Advances in VA Utilization and Cost Data VA HSR&D National Meeting February 16, 2005 Mark W. Smith Paul Barnett Todd Wagner

Advances in VA Advances in VA Utilization and Cost DataUtilization and Cost Data

VA HSR&D National MeetingVA HSR&D National Meeting

February 16, 2005February 16, 2005

Mark W. SmithMark W. Smith

Paul BarnettPaul Barnett

Todd WagnerTodd Wagner

Health Economics Resource CenterHealth Economics Resource Center 22

OutlineOutline

1.1. OverviewOverview

2.2. DSS NDEs vs. HERC average cost dataDSS NDEs vs. HERC average cost data

3.3. DSS intermediate product dataDSS intermediate product data

3.3. NPPD prosthetics dataNPPD prosthetics data

4. Fee Basis data4. Fee Basis data


Study objectives and data needs

VA Utilization

Non-VA Utilization

Patient costs


VA Utilization

HERC AnnualPerson-level costs

EncounterLevel

DSS IntermediateProduct

Specialty care:e.g., prosthetics


VA Utilization


EncounterLevel


HERC

DSS

Bedsecn

Discharge

TRT

Discharge

Opat

Opat


Pharmacy

Med/surg

Rehab, MH,LTC


VA Utilization


EncounterLevel


HERC

DSS

Bedsecn

Discharge

TRT

Discharge

Opat

Opat


Pharmacy

Med/surg

Rehab, MH,LTC


HERC

DSS

Discharge

TRT

Discharge

Opat

Outpatient

Med/surg

Rehab, MH, LTC PTF Bedsection files

PTF Main files

NPCD

PTF Bedsection files

PTF Main files

NPCD

easy

hard

easy

easy

very hard

easy

moderate


Non -VA Utilization

Paid by VA

Not paid byVA

Fee Basis

Contract Care

Out of pocket

Private Insurance

Medicare/Medicaid

HERC vs DSSHERC vs DSS

Todd WagnerTodd Wagner


HERC or DSSHERC or DSS

Strategies for choosing datasetStrategies for choosing dataset– Cost determination methodCost determination method

– VA versus non-VA Relative value unitsVA versus non-VA Relative value units

– Ease of useEase of use


Cost Determination MethodCost Determination Method

DSS costs are created using an activity-DSS costs are created using an activity-based costing allocation methodbased costing allocation method

HERC is created using a mixture of HERC is created using a mixture of methodsmethods

Advantage: Advantage: – Inpatient: DSSInpatient: DSS

– Outpatient: TieOutpatient: Tie


RVU-based decisionRVU-based decision

DSS is based on VA relative value units DSS is based on VA relative value units (RVUs); hospitals can modify RVUs(RVUs); hospitals can modify RVUs

HERC is based on non-VA RVUs HERC is based on non-VA RVUs (mostly Medicare)(mostly Medicare)

Advantage: depends on audience (slight Advantage: depends on audience (slight advantage to HERC)advantage to HERC)


Ease of UseEase of Use

HERC annual person level is easy to useHERC annual person level is easy to use HERC discharge dataset merges to PTF HERC discharge dataset merges to PTF

mainmain– Has subtotal costs and LOS for HERC Has subtotal costs and LOS for HERC

categoriescategories Advantage HERCAdvantage HERC Caveat: HERC may not exist foreverCaveat: HERC may not exist forever


AccuracyAccuracy

Is one more accurate?Is one more accurate?

