Fee Basis & NPPD Data

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

2. The Fee Basis (FEE) Files

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

22. Questions on Fee Basis Files?

23. National Prosthetics Patient Database (NPPD)

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

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

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

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

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

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

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