $132,369 to $160,981 per annum (within 10 Bay Area counties) or $91,609 to $141,317 per annum (all other regions). View the full job summary to learn more and apply.