Don’t confuse Don’t confuse precision and precision and accuracyaccuracy


AccuracyAccuracy

Hard to quantify accuracy of cost dataHard to quantify accuracy of cost data– Quality changes over timeQuality changes over time

– Varies by medical center and type of careVaries by medical center and type of care

– True costs are unknownTrue costs are unknown Comparisons to other VA or non-VA Comparisons to other VA or non-VA

costs (construct validity)costs (construct validity) Understand the production costsUnderstand the production costs


OutliersOutliers

DSS is more subject to outliers than DSS is more subject to outliers than HERCHERC

DSS tries to weed out high cost outliers DSS tries to weed out high cost outliers in production datain production data


Identifying Inpatient OutliersIdentifying Inpatient Outliers

Decompose the discharge dataDecompose the discharge data Rehab, MH, LTC:Rehab, MH, LTC:

– Calculate a per diem costCalculate a per diem cost– Multiply per diem by LOSMultiply per diem by LOS– Compare estimated cost to costCompare estimated cost to cost

Med/surgMed/surg– Calculate cost per DRGwt per day; flag records Calculate cost per DRGwt per day; flag records

with >$50000with >$50000


SummarySummary Choice of data should be based on:Choice of data should be based on:

– The precision you needThe precision you need

– Level of detailLevel of detail

– Your audienceYour audience Choose a primary database (HERC or DSS)Choose a primary database (HERC or DSS)

– Don’t mix and match DSS and HERCDon’t mix and match DSS and HERC

– Except for HERC with DSS pharmacyExcept for HERC with DSS pharmacy


Accuracy and OutliersAccuracy and Outliers

No easy solutionNo easy solution

Consider:Consider:– Comparing costs to other another cost Comparing costs to other another cost

datasetdataset

– Investigate DSS production dataInvestigate DSS production data

– Check accuracy of outliersCheck accuracy of outliers


Remainder of WorkshopRemainder of Workshop

DSS Intermediate Product data: DSS Intermediate Product data:

- - Greater granularity on procedures Greater granularity on procedures

National Prosthetics Patient Database (NPPD):National Prosthetics Patient Database (NPPD):- Only source of prosthetics information: cost, type, patients- Only source of prosthetics information: cost, type, patients- Essential for rehab studies, polytrauma patients - Essential for rehab studies, polytrauma patients

Fee Basis data:Fee Basis data:- Non-VA costs excluded from HERC average cost data- Non-VA costs excluded from HERC average cost data- Most non-VA costs excluded from DSS- Most non-VA costs excluded from DSS- Useful for studying outsourcing of care, home-based care- Useful for studying outsourcing of care, home-based care


DSS Intermediate Product Detail: DSS Intermediate Product Detail: Looking Inside the Black BoxLooking Inside the Black Box

Paul G. Barnett PhDPaul G. Barnett PhD

Shuo Chen PhDShuo Chen PhD


DSS National Data ExtractsDSS National Data Extracts

National files available at VA national National files available at VA national computing center in Austin, TXcomputing center in Austin, TX– Hospital staysHospital stays

– Bed section segment of a stayBed section segment of a stay

– Days in outpatient clinicDays in outpatient clinic

– Day of outpatient pharmacy Day of outpatient pharmacy

– Dispensed prescriptionsDispensed prescriptions


Data in DSS National Data ExtractsData in DSS National Data Extracts

Total cost of an encounterTotal cost of an encounter

Some subtotalsSome subtotals


Study questionsStudy questions

Where to DSS cost estimates come from?Where to DSS cost estimates come from?

Are they accurate?Are they accurate?– What is importance of previously identified What is importance of previously identified

limitations?limitations?


Where do DSS data come from?Where do DSS data come from?

Extracts of DSS- SAS Files at Austin

Cost of stays and visits

DSS VISN Level Production Databases

(a “Black Box” to most researchers)

Cost of intermediate products, stays, visits


Where do DSS data come from? Where do DSS data come from?

DSS allocates cost to departments DSS allocates cost to departments

DSS finds quantity of services and products DSS finds quantity of services and products from VISTA (VA electronic medical from VISTA (VA electronic medical records)records)

DSS assigns set of Relative Value Units DSS assigns set of Relative Value Units (RVUs) to each service and product(RVUs) to each service and product


Intermediate productIntermediate product

The products (and services) used during a The products (and services) used during a hospital stay or an outpatient encounter, hospital stay or an outpatient encounter, e.g.:e.g.:– Days in wardDays in ward

– Number of chest x-raysNumber of chest x-rays

– Minutes in operating room Minutes in operating room


Where do DSS data come from? Where do DSS data come from?

