PowerPoint Template HERCPowerPoint模板的设备.pptVIP

VA Economic Data Sets VI:HERC Average Cost Datasets Todd Wagner, Ph.D. Ciaran Phibbs, Ph.D. Learning Objectives At the end of this lecture, you will Understand how we created the average cost data Relate the methods to other cost determination methods Know how to access the data Be aware of the HERC data limitations Have information to help choose between HERC or DSS VA Cost Data In 1990’s, we lacked of accurate encounter-level cost data for economic and health services research HERC’s Goal: Create encounter level cost estimates for all care provided at VA facilities Costing Methods HERC Inpatient Costs Average Cost Categories Ten categories of inpatient care Medicine and surgery (med/surg) Rehab Blind rehab Spinal cord injury Psychiatry Substance abuse Intermediate medicine Domiciliary Psychosocial residential rehabilitation Nursing home (risk adjusted FY98-00 only) Step 1: Create Categories Utilization Patient Treatment Files (PTF) bedsection file Use bedsection variable to create category Costs FY98-03 Cost Distribution Report FY04- Summary of DSS data Step 2: Merge and Reconcile Utilization and Costs Utilization and cost data come from different datasets Sometimes there are costs for a bedsection with no utilization (must fix). Sometimes there are utilization data but no costs (must fix). After Reconciliation A few bedsections stays were reclassified Some costs were moved into other categories Most common fix: we reclassified substance abuse cost or days as psychiatry Step 3: Calculate Daily Rate Two Cost Estimates For each category of care, we estimated Local cost per day National cost per day Flagged local costs where they differ = 2 standard deviations from national costs COSTL= length of stay*local cost per day COSTN= length of stay*national cost per day Step 4: Med/surg Hospitalizations Use average daily rate? Unpalatable assumption that the daily cost does not vary by diagnosis Med/surg Hospitalizations Additional data can help us estimate costs