using cost data from the managerial cost accounting system ... · 2/7/2018 · unexpectedly high...
TRANSCRIPT
![Page 1: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/1.jpg)
Using Cost Data from the Managerial Cost Accounting
System (MCA) and HERC Average Costs
Jean Yoon February 7 2018
Outline
MCA National Data Extracts ndash How MCA gets costs
ndash Inpatient data
ndash Outpatient data
ndash Pharmacy data
ndash Advantages of using MCA
HERC Average Costs ndash Methods for HERC-created files
ndash Inpatient
ndash Outpatient
ndash Annual Summary
Using HERC or MCA
Data resources
2
Poll I have used
MCA data
HERC Average Cost data
Both
Neither
3
Poll Is MCA (versus AC data) better for
A Comparing patient costs of different interventions
B Budget impact of a primary care program in one VAMC
C Prescription drug costs for VA prescriptions
D Comparing efficiency between two VAMCs
4
Top Down Bottom Up
HERC data uses relative value weights to estimate cost per encounter (top down)
Top Down
Bottom Up
National approach Experience based
MCA data are based on an activity based costing methodology (bottom up)
Local approach Activity based
5
MCA National Data
Extracts
How Does MCA Provide VHA Cost Data
VISTA workload clinical amp financial data (FMS PAID)
National Data Extracts of MCA
Time allocation Relative values
MCA Facility Level Production Databases
7
MCA Determines Costs of Products
Products are components of encounter ndash Eg 20 min clinic visit lab test chest x-ray
VAMC assigns costs to cost center (corresponding product dept) ndash VAMC staff labor mapping and financial data ndash Cost of overhead distributed to direct care depts
Products in each department tabulated Relative values assigned to products ndash RVUrsquos for providers is time
8
MCA Determines Costs of Products
Unit cost of each product determined
Cost = MD-20 Min Visit
[Total MD Primary Care Dept CostsΣRVUMD-PC ]RVUMD-20 Min Visit
9
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 2: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/2.jpg)
Outline
MCA National Data Extracts ndash How MCA gets costs
ndash Inpatient data
ndash Outpatient data
ndash Pharmacy data
ndash Advantages of using MCA
HERC Average Costs ndash Methods for HERC-created files
ndash Inpatient
ndash Outpatient
ndash Annual Summary
Using HERC or MCA
Data resources
2
Poll I have used
MCA data
HERC Average Cost data
Both
Neither
3
Poll Is MCA (versus AC data) better for
A Comparing patient costs of different interventions
B Budget impact of a primary care program in one VAMC
C Prescription drug costs for VA prescriptions
D Comparing efficiency between two VAMCs
4
Top Down Bottom Up
HERC data uses relative value weights to estimate cost per encounter (top down)
Top Down
Bottom Up
National approach Experience based
MCA data are based on an activity based costing methodology (bottom up)
Local approach Activity based
5
MCA National Data
Extracts
How Does MCA Provide VHA Cost Data
VISTA workload clinical amp financial data (FMS PAID)
National Data Extracts of MCA
Time allocation Relative values
MCA Facility Level Production Databases
7
MCA Determines Costs of Products
Products are components of encounter ndash Eg 20 min clinic visit lab test chest x-ray
VAMC assigns costs to cost center (corresponding product dept) ndash VAMC staff labor mapping and financial data ndash Cost of overhead distributed to direct care depts
Products in each department tabulated Relative values assigned to products ndash RVUrsquos for providers is time
8
MCA Determines Costs of Products
Unit cost of each product determined
Cost = MD-20 Min Visit
[Total MD Primary Care Dept CostsΣRVUMD-PC ]RVUMD-20 Min Visit
9
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 3: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/3.jpg)
Poll I have used
MCA data
HERC Average Cost data
Both
Neither
3
Poll Is MCA (versus AC data) better for
A Comparing patient costs of different interventions
B Budget impact of a primary care program in one VAMC
C Prescription drug costs for VA prescriptions
D Comparing efficiency between two VAMCs
4
Top Down Bottom Up
HERC data uses relative value weights to estimate cost per encounter (top down)
Top Down
Bottom Up
National approach Experience based
MCA data are based on an activity based costing methodology (bottom up)
Local approach Activity based
5
MCA National Data
Extracts
How Does MCA Provide VHA Cost Data
VISTA workload clinical amp financial data (FMS PAID)
National Data Extracts of MCA
Time allocation Relative values
MCA Facility Level Production Databases
7
MCA Determines Costs of Products
Products are components of encounter ndash Eg 20 min clinic visit lab test chest x-ray
VAMC assigns costs to cost center (corresponding product dept) ndash VAMC staff labor mapping and financial data ndash Cost of overhead distributed to direct care depts
Products in each department tabulated Relative values assigned to products ndash RVUrsquos for providers is time
