By category
View All | Comparing Costs | Cost Analysis | Determine Cost of X | Missing and Outlier Data | Non-VA Costs | Pharmacy | Staff and Labor | VA Cost Data
VA provides several types of telehealth, including clinic-based real-time video telehealth (where a patient is in a VA clinic/hospital and has a telehealth communication with a VA provider in another clinic or facility); home video telehealth (where a patient is at home and the provider is at a VA clinical site); store-and-forward telehealth (where a patient at a VA clinic/hospital and a video/photos that are stored in the VA health record for a provider to review and diagnose at a later date – generally for radiology, pathology, dermatology, ophthalmology, and wound care); and remote patient monitoring (where there is ongoing assessment, monitoring, and case management of a patient using a disease management protocol in the patient’s residential environment). Below, we focus on clinic-based real-time video telehealth and home video telehealth, but details on how to identify all the above-mentioned types of telehealth are outlined in HERC’s “Overview of Telehealth” presentation from the VA Data Bootcamp (intranet only): https://vaww.herc.research.va.gov/include/page.asp?id=va-data-bootcamp-2022.
For clinic-based real-time video telehealth and home video telehealth, you need to identify a primary and secondary stop code pair. A stop code is a three-digit code that characterizes a VA outpatient encounter to define clinical work units for resource allocation. The primary stop code is the clinic of interest. For example, if you wish to identify primary care telehealth visits, you would identify primary clinic stops 301 and 323. Secondary stop codes identify the specific type of telehealth provided (see details below). All stop codes (primary and secondary) can be identified by using the list of active stop codes from the VA Managerial Cost Accounting Office (MCAO) http://vaww.dss.med.va.gov/programdocs/pd_oident.asp (VA intranet only).
Clinic-based real time video telehealth. The secondary stop codes for scheduled, general clinic-based real time video telehealth visits are 690 (Real Time Clinical Video Telehealth – Patient Site), 692 (Real Time Clinical Video Telehealth – Provider Site (Same Station)), 693 (Real Time Clinical Video Telehealth – Provider Site (Not Same Station)). There are typically 2 records for clinic based real time telehealth appointments: 1 record for the patient site; 1 record for the provider site. Both records will have the same primary stop code but different secondary stop codes, which differentiate the patient-site record from the provider-site record.
Home video telehealth/telehealth to a non-VA site.* The secondary stop codes for home video telehealth are 179 (Real Time Clinical Video Telehealth to Home – Provider Site), 648 (Real Time Clinical Video Telehealth with Non-VAMC Location- Provider Site) and 679 (National Center Real Time Clinical Video Telehealth to Home- Provider Site).** In 2019, the vast majority of home video telehealth visits use stop code 179, although some visits use codes 648 and 679. There is only 1 record for home telehealth visits.***
*Telehealth to non-VA sites includes programs that enable homeless Veterans to access video visits in a library setting, or a community center.
**Two additional stop codes for home telehealth are 684 (Home Telehealth Non-Video Intervention) and 685 (Care of Home Telehealth Program Patients). These stop codes are not for video encounters.
*** There is some evidence that the home telehealth stop codes were not always used consistently in previous years. Studies that compared stop codes with VA-issued tablet utilization data found that approximately 25% of possible video encounters were not recorded with a VA stop code in 2016.
HERC researchers recommend using the Primary Care Management Module (PCMM) or Reengineered Primary Care Management Module (RPCMM) in the Corporate Data Warehouse (CDW) to identify a patient’s primary care provider. RPCMM is the current system used at most, but not all, sites. PCMM is the legacy system that is still in use. In general, if you are interested in years prior to fiscal year 2016 (FY16), use the PCMM file; if you are interested in FY16 or later, use both the PCMM and RPCMM.
PCMM/RPCMM list an assignment between the primary care provider (PCP) and the patient. Each record in PCMM/RPCMM lists the date the assignment started (RelationshipStartDate) and the date the assignment ended (RelationshipEndDate), if applicable. Relationship end dates may be missing for two reasons: the relationship has not ended, or the ending date was never posted to the dataset. In general, patients can have only 1 assigned primary care provider at a time, unless they have multiple residences.
Researchers working PCMM/RPCMM should note that both domains include records for care assignments other than primary care (such as case managers). It is important to distinguish these, and not regard them as primary care assignments, when filling in missing values for the end date for the primary care relationship. To identify a list of PCPs in the PCMM table PatientProviders, try the following logic: (ProviderRole="PC ASSIGNMENT" OR "PC ATTENDING") AND (TeamPurpose="Primary CARE" OR "PRIMARY CARE _ HBPC"). The resulting list allows you to identify a provider using the variable PrimaryProviderSID.
To identify current PCP assignments in the CDW PCMM/RPCMM domain table, only use records where: [(CurrentProviderFlag=YES) AND (RelationshipEndDate=(.))].
When you have identified a list of providers in PCMM/RPCMM, you can use the variables PrimaryProviderSID and sta3n to identify these providers in other files. The combination of PrimaryProviderSID+sta3n from the CDW PCMM.PatientProviders table can be crosswalked to the CDW Staff table as StaffSID+sta3n. (Essentially, PrimaryProviderSID is the same as StaffSID for a given sta3n).
Resources on PCMM/RPCMM can be found on the VIReC CDW Documentation intranet site (Intranet-only: https://vaww.virec.research.va.gov/CDW/Documentation.htm) and the CDW MetaData Reports Page on the CDW SharePoint site (Intranet-only: https://vaww.cdw.va.gov/Pages/CDWHome.aspx).
For answers to more commonly asked questions about identifying providers in VA administrative data, visit the webpage Identifying Providers in VA Administrative Data
