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Fee Basis & NPPD Data. Mark W. Smith, Ph.D. August 3, 2005 Health Economics Teleconference Seminar 1-800-767-1750 access code 45043. The Fee Basis (FEE) Files. Overview of Fee Basis Program. Pays for care at non-VA facilities when it is the only source available, or VA could save money

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fee basis nppd data

Fee Basis & NPPD Data

Mark W. Smith, Ph.D.August 3, 2005Health Economics Teleconference Seminar

1-800-767-1750 access code 45043

overview of fee basis program
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
fee basis files
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
names of fee basis files i
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

names of fee basis files ii
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

highlights of patient data
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
highlights of clinical data
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*)
highlights of financial data
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.
decimals in payment fields
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
highlights of vendor data
Highlights of Vendor Data
  • Vendor ID
  • Address (city, state, zip)
  • Related VA station number
  • Payment totals by month
fee basis payments fy2003
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
notes on fee basis data
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
notes cont
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.
notes cont15
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.
notes cont16
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
notes cont17
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
using fee basis files cautions
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
cautions cont
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
changes in fee basis files
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.
herc technical report
HERC Technical Report

Coming soon!

Watch the HERC web site: www.herc.research.med.va.gov/pubs.htm.

nppd description
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
  • Available FY1998 – present
nppd contents
NPPD Contents
  • Selected Variables
    • location of service
    • new vs. used item
    • HCPCS code & item description
    • cost estimate
    • quantity dispensed
    • patient ID (links to SSN)
nppd vs utilization files i
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.
nppd vs utilization files ii
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
notes on nppd
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.
recommendations
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.
references
References
  • Contents: VIReC Insights 2001;2(3))
  • Comparison to utilization files: HERC technical report coming soon!
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