DSS combines department costs with count DSS combines department costs with count of products and RVUs of products and RVUs

DSS determines the cost of each DSS determines the cost of each intermediate productintermediate product

DSS sums the costs of all intermediate DSS sums the costs of all intermediate products used in a stay or visitproducts used in a stay or visit


Previously identified problems with Previously identified problems with DSS cost estimatesDSS cost estimates

““Million dollar” products.Million dollar” products.– Unit costs errorsUnit costs errors

– Encounters assigned extremely high costs Encounters assigned extremely high costs


Previously identified problems (cont.) Previously identified problems (cont.)

Missing medical proceduresMissing medical procedures– At some sites inpatient medical procedures not At some sites inpatient medical procedures not

recorded in a way that can be extracted by DSSrecorded in a way that can be extracted by DSS– Medical procedures: endoscopy, cardiac Medical procedures: endoscopy, cardiac

catheterization (expensive procedures not recorded catheterization (expensive procedures not recorded in surgical software package)in surgical software package)

– May result in an May result in an underestimateunderestimate of costs of some of costs of some hospital stays and outpatient visitshospital stays and outpatient visits


Looking inside the “black box”Looking inside the “black box”

Goals: Goals: – Evaluate if unit cost outliers affect cost Evaluate if unit cost outliers affect cost

estimatesestimates

– Identify if DSS used information on Identify if DSS used information on inpatient medical procedures to assign costinpatient medical procedures to assign cost

– Where procedure data are missing, find the Where procedure data are missing, find the effect on cost estimateseffect on cost estimates


Evaluation of DSS cost estimates of Evaluation of DSS cost estimates of stays involving medical proceduresstays involving medical procedures

Study population: Study population: – Clinical trial participants who had cardiac Clinical trial participants who had cardiac

angioplasty angioplasty

Method:Method:– Obtained detailed data on cost of each product Obtained detailed data on cost of each product

used in inpatient stays (2001-2002)used in inpatient stays (2001-2002)– Compared to corresponding record in DSS NDECompared to corresponding record in DSS NDE– Studied stays with angioplasty according to PTFStudied stays with angioplasty according to PTF

Evaluated intermediate products of these staysEvaluated intermediate products of these stays


Access to DSS Intermediate Product Access to DSS Intermediate Product DetailDetail

In In production levelproduction level data (in the black box) data (in the black box)– No national level extract of intermediate No national level extract of intermediate

products (data set would be too large) products (data set would be too large)

– Access granted by each medical centerAccess granted by each medical center

– Alternative: DSS national program office Alternative: DSS national program office can extract detailcan extract detail


Access to DSS Intermediate Product Access to DSS Intermediate Product DetailDetail

Requested data from DSS national program Requested data from DSS national program officeoffice– Hoped to pilot test method for future use by other Hoped to pilot test method for future use by other

researchers researchers – 2 year wait to obtain these data 2 year wait to obtain these data – Probably not a viable strategy for other researchersProbably not a viable strategy for other researchers

DSS office not funded to do this workDSS office not funded to do this work System not designed to extract data on a cohortSystem not designed to extract data on a cohort


Comparison of intermediate product Comparison of intermediate product detail to national data extractdetail to national data extract

– Costs in intermediate product data nearly Costs in intermediate product data nearly matched national data extracts (NDE)matched national data extracts (NDE) A very few records for products with costs A very few records for products with costs

greater than $30,000 had been excluded in greater than $30,000 had been excluded in tabulating costs to prepare NDE tabulating costs to prepare NDE

Evidently “high cost outliers” are filtered out in Evidently “high cost outliers” are filtered out in preparing NDEpreparing NDE

Appropriate to exclude these valuesAppropriate to exclude these values


Evaluation of intermediate products on Evaluation of intermediate products on cost estimatescost estimates

Study of inpatient stays with cardiac angioplastyStudy of inpatient stays with cardiac angioplasty– Identified 158 inpatient stays in which angioplasty Identified 158 inpatient stays in which angioplasty

took place according to Patient Treatment File took place according to Patient Treatment File (PTF)(PTF)

– Identified whether stay had intermediate products Identified whether stay had intermediate products for “angioplasty”, “PTCA”, or “catheterization”, for “angioplasty”, “PTCA”, or “catheterization”, etc.etc.

