VA Economic Data Sets: CDR, MPCR, Person-level cost

Todd Wagner

VA Cost Distribution Report

CDR

• Financial database that records costs at a functional or organizational level– Medical Service– Surgical Service– Sanitation Operations

• No encounter or patient level costs

Time Frame

• Costs represent dollars expended during the report month

• Annual Reconciled Report

CDR Costs

• Costs include reconciliations

Variable Obs Mean Min Max

totcost 136575 156039.7 -2.68e+08 2.67e+08

pscost 136575 85667.72 -331555.8 5.77e+07

othcost 136575 70371.98 -2.68e+08 2.61e+08

Source: 2001 CDR

Variables

• STA3N• STA5

• Cost Center• Acctno• Costs• FTE

Use for linking data

File Displaysta3n acctno acctname cc ccname totcost fte528 1110 GENERAL MEDICINE 201 MEDICAL 495,877 5.1528 1110 GENERAL MEDICINE 202 SURGICAL 406,929 1.61528 1110 GENERAL MEDICINE 222 DIAGNOSTIC RADIOLOGY 356,982 2.73528 1110 GENERAL MEDICINE 223 LABORATORY 354,279 2.91528 1110 GENERAL MEDICINE 224 PHARMACY 630,123 7.32528 1110 GENERAL MEDICINE 225 MEDICAL MEDIA PROD 3,625 0.06528 1110 GENERAL MEDICINE 226 LIBRARIES 45,778 0.34528 1110 GENERAL MEDICINE 227 PSYCHOLOGY 12,652 0.14528 1110 GENERAL MEDICINE 229 NUCLEAR MEDICINE 61,171 0.46528 1110 GENERAL MEDICINE 241 NURSING SERVICE 3,865,734 67.3528 1110 GENERAL MEDICINE 242 REHAB MEDICINE SERV 82,711 1.25528 1110 GENERAL MEDICINE 243 DIETETIC 430,818 8.08528 1110 GENERAL MEDICINE 244 CHAPLAINS 50,782 0.53528 1110 GENERAL MEDICINE 281 SUPPLY PROC & DIST 318,131 2.19528 1111 NEUROLOGY 201 MEDICAL 63,963 0.79

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

Account Number

X X X X. x x

Department

Major Cost Category (e.g., 1=inpatient, 2=outpatient)

Indirect Accounts

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.

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

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

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

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

CDR: Trend MonitoringCATEGORY OF CARE FY98 FY99 FY00 FY01 FY02 FY03Inpatient Rehabilitation $778 $937 $1,021 $1,329 $1,358 $1,263 Inpatient Blind Rehabilitation $747 $777 $863 $904 $895 $902 Inpatient Spinal Cord $720 $803 $829 $887 $952 $1,069 Inpatient Psychiatry $495 $567 $635 $708 $795 $867 Inpatient Substance Abuse $521 $576 $456 $588 $562 $592 Inpatient Intermediate $384 $423 $491 $617 $822 $1,275 Inpatient Domiciliary $109 $119 $112 $146 $152 $164 Inpatient Long Term $249 $278 $303 $340 $357 $381 PRRTP $148 $161 $172 $173 $231 $237

Monthly Program Cost Report (MPCR)

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.

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

Access

• KLF Menu

• Austin

• CD-ROM via chief of fiscal service

Cost Categories

Table 1: Major Cost CategoriesCategoryInpatient – VA 1000Outpatient – VA 2000Inpatient – Non –VA 3000Outpatient – Non –VA 4000Off-Facility Programs – VA 5000Miscellaneous Benefits & Services 6000Corporate Cost and Depreciation 7000Services Furnished Other Than VHA

8000

Account Suffix CodesDirect Care 0Indirect Care 0.3

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.

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)

MPCR vs CDR

Table 3: FY04 Total Cost By Major Cost Categories ($ in Millions) Major Cost Categories MPCR CDR Inpatient VA (1000 series) $9,121 $10,728Outpatient VA (2000 series) $14,397 $12,850Inpatient Non-VA (3000 series) $1,250 $1,296Outpatient Non-VA (4000 series) $476 $989Off-Facility Programs (5000 series) $508 $363Miscellaneous Benefits (6000 series) $721 $1,734Corporate Cost And Depreciation (7000 series) $3,075 $0Services Furnished Other Than VA (8000 series) $23 $107Total $29,571 *$28,068 *

* These totaled amounts matches the summary reports generated by ARC.

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

Questions on MPCR?

NDE Summary

NDE Summary

• 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

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

Disadvantages

• Cost totals by STA3N by HERC category– No subtotals for indirect costs– Limited to HERC categories

• Available after DSS NDEs are released

Inpatient NDE Costs2001 2002 2003 2004

AC AC AC ACMedicine 1,337 1,384 1,516 1,646Rehab 995 1,050 1,146 1,146Blind Rehab 809 825 789 857SCI 869 911 974 1,052Surgery 2,111 2,184 2,412 2,574Psych 612 673 737 774SUD 539 550 540 558Intermed 668 752 909 967Domiciliary 141 184 196 214NH 386 428 474 517PRRTP 230 280 305 312

Inpatient NDE Days2001 2002 2003 2004

Days Days Days DaysMedicine 16,276 16,862 17,222 17,529Rehab 2,308 2,514 2,470 2,486Blind Rehab 6,642 6,195 6,568 7,177SCI 11,465 12,312 12,252 12,347Surgery 7,091 7,090 7,139 7,247Psych 13,872 12,682 12,115 12,051SUD 3,132 3,289 3,456 3,515Intermed 7,145 5,133 3,357 3,255Domiciliary 48,130 46,542 45,585 42,353NH 39,072 39,466 40,800 41,688PRRTP 9,688 10,377 10,500 10,601

NDE Summary vs CDR2003

DSS CDRMedicine 1516 1612Rehab 1146 1351Blind Rehab 789 902SCI 974 1069Surgery 2412 3162Psych 737 852SUD 540 708Intermed 909 1268Domiciliary 196 164NH 474 380PRRTP 305 237

HERC Person-Level Data

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

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

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.

Questions on HERC Person-level Data?