8
MCA Determines Costs of Products
Unit cost of each product determined
Cost = MD-20 Min Visit
[Total MD Primary Care Dept CostsΣRVUMD-PC ]RVUMD-20 Min Visit
9
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 4: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/4.jpg)
Poll Is MCA (versus AC data) better for
A Comparing patient costs of different interventions
B Budget impact of a primary care program in one VAMC
C Prescription drug costs for VA prescriptions
D Comparing efficiency between two VAMCs
4
Top Down Bottom Up
HERC data uses relative value weights to estimate cost per encounter (top down)
Top Down
Bottom Up
National approach Experience based
MCA data are based on an activity based costing methodology (bottom up)
Local approach Activity based
5
MCA National Data
Extracts
How Does MCA Provide VHA Cost Data
VISTA workload clinical amp financial data (FMS PAID)
National Data Extracts of MCA
Time allocation Relative values
MCA Facility Level Production Databases
7
MCA Determines Costs of Products
Products are components of encounter ndash Eg 20 min clinic visit lab test chest x-ray
VAMC assigns costs to cost center (corresponding product dept) ndash VAMC staff labor mapping and financial data ndash Cost of overhead distributed to direct care depts
Products in each department tabulated Relative values assigned to products ndash RVUrsquos for providers is time
8
MCA Determines Costs of Products
Unit cost of each product determined
Cost = MD-20 Min Visit
[Total MD Primary Care Dept CostsΣRVUMD-PC ]RVUMD-20 Min Visit
9
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 5: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/5.jpg)
Top Down Bottom Up
HERC data uses relative value weights to estimate cost per encounter (top down)
Top Down
Bottom Up
National approach Experience based
MCA data are based on an activity based costing methodology (bottom up)
Local approach Activity based
5
MCA National Data
Extracts
How Does MCA Provide VHA Cost Data
VISTA workload clinical amp financial data (FMS PAID)
National Data Extracts of MCA
Time allocation Relative values
MCA Facility Level Production Databases
7
MCA Determines Costs of Products
Products are components of encounter ndash Eg 20 min clinic visit lab test chest x-ray
VAMC assigns costs to cost center (corresponding product dept) ndash VAMC staff labor mapping and financial data ndash Cost of overhead distributed to direct care depts
Products in each department tabulated Relative values assigned to products ndash RVUrsquos for providers is time
8
MCA Determines Costs of Products
Unit cost of each product determined
Cost = MD-20 Min Visit
[Total MD Primary Care Dept CostsΣRVUMD-PC ]RVUMD-20 Min Visit
9
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 6: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/6.jpg)
MCA National Data
Extracts
How Does MCA Provide VHA Cost Data
VISTA workload clinical amp financial data (FMS PAID)
National Data Extracts of MCA
Time allocation Relative values
MCA Facility Level Production Databases
7
MCA Determines Costs of Products
Products are components of encounter ndash Eg 20 min clinic visit lab test chest x-ray
VAMC assigns costs to cost center (corresponding product dept) ndash VAMC staff labor mapping and financial data ndash Cost of overhead distributed to direct care depts
Products in each department tabulated Relative values assigned to products ndash RVUrsquos for providers is time
8
MCA Determines Costs of Products
Unit cost of each product determined
Cost = MD-20 Min Visit
[Total MD Primary Care Dept CostsΣRVUMD-PC ]RVUMD-20 Min Visit
9
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 7: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/7.jpg)
How Does MCA Provide VHA Cost Data
VISTA workload clinical amp financial data (FMS PAID)
National Data Extracts of MCA
Time allocation Relative values
MCA Facility Level Production Databases
7
MCA Determines Costs of Products
Products are components of encounter ndash Eg 20 min clinic visit lab test chest x-ray
VAMC assigns costs to cost center (corresponding product dept) ndash VAMC staff labor mapping and financial data ndash Cost of overhead distributed to direct care depts
Products in each department tabulated Relative values assigned to products ndash RVUrsquos for providers is time
8
MCA Determines Costs of Products
Unit cost of each product determined
Cost = MD-20 Min Visit
[Total MD Primary Care Dept CostsΣRVUMD-PC ]RVUMD-20 Min Visit
9
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 8: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/8.jpg)
MCA Determines Costs of Products
Products are components of encounter ndash Eg 20 min clinic visit lab test chest x-ray
VAMC assigns costs to cost center (corresponding product dept) ndash VAMC staff labor mapping and financial data ndash Cost of overhead distributed to direct care depts