– Matched stay to “wage index” assigned to Matched stay to “wage index” assigned to geographic area by Medicaregeographic area by Medicare


Evaluation of inpatient costs using Evaluation of inpatient costs using intermediate products on cost estimates intermediate products on cost estimates

– Mean cost of a stay was $11,941Mean cost of a stay was $11,941– 55/158 stays (35%) had at least one angioplasty 55/158 stays (35%) had at least one angioplasty

productproduct– Regression Regression

Dependent variable: DSS cost Dependent variable: DSS cost Independent variables: length of stay, wage, days in Independent variables: length of stay, wage, days in

ICU, and whether DSS included an angioplasty ICU, and whether DSS included an angioplasty intermediate product intermediate product

– Stay with at least one angioplasty product were Stay with at least one angioplasty product were assigned $7,404 greater cost assigned $7,404 greater cost


Study limitationsStudy limitations

Hard to evaluate cost or quantity of an Hard to evaluate cost or quantity of an intermediate productintermediate product– products may be characterized differently at each products may be characterized differently at each

site, according to work processes and organizationsite, according to work processes and organization

Uncertain if we identified all angioplasty Uncertain if we identified all angioplasty products products – e.g., generic names: minutes in ambulatory surgerye.g., generic names: minutes in ambulatory surgery

VA continues to improve methods since study VA continues to improve methods since study time frame (2001-2002)time frame (2001-2002)


Improved inpatient procedure reportingImproved inpatient procedure reporting

New VA mandate that cardiac procedures New VA mandate that cardiac procedures be recorded as data (not just text)be recorded as data (not just text)


A new way to look into the black boxA new way to look into the black boxIntermediate Product Intermediate Product Department (IPD) Department (IPD) DetailDetail

– One record with costs incurred in each IPD One record with costs incurred in each IPD (Production Unit) during the stay/visit(Production Unit) during the stay/visit Gives sum of cost of all products from the departmentGives sum of cost of all products from the department Does not give quantity or cost of intermediate Does not give quantity or cost of intermediate productsproducts

– Both inpatient and outpatient filesBoth inpatient and outpatient files– Located at AustinLocated at Austin– Not yet documentedNot yet documented– Will allow researchers to estimate cost subtotals Will allow researchers to estimate cost subtotals


ConclusionsConclusions

DSS is excluding “million dollar products” DSS is excluding “million dollar products” in building the NDEin building the NDE

Incomplete data on inpatient procedures Incomplete data on inpatient procedures may result in significant underestimate of may result in significant underestimate of the cost of some hospital staysthe cost of some hospital stays


Recommendations Recommendations

Is accurate estimate of cost of stays Is accurate estimate of cost of stays involving inpatient procedures important involving inpatient procedures important to study? to study? – See DSS IPD extract to see if costs assigned See DSS IPD extract to see if costs assigned

to appropriate intermediate product to appropriate intermediate product department department


RecommendationsRecommendations

Alternatives Alternatives – Use HERC cost estimates as primary, Use HERC cost estimates as primary,

especially if data are several years old.especially if data are several years old.

– Conduct sensitivity analysis using HERC Conduct sensitivity analysis using HERC estimates estimates

– Estimate a cost function with DSS data and Estimate a cost function with DSS data and use it to simulate missing cost datause it to simulate missing cost data


Alternatives (cont.)Alternatives (cont.)

Estimate costs using DSS cost functionEstimate costs using DSS cost function– Estimate cost function Estimate cost function

Data: stays that have costs based on appropriate IPD Data: stays that have costs based on appropriate IPD Independent variables: Use clinical characteristics, Independent variables: Use clinical characteristics,

LOS, days in ICU, wage index, etc. LOS, days in ICU, wage index, etc.

