1. Fee Basis & NPPD Data Mark W. Smith, Ph.D. August 3, 2005 Health Economics Teleconference Seminar 1-800-767-1750 access code 45043

2. The Fee Basis (FEE) Files

3. Overview of Fee Basis Program Pays for care at non-VA facilities when –it is the only source available, or –VA could save money Full range of services covered Mostly pre-arranged; limited emergent care

4. Fee Basis files Subset of all VA contract care –Non-VA PTF has detail on hospital stays; some overlap with Fee Basis files –Substantial utilization unaccounted for SAS format

5. Names of Fee Basis Files - I Hospital stay MDPPRD.MDP.SAS.FEN.FY04.INPT Ancillary services provided to inpatients MDPPRD.MDP.SAS.FEN.FY04.INPT.ANCIL Outpatient services MDPPRD.MDP.SAS.FEN.FY04.MED Payments to pharmacies MDPPRD.MDP.SAS.FEN.FY04.PHR

6. Names of Fee Basis Files - II Travel expenses MDPPRD.MDP.SAS.FEN.FY04.TVL Pharmacy vendor file MDPPRD.MDP.SAS.FEN.FY04.PHARVEN Other vendors file MDPPRD.MDP.SAS.FEN.FY04.VEN Veterans with FEE cards (long-term users) MDPPRD.MDP.SAS.FEN.FY04.VET

7. Highlights of Patient Data Scrambled SSN Primary Service Area (PSA) County, state, zip In VET file only: –death date, if any –prisoner of war code –war code

8. Highlights of Clinical Data Outpatient: –Date of service –1 CPT procedure code Inpatient: –Start and end dates of invoiced period (often different from overall admission & discharge) –Up to 5 surgery codes –Up to 5 ICD-9 diagnosis codes (*no decimal*)

9. Highlights of Financial Data Amount claimed Amount paid often much less than amount claimed Many variables relating to FMS record- keeping: invoice date, processing date, check number, check date, cancel code, etc.

10. Decimals in Payment Fields Claimed amount (AMTCLMD) has a decimal point, but Dispensed Amount (DISAMT) does not It appears that DISAMT has two implied decimal places: 2160 = $21.60 Check against AMTCLMD to be sure

11. Highlights of Vendor Data Vendor ID Address (city, state, zip) Related VA station number Payment totals by month

12. Fee Basis Payments FY2003 Inpatient facility payments (INPT) –50,268 unique SCRSSNs –63,306 unique admissions –1,783,984 total days –$554,977,000 total payments

13. Notes on Fee Basis Data LINENO refers to consecutive records for the same person Each row of data represents a service provided for a particular date (outpatient) or time period (inpatient) –TREATDTF: Inpatient start of invoice period –TREATDTO: Inpatient end of invoice period –TREATDT: Outpatient date of service

14. Notes (cont) Multiple services may be paid by a single VA check. See EFTNO (electronic funds transfer no. ~= check no.) and CHKDAT (check date) 70-75% of records in the Non-VA Hospitalization file also appear in the Fee Basis data. –The reverse is not true: most Fee Basis records are not in the Non-VA Hospitalization file.

15. Notes (cont) There is repetition across variables: state appears twice, some dates appear in both Julian and SAS formats Blank fields are common! They could mean “not applicable” as well as “missing.” Each paid invoice has a separate record. –Example: an inpatient stay typically has one invoice (and therefore one record) for each calendar month.

16. Notes (cont) Records are typically processed within 30 days of invoicing BUT Invoices may be sent LONG after services are rendered. THEREFORE To find all services in a fiscal year, look in the Fee Basis files in that year and the following year. Search by –TREATDTF and TREATDTO for inpatient records –TREATDT for outpatient records

17. Notes (cont) Can use FPOV (Fee Purpose of Visit) to help distinguish type of care. –Example: To locate chiropractic care, search for CPT codes 98940-98943 or FPOV = 75. New POV codes are added over time

18. Using Fee Basis Files: Cautions Beware of missing decimal places –ICD diagnosis codes –Payment amounts (see next slide) Care in community nursing homes, state veterans homes, and some non-VA hospitals may also be recorded in other files –e.g., some contract nursing home care appears in DSS outpatient files

19. Cautions (cont) To find length of stay, concatenate by person using TREATDTF and TREATDTO. Watch for outliers: extremely long stays (400+ days) If a stay appears to end on September 30, check the October records

20. Changes in Fee Basis Files Until FY2004, some non-Fee care was recorded in the Fee Basis records because there was no else to record it. –e.g., care under sharing agreements In FY2005, only Fee Basis care is supposed to appear in the Fee Basis files.

21. HERC Technical Report Coming soon! Watch the HERC web site: www.herc.research.med.va.gov/pubs.htm.

22. Questions on Fee Basis Files?

23. National Prosthetics Patient Database (NPPD)

24. NPPD Description Contains records of prosthetics dispensed in VA –e.g. glasses, hearing aids, artificial limbs, stents, metal fixtures Data drawn from VISTA and Denver Distribution Center records Created and stored at Hines –contact: Liz.Kiley@med.va.gov Available FY1998 – present

25. NPPD Contents Selected Variables –location of service –new vs. used item –HCPCS code & item description –cost estimate –quantity dispensed –patient ID (links to SSN)

26. NPPD vs. Utilization Files - I HERC has compared NPPD records to major utilization databases: –Outpatient: NPCD (OPC), DSS NDE –Inpatient: PTF, DSS NDE Idea: a prosthetic recorded in NPPD had to be given/installed in an encounter. That encounter should be recorded in a utilization record.

27. NPPD vs. Utilization Files - II Correspondence is poor! Only about 50% of records match –Use date of outpatient NPPD record –look +/- 30 days for an outpatient visit in NPCD (OPC) with a related clinic stop Poor correspondence for inpatient records

28. Notes on NPPD NPPD date refers to financial reconciliation, NOT to date of service! There is no service date. Many procedures using prosthetics do not have matching NPPD records. Costs may vary by site due to local contracts.

29. Recommendations NPPD is a work in progress –It does not list every prosthetic –It does not have a service date Potential use: estimating purchase cost of new prosthetic items, locally or nationally Be wary of costs reported for used/repaired items. Any assumption about costing used items is arguable.

30. References Contents: VIReC Insights 2001;2(3)) Comparison to utilization files: HERC technical report coming soon!