Products in each department tabulated Relative values assigned to products ndash RVUrsquos for providers is time
8
MCA Determines Costs of Products
Unit cost of each product determined
Cost = MD-20 Min Visit
[Total MD Primary Care Dept CostsΣRVUMD-PC ]RVUMD-20 Min Visit
9
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 9: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/9.jpg)
MCA Determines Costs of Products
Unit cost of each product determined
Cost = MD-20 Min Visit
[Total MD Primary Care Dept CostsΣRVUMD-PC ]RVUMD-20 Min Visit
9
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 10: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/10.jpg)
MCA Assigns Cost to Encounters
sumIntermediate X IP Cost = Total cost
Product (IP) of encounter
used by patient
10
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 11: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/11.jpg)
MCA National Data Extracts
Inpatient (Treating Specialty Discharge)
Outpatient Encounter
Pharmacy
Intermediate Product Department
Account Level Budget Cost Center
11
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 12: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/12.jpg)
MCA Cost File Inpatient Discharge File
Care of patients discharged in each fiscal year
One record per discharge
May include cost incurred in prior fiscal years
Data only in Discharge file
ndash Discharge day
ndash Total days of stay
ndash Discharge bedsection
12
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 13: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/13.jpg)
Discharge example
Patient ADMITDAY DISDAY FP LOS DBEDSECT TOT
A 24SEP05 01OCT05 1 7 Gen Acute Med
982424
A 31OCT05 11NOV05 2 11 Gen Acute Med
467301
A 04AUG06 21SEP06 12 48 Rehab 8186877
3 different admitdischarge dates
Same patient
13
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 14: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/14.jpg)
MCA Cost File Inpatient Treating Specialty File
Treating specialty
One record per treating specialty per month
ndash More than one record in a month if more than one treating specialty in a month
ndash All care provided during fiscal year
ndash Include stays not yet over
14
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 15: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/15.jpg)
MCA Data Only in Treating Specialty File
Treating specialty
Census indicator
Date of entry and exit from treating specialty
ndash No discharge date
Treating specialty length of stay
ndash No total length of stay
15
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 16: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/16.jpg)
MCA Treating Specialty File Example
Patient TRTIN TRTOUT TR SP TR SP LOS FP TCST_TOT
A 01OCT05 01OCT05 15 1 1 35001
A 31OCT05 11NOV05 15 1 1 54424
A 31OCT05 11NOV05 15 10 2 2378722
2 records with same different But different months (FP) admitdischarge dates
Same patient
16
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 17: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/17.jpg)
MCA Data in Both Inpatient Files
Admit day
Admitting diagnosis related group (DRG)
Principal diagnosis
Admitting diagnosis
17
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 18: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/18.jpg)
MCA Cost Files Outpatient Files
One record per patient per day per clinic stop (identifier)
ndash National Patient Care Database (NPCD) events file allows more than 1 record per clinic stop per day
ndash MCA includes care not in NPCD events file eg prosthetics
Primary DX and CPT codes
18
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 19: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/19.jpg)
MCA Data Only in Outpatient Files
Date of encounter
MCA identifier (clinic stop)
ndash MCA uses ldquopseudo stoprdquo code for prosthetics pharmacy etc
Flag variables identifying data source
ndash NPCD pharmacy prosthetics Vast CBOC etc
19
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 20: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/20.jpg)
MCA Outpatient Example
Patient VIZDAY CLSTOP OCST_TOT
A 20051018 411 3410
A 20051018 108 2433
A 20051018 306 2520
Same patient Same visit dates Different clinic stops
20
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 21: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/21.jpg)
MCA Cost Variables in All Files
Fixed direct
Fixed indirect
Variable direct
Variable supply
Total
Variable labor category 4 amp 5
21
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 22: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/22.jpg)
Additional Cost Variables in Inpatient Files
Separate costs for lab nursing pharmacy radiology surgery all other
ndash Variable fixed direct fixed indirect supply (where applicable)
22
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 23: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/23.jpg)
MCA Pharmacy File