– Predict costs based on clinical characteristicsPredict costs based on clinical characteristics– In our example, we would have added about In our example, we would have added about

$7,400 to cost estimates$7,400 to cost estimates

The Fee Basis (FEE) filesThe Fee Basis (FEE) files

Mark W. Smith, PhDMark W. Smith, PhDAdam Chow, B.A.Adam Chow, B.A.


Overview of Fee Basis ProgramOverview of Fee Basis Program

Pays for care at Pays for care at non-VA facilitiesnon-VA facilities in three in three situations:situations:– VA cannot provide the care locallyVA cannot provide the care locally– It is economical to do soIt is economical to do so– Travel to a VA facility is medically infeasibleTravel to a VA facility is medically infeasible



Limited emergent care:Limited emergent care:

- no more than 10-day supply of Rx- no more than 10-day supply of Rx

- inpatient only until transfer is medically - inpatient only until transfer is medically feasible, typically 3 days or lessfeasible, typically 3 days or less

Full range of services coveredFull range of services covered



Some common uses:Some common uses:

Community nursing home careCommunity nursing home care

Home-based care Home-based care – E.g.: long-term oxygen therapyE.g.: long-term oxygen therapy

Compensation & pension examsCompensation & pension exams

Health Economics Resource CenterHealth Economics Resource Center

Fee Basis files Fee Basis files

Subset of all VA contract careSubset of all VA contract care– Most “sharing agreement” care from Most “sharing agreement” care from

affiliate universities is affiliate universities is notnot included included– Substantial non-VA utilization unaccounted Substantial non-VA utilization unaccounted

forfor


Fee Basis Payments FY2003Fee Basis Payments FY2003

Service typeService type Fee Basis Fee Basis PaymentsPayments FrequencyFrequency

Inpatient 116,000 stays $ 545 mNon-Rx Outpatient 5,418,000 visits $ 477 mRx 15,000 scripts $ 0.6 m

TOTAL $ 1,023 m


Names of Fee Basis Files - INames of Fee Basis Files - I

Hospital stayHospital stayMDPPRD.MDP.SAS.FEN.FYyy.INPTMDPPRD.MDP.SAS.FEN.FYyy.INPT

Ancillary services provided to inpatientsAncillary services provided to inpatientsMDPPRD.MDP.SAS.FEN.FYyy.INPT.ANCILMDPPRD.MDP.SAS.FEN.FYyy.INPT.ANCIL

Outpatient servicesOutpatient servicesMDPPRD.MDP.SAS.FEN.FYyy.MEDMDPPRD.MDP.SAS.FEN.FYyy.MED

Payments to pharmaciesPayments to pharmaciesMDPPRD.MDP.SAS.FEN.FYyy.PHRMDPPRD.MDP.SAS.FEN.FYyy.PHR


Names of Fee Basis Files - IINames of Fee Basis Files - IITravel expensesTravel expenses MDPPRD.MDP.SAS.FEN.FYyy.TVLMDPPRD.MDP.SAS.FEN.FYyy.TVL

Pharmacy vendor file Pharmacy vendor file MDPPRD.MDP.SAS.FEN.FYyy.PHARVENMDPPRD.MDP.SAS.FEN.FYyy.PHARVEN

Other vendors file Other vendors file MDPPRD.MDP.SAS.FEN.FYyy.VENMDPPRD.MDP.SAS.FEN.FYyy.VEN

Veterans with FEE cards (long-term users)Veterans with FEE cards (long-term users)

MDPPRD.MDP.SAS.FEN.FYyy.VETMDPPRD.MDP.SAS.FEN.FYyy.VET


Highlights of Patient DataHighlights of Patient Data

Scrambled SSN Scrambled SSN

Primary Service Area (PSA)Primary Service Area (PSA)– 3-digit station number3-digit station number

County, state, zip County, state, zip


Highlights of Clinical DataHighlights of Clinical Data

Outpatient: Outpatient: – Date of serviceDate of service– 1 CPT procedure code1 CPT procedure code

Inpatient:Inpatient:– Start and end dates of invoice period Start and end dates of invoice period – Up to 5 surgery codesUp to 5 surgery codes– Up to 5 ICD-9 diagnosis codes (*no decimal*)Up to 5 ICD-9 diagnosis codes (*no decimal*)


Highlights of Financial DataHighlights of Financial Data

Amount claimedAmount claimed

Amount paidAmount paid

Medicare prospective payment amount (inpatient) Medicare prospective payment amount (inpatient)

Many variable relating to FMS record-keeping: Many variable relating to FMS record-keeping: invoice date, processing date, check number, etc.invoice date, processing date, check number, etc.


