1. VA Economic Data Sets: CDR, MPCR, Person-level cost Todd Wagner

2. VA Cost Distribution Report

3. CDR Financial database that records costs at a functional or organizational level –Medical Service –Surgical Service –Sanitation Operations No encounter or patient level costs

4. Time Frame Costs represent dollars expended during the report month Annual Reconciled Report

5. CDR Costs Costs include reconciliations VariableObsMeanMinMax totcost136575156039.7-2.68e+082.67e+08 pscost13657585667.72-331555.85.77e+07 othcost13657570371.98-2.68e+082.61e+08 Source: 2001 CDR

6. Variables STA3N STA5 Cost Center Acctno Costs FTE Use for linking data

7. File Display

8. Cost Center Category Account Series –2xx Direct Medical –3xx Contract and Fee care –4xx Administration –5xx Engineering –6xx Miscellaneous Benefits & Services –9xx Medical Care Cost Recovery

9. Account Number X X X X. x x Department Major Cost Category (e.g., 1=inpatient, 2=outpatient) Indirect Accounts

10. Costs and FTE Costs & FTE are available for each account number Costs include personnel, other and total FTE data come from FMS. Calculated on a basis of 80 hours per pay period regardless of how much time is actually worked.

11. Units and Unit Costs Our advice: don’t rely on these fields It is more reasonable to find average costs using utilization from PTF and OPC National average daily cost and average visits costs available from HERC for 1993- 2004

12. Allocations Allocations based on service chief estimates of activity Uncertain accuracy of service chief allocation Past incentive to misreport costs Past activity reports carried forward as default

13. Using the CDR Flat file that must be read into SAS Exclude 9000 series accounts Documentation –1996 CDR handbook www.herc.research.med.va.gov/CostData_Files/CDR_Handbook.PDF References –Swindle, Beattie, Barnett (1996) Medical Care 34(3):MS83-90 Ended in FY04; replaced by MPCR for FY05 onward

14. Applications of CDR Useful to find average cost –Average cost per day of stay in long-term care –Average cost per psychiatric visit Monitor trends in VA expenditures by program –Chen S, Wagner TH, Barnett PG. Health Affairs 2001;20(4):169-175. –Chen S, Smith MW, Wagner TH, Barnett PG. Health Affairs 2003;22(6):256-263

15. CDR: Trend Monitoring

16. Monthly Program Cost Report (MPCR)

17. File History New DSS financial dataset for FY04- Replaced the Cost Distribution Report. Last CDR year was FY04. Both CDR and MPCR are available in FY04. –FY03 MPCR is a test case (don’t use) MPCR is created monthly, not reconciled.

18. File Construction Costs are from FMS Costs are distributed to Cost Distribution Accounts (same as in CDR) Facility is tracked by STA3N –No longer are substations being tracked

19. Access KLF Menu Austin CD-ROM via chief of fiscal service

20. Cost Categories

21. Indirect Costs Uses FMS definition of direct/indirect cost. Assigns indirect costs to each activity account. Can’t separately identify subcomponents of indirect cost (e.g., research and education), as was possible in CDR.

22. Advantages and Disadvantages Workload –MPCR uses DSS workload to distribute costs. –Timely, however, users can’t override problems in errant workload DSS does not reconcile MPCR to FMS 830 Reports (monthly VAMC cost report)

23. MPCR vs CDR

24. MPCR for Research Result: MPCR is a report for Congress that projects workload and costs. It is not reconciled later (although ARC conducts reconciliations) Conclusion: Use it cautiously for research Look for upcoming HERC guidebook Also: HERC is creating a department-level cost dataset based on NDE

25. Questions on MPCR?

26. NDE Summary

27. Created a department-level cost dataset from the DSS NDE extracts. –Inpatient FY01-04 –Outpatient FY04 HERC is using this summary to create the Average Cost file for FY04 onwards

28. Benefits Reconciles with the NDE extracts Allows people to compare HERC to DSS more directly –Same total costs –Different RVUs Researchers can go back in time to track spending patterns

29. Disadvantages Cost totals by STA3N by HERC category –No subtotals for indirect costs –Limited to HERC categories Available after DSS NDEs are released

30. Inpatient NDE Costs

31. Inpatient NDE Days

32. NDE Summary vs CDR

33. HERC Person-Level Data

34. HERC Person-Level Data: Inpatient Costs and LOS summed across all stays Costs and LOS summed within five categories: - Medical / Surgical - Behavioral - Long-Term Care - Residential / Domiciliary - Other

35. HERC Person-Level Data: Outpatient Costs summed across all visits Costs summed within four categories: –Medical / Surgical –Behavioral –Diagnostic –Other Separate total for all DSS pharmacy costs

36. HERC Person-Level Data: Access AAC files in SAS format: RMTPRD.HERC.SAS.PLCOSTyy Years available to date: FY98-FY03 Reference guide on HERC web site: Hill A, Yu W. Guidebook for the HERC Person Level Cost Data Sets. HERC Technical Report #16. 2004.

37. Questions on HERC Person-level Data?