In the MCA Pharmacy Extract file
ndash For outpatient records there is one record
Per prescription or supply per person per day
ndash For inpatient records there is one record
Per person per day
MCA sometimes groups two prescriptions into one record if they are for the same NDC and the same person on the same day
23
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 24: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/24.jpg)
MCA Pharmacy Variables
Medication drug name NDC formulary indicators VA drug class Dispensing fill date quantity dispensed days supplied
Patient SCRSSN date of birth gender age
Ordering provider provider ID provider treating specialty
Note Clinical information on related visitsstays can be linked to Rx data using SCRSSN Cost VA cost including direct labor indirect costs of the pharmacy department and supplies
Total VA cost prescription = ACT_COST + DISPCOST Costs can be negative ex return to pharmacy
24
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 25: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/25.jpg)
Pharmacy Copayments
VA charges some copayments ndash Depends on income disability percentage
ndash Rules amp eligibility levels change year to year
ndash Rules available on VA internet
MCA does not show copayments they show VArsquos expense
Medical Care Cost Recovery (MCRR) files could show reimbursement from private insurance if collected
25
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 26: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/26.jpg)
Cost Outliers in MCA Users should look for cost estimates that are
unexpectedly high given characteristics of care
Mismatch of cost and utilization can result in unit costs that are very high cost or negative
MCA quality assurance efforts
ndash Monthly audits and reconciliations performed
ndash Extremely high outliers are identified when MCA national data extracts (NDE) are built
26
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 27: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/27.jpg)
Advantages of Using MCA
MCA costs estimate reflect facility differences in productivity efficiencies economies of scale etc
MCA has pharmacy data
MCA has state nursing home stays
MCA is an activity-based method and is the official managerial cost accounting system for the entire Department of VA
27
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 28: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/28.jpg)
HERC Average Costs Datasets
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 29: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/29.jpg)
HERC Method
Acute medical surgical stays
ndash Estimate of what stay would have cost in a Medicare hospital based on a regression model
Other inpatient care
ndash Length of stay
Outpatient care
ndash Hypothetical Medicare payment based on procedure codes assigned to visit
29
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 30: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/30.jpg)
HERC MedicalSurgical Stays
Cost regression estimated using Medicare data
ndash Length of stay
ndash Days of intensive care
ndash Diagnosis Related Group (MS-DRG)
Stay is assigned to one of DRG groups based on diagnosis and procedures
Medicare relative value weights for DRG
30
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 31: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/31.jpg)
HERC MedicalSurgical Stays
HERC identifies acute medical surgical components of stays in the VA Patient Treatment File (PTF)
ndash Consistent with non-VA hospital definition
ndash Contiguous medical-surgical bed section segments
31
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 32: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/32.jpg)
HERC MedicalSurgical Stays
HERC applies regression parameters to VA stays to estimate what stay would have cost in a Medicare hospital
Estimates adjusted to reflect actual VA expenditures from MCA
32
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 33: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/33.jpg)
HERC Other Inpatient Stays
Costs assumed to be proportional to length of stay ndash Rehabilitation
ndash Blind rehabilitation
ndash Spinal cord injury
ndash Psychiatry
ndash Substance abuse
ndash Intermediate medicine
ndash Domiciliary
ndash Psychosocial residential rehabilitation
ndash Long-Term Care
33
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 34: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/34.jpg)
HERC Inpatient Discharge Data
Cost of each VA hospital discharge reported in Patient Treatment File (PTF) ndash Stays ending in discharge in Fiscal Year ndash Excludes stays that began before FY98
Subtotals of days and costs in 10 categories
Medicine and surgery Rehabilitation Blind rehabilitation Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psych residential rehab Nursing home
34