What Data Rows RepresentWhat Data Rows Represent

Each row of data represents a service Each row of data represents a service provided for a particular date provided for a particular date (outpatient) or time period (inpatient)(outpatient) or time period (inpatient)

TREATDT: Outpatient date of service TREATDT: Outpatient date of service

TREATDTF: Inpatient start of invoice periodTREATDTF: Inpatient start of invoice period

TREATDTO: Inpatient end of invoice periodTREATDTO: Inpatient end of invoice period


Highlights of Vendor DataHighlights of Vendor Data

Vendor IDVendor ID

Address (city, state, zip)Address (city, state, zip)

Related VA station numberRelated VA station number

Payment totals by month, not by patient or servicePayment totals by month, not by patient or service


Finding CasesFinding Cases

Search all relevant variables:Search all relevant variables:

– Place of service (PLSER) Place of service (PLSER) – Treatment code (TRETYPE) Treatment code (TRETYPE) – Purpose of visit (FPOV)Purpose of visit (FPOV)

Cautions:Cautions: – Variable values can change year to yearVariable values can change year to year– Missing valuesMissing values


Creating Discharge Records (1)Creating Discharge Records (1)

Goal: Create a single discharge record Goal: Create a single discharge record from multiple inpatient service (INPT) from multiple inpatient service (INPT) recordsrecords

Method: Concatenate by SCRSSN using Method: Concatenate by SCRSSN using TREATDTF and TREATDTO.TREATDTF and TREATDTO.



Records are typically processed within 30 days of Records are typically processed within 30 days of invoicing.invoicing.

BUTBUT

Invoices may be sent LONG after services are Invoices may be sent LONG after services are rendered.rendered.

THEREFORETHEREFORE

To find all services in a fiscal year, look in the Fee To find all services in a fiscal year, look in the Fee Basis files in that year Basis files in that year andand the 2 following years. the 2 following years.



Searching for records:Searching for records:Outpatient: TREATDT Outpatient: TREATDT

Inpatient: TREATDTF, TREATDTOInpatient: TREATDTF, TREATDTO

Use vendor ID (VENDID) to track particular Use vendor ID (VENDID) to track particular facilitiesfacilities



CautionsCautions– Watch for outliers: extremely long staysWatch for outliers: extremely long stays

– If a stay appears to end on September 30, check If a stay appears to end on September 30, check the October recordsthe October records

– Stays may end with a transfer to VA – look for Stays may end with a transfer to VA – look for VA recordVA record


Other NotesOther Notes

There is repetition across variables: state There is repetition across variables: state appears twice, some dates appear in both appears twice, some dates appear in both Julian and SAS formatsJulian and SAS formats

Blank fields are common. They could Blank fields are common. They could mean “not applicable” as well as mean “not applicable” as well as “missing.”“missing.”


Overlap with Other VA FilesOverlap with Other VA Files

Community nursing home care also inCommunity nursing home care also in– DSS outpatient filesDSS outpatient files– PTF Extended Care filesPTF Extended Care files

Most completed hospital stays also in PTF Most completed hospital stays also in PTF Non-VA Hospitalization filesNon-VA Hospitalization files


HERC Technical ReportHERC Technical Report

A HERC technical report on Fee Basis data A HERC technical report on Fee Basis data can be found on the HERC web site atcan be found on the HERC web site at

http://www.herc.research.med.va.gov/publications/ http://www.herc.research.med.va.gov/publications/ technical_reports.asptechnical_reports.asp


Questions on Fee Basis files?Questions on Fee Basis files?

National Prosthetics Patient National Prosthetics Patient Database (NPPD)Database (NPPD)

Ciaran Phibbs, PhDCiaran Phibbs, PhDMark W. Smith, PhDMark W. Smith, PhD

Pon Su, MAPon Su, MA


NPPD DescriptionNPPD Description

Contains records of prosthetics dispensed in VAContains records of prosthetics dispensed in VA– e.g. glasses, hearing aids, artificial limbs, e.g. glasses, hearing aids, artificial limbs,

stents, metal fixturesstents, metal fixtures

Data drawn from VISTA and Denver Data drawn from VISTA and Denver Distribution Center recordsDistribution Center records

Available FY1998 – presentAvailable FY1998 – present


Selected VariablesSelected Variables

Patient ID (links to SSN)Patient ID (links to SSN)

Location of serviceLocation of service

HCPCS code & item description HCPCS code & item description

Quantity dispensedQuantity dispensed

Cost estimateCost estimate


Additional Notes on NPPDAdditional Notes on NPPD

NPPD date refers to the day the record was NPPD date refers to the day the record was entered, NOT to date of service! There is no entered, NOT to date of service! There is no service date.service date.

Costs may vary by site due to local contracts.Costs may vary by site due to local contracts.

Used items automatically assigned 50% of new Used items automatically assigned 50% of new cost. cost.


NPPD vs. Utilization Files (1)NPPD vs. Utilization Files (1)

HERC compared NPPD records to major HERC compared NPPD records to major utilization databases:utilization databases:– Outpatient: OPC, DSS NDEOutpatient: OPC, DSS NDE– Inpatient: PTF, DSS NDEInpatient: PTF, DSS NDE

Purpose: To determine validity of NPPDPurpose: To determine validity of NPPD



Idea: Prosthetics should be dispensed in an Idea: Prosthetics should be dispensed in an encounter that is recorded in a utilization encounter that is recorded in a utilization record.record.



MethodMethod– Use date of outpatient NPPD record Use date of outpatient NPPD record – Look –30 to +30 days around outpatient Look –30 to +30 days around outpatient

visit in NPCD (OPC) for a related clinic visit in NPCD (OPC) for a related clinic stop stop

ResultResult– Only about 50% of records matchOnly about 50% of records match– Poor correspondence for inpatient recordsPoor correspondence for inpatient records



ResultResult– Only about 50% of records match!Only about 50% of records match!

– Poor correspondence for inpatient recordsPoor correspondence for inpatient records

Potential CausesPotential Causes– Need to use longer window: -30 to +90 days ?Need to use longer window: -30 to +90 days ?

– Blind rehab units report using ward stock – not Blind rehab units report using ward stock – not

tied to individual patients.tied to individual patients.

– Weak incentive for accurate data entryWeak incentive for accurate data entry


RecommendationsRecommendations

NPPD is a work in progressNPPD is a work in progress– It does not list every prostheticIt does not list every prosthetic– It does not have a service dateIt does not have a service date

Potential use: estimating purchase cost of new Potential use: estimating purchase cost of new prosthetic items, locally or nationallyprosthetic items, locally or nationally


ReferencesReferences

Contents: Contents: VIReC InsightsVIReC Insights 2001;2(3)) 2001;2(3))

Comparison to utilization files: Comparison to utilization files: HERC technical report (in progress)HERC technical report (in progress)


Access to NPPDAccess to NPPD

ContactsContactsFrederick Downs, MD (VACO)Frederick Downs, MD (VACO)Liz Kiley, NPPD data manager (Hines)Liz Kiley, NPPD data manager (Hines)

ProcessProcessSubmit request to Frederick Downs with project Submit request to Frederick Downs with project

description, IRB approval, list of variables description, IRB approval, list of variables neededneeded


Questions on NPPD files?Questions on NPPD files?

Documents

Advances in VA Utilization and Cost Data VA HSR&D National Meeting February 16, 2005 Mark W. Smith Paul Barnett Todd Wagner