HERC: DaVINCI Cost Data
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DaVINCI Cost Data

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VA data users have access to Military Health System Data Repository (MDR) data through Department of Defense VA Infrastructure for Clinical Intelligence (DaVINCI). MDR data contain comprehensive clinical, demographic, beneficiary, cost, and service-related information.

DaVINCI Data Academy includes several useful resources for understanding and working with DaVINCI data including training webinars, a DaVINCI Data Dictionary, and DoD Dataset Descriptions.

On this page, we focus on DaVINCI cost data and tips for using DaVINCI data in research.

Data Availability

DaVINCI includes MDR data for all Veterans and active-duty military. Most clinical data is available beginning 2009; some administrative records are available beginning FY 1989.

Key DaVINCI datasets for assessing costs:

  • Src.DaVINCI_SIDR: Inpatient direct care
  • Src.DaVINCI_TEDI: Inpatient care received through Tricare
  • Src.DaVINCI_CAPER: Outpatient direct care
  • Src.DaVINCI_TEDNI: Outpatient care received through Tricare

 

Access to DaVINCI data is currently available for approved research and operations projects. Staff of approved research projects can request access through the Data Access Request Tracker (DART). Visit the VHA Data Portal to learn more about accessing DaVINCI data.

Approved operations projects should submit a DaVINCI Data Request Memo to VINCI staff. Additional information is available on the DaVINCI Data Academy webpage

DaVINCI data is also available in Observational Medical Outcomes Partnership (OMOP) format. Either format can be requested through DART. OMOP DaVINCI data does not contain cost at this time.

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Background

The Military Health System (MHS) includes both direct care and purchased care. Direct care is care provided in hospitals and clinics operated by MHS (Military Medical Treatment Facilities or MTFs). Stateside, this data is referred to as MTF data; when service members receive direct care abroad, it is referred to as Theatre data. Theatre data is available in DaVINCI databases but does not include costs.

Most beneficiaries also have supplemental insurance through MHS to receive care in the private sector, called Tricare. Tricare data reflects claims private sector providers submit to MHS to be reimbursed for care. Tricare accounts for a larger portion of utilization and expenditures than direct care: in FY21, Tricare utilization was approximately double that of direct care utilization (https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Health-Care-Program-Evaluation/Annual-Evaluation-of-the-TRICARE-Program). 

Detailed electronic medical record information is available for MTF care (direct care). Only claims data is available for care received through Tricare (purchased care).

Who is Included in DaVINCI Records?

DaVINCI databases include records for Veterans and active-duty military. There is not a clear line separating MHS care use (MTF care and Tricare) and VA care. Patients may go back and forth between systems. For example, active duty individuals with traumatic brain injury (TBI) may use VA’s polytrauma rehab centers. Once individuals separate from DoD, they may use Tricare in combination with VA.

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DaVINCI Data Overview

DaVINCI data contain comprehensive clinical, demographic, beneficiary, cost, and service-related information for all active-duty military. DaVINCI databases contain a unique identifier researchers can use to link across data sources.

DaVINCI includes datasets familiar to VA researchers, albeit with a different name, including

  • Outpatient utilization (CAPER)
  • Inpatient utilization (SIDR)
  • Demographic information (DEERS)
  • Purchased care (TED-I and TED-NI)

 

DaVINCI also includes information not found in other VA databases such as

  • Risk factors identified during military service (Health Risk files)
  • Codes for injuries that took place during military service (injury codes)
  • Military characteristics not found in VA, such as rank and locations of service

 

Much like clinic stops or treating specialties in VA, Medical Expense and Performance Reporting System (MEPRS) codes are used to identify the clinic where the care occurred. A list of MEPRS codes can be found in the DaVINCI Data Dictionary available through the DaVINCI Data Academy. Data users are encouraged to use these codes with caution, as HERC researchers have found inconsistencies in code use across services.

The DaVINCI Data Academy includes resources for understanding and working with DaVINCI data including training webinars, a DaVINCI Data Dictionary, and DoD Dataset Descriptions.

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DaVINCI Cost Data

DaVINCI contains cost data for inpatient and outpatient care in military treatment facilities (MTFs) as well as civilian hospitals via Tricare.

Inpatient Cost Data

Inpatient cost data can be found in Src.DaVINCI_SIDR and Src.DaVINCI_TEDI.

  • The SIDR file contains data from MTF inpatient care (i.e., direct care).  
  • The TED-I file contains data on inpatient hospital care received through Tricare (i.e., purchased care).

 

The SIDR file contains one record per discharge. It does not include a total cost variable, rather there are variables with subtotals for different components of the cost. To calculate total costs in the most comparable way to VA, data users can sum the following cost variables

FCANCLAB+FCANCRAD+FCCLNSAL+FCICU+FCOTHANC+FCOTHSAL+FCSUPPRT+FCSURG = total cost

This sum can be compared to the total cost variable (totcost) in HERC’s MCA Discharge File. Table 1 includes the list of full cost variables available in the SIDR file. 

Table 1. Inpatient MTF Care