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 35: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/35.jpg)
HERC Outpatient costs
HERC assigns hypothetical payment
ndash based on Current Procedure Terminology (CPT) and HCPCS codes up to 20 per visit
ndash Physician reimbursement rates from Medicare and other payers
ndash Facility reimbursement rates from Medicare
Adjusted to reflect expenditures in the category of outpatient care defined using clinic stop (MCA identifier)
35
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 36: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/36.jpg)
HERC Cost File Person-Level Annual Cost
One person per record
Total VA cost and costs of five inpatient and five outpatient categories LOS for inpatient care
Includes MCA outpatient pharmacy
Stays that cross fiscal years are assigned cost in proportion to the days in fiscal year
36
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 37: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/37.jpg)
MCA or HERC
37
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 38: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/38.jpg)
Which to Choose
We are often asked which to use
Criteria
ndash Is costing method consistent with study goals
ndash Precision and Accuracy
38
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 39: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/39.jpg)
Is costing method consistent with study goals
Study to determine cost-effectiveness for US health care system ndash HERC uses non-VA relative values
ndash HERC costs more like costs typical of non-VA health care settings
Study to determine efficiency of different VA providers ndash MCA costs reflect differences in productivity efficiencies
economies of scale etc
ndash Strong assumptions make HERC estimates inappropriate for this type of study
39
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 40: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/40.jpg)
Precision and Accuracy
Chapko M K Liu C F Perkins M Li Y F Fortney J C amp Maciejewski M L (2008) Equivalence of two healthcare costing methods bottom-up and top-down Health Economics
Precision ndash Bottom up approaches such as MCA can be very precise ndash HERC data are less precise than MCA given costing method ndash If you use MCA data you want to control for geographic wage
differentials
Accuracy ndash Bottom up approaches can lead to rare irregularities
Recommendation use both one as primary and one as sensitivity analysis
40
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 41: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/41.jpg)
Data Resources
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 42: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/42.jpg)
MCA Data Access
Access to MCA data should be requested through CDWVINCI and National Data Systems (NDS)
MCA Program Office Web Site (VA Intranet MCAO web site)
All MCA files were removed from AITC in 2013 but FY2001-FY2012 MCA SAS lsquolegacyrsquo files are on CDWVINCI servers
MCA NDE SQL data are available in CDW from FY05 to current year ndash Accessed through CDW Raw server lsquoVHACDWA06vhamedvagovrsquo
MCA data also available in VHA Managerial Cost Accounting (MCA) reports from MCA intranet site
42
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 43: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/43.jpg)
HERC Data Access
Access to HERC data should be requested through CDWVINCI and National Data Systems (NDS)
All historical files 2001-2012 are available from AITC
SQL tables on CDW static server vhacdwrb01vhamedvagov database VINCI_HERC
SAS datasets on vhacdwsasrds01HERC
43
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 44: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/44.jpg)
HERC MCA Guidebooks httpwwwhercresearchvagovincludepageaspid=guidebooks
Research Guide to the Managerial Cost Accounting National Cost Extracts
Guidebooks for HERCs datasets
44
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 45: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/45.jpg)
MCA Pharmacy Resources
VIReCrsquos Pharmacy Prescription Data Guide ndash VIReC research user guide on MCA and PBM pharmacy prescription
data
httpwwwvirecresearchvagov
HERC Technical Report ndash Comparing Outpatient Cost Data in the MCA National Pharmacy
Extract and the Pharmacy Benefits Management V30 Database httpwwwhercresearchvagovincludepageaspid=technical-reports
45
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46
![Page 46: Using Cost Data from the Managerial Cost Accounting System ... · 2/7/2018 · unexpectedly high given characteristics of care Mismatch of cost and utilization can result in unit](https://reader033.vdocument.in/reader033/viewer/2022050606/5fad68c8a18a2641857d05f3/html5/thumbnails/46.jpg)
Next Classes
0214 Jo Jacobs Introduction to Effectiveness Patient Preferences and Utilities
0228 Risha Estimating Transition Gidwani Probabilities for a Model
46