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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 l.jpg

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 l.jpg
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

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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

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Names of Fee Basis Files - I

  • Hospital stay


  • Ancillary services provided to inpatients


  • Outpatient services


  • Payments to pharmacies


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Names of Fee Basis Files - II

  • Travel expenses


  • Pharmacy vendor fileMDPPRD.MDP.SAS.FEN.FY04.PHARVEN

  • Other vendors file MDPPRD.MDP.SAS.FEN.FY04.VEN

  • Veterans with FEE cards (long-term users)


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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

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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*)

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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.

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    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

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    Highlights of Vendor Data

    • Vendor ID

    • Address (city, state, zip)

    • Related VA station number

    • Payment totals by month

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    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

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    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

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    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.

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    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.

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    Notes (cont)

    • Records are typically processed within 30 days of invoicing


    • Invoices may be sent LONG after services are rendered.


    • 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

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    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

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    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

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    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

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    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.

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    HERC Technical Report

    Coming soon!

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

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    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

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    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 l.jpg
    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 l.jpg
    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

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    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 l.jpg

    • 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 l.jpg

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

    • Comparison to utilization files: HERC technical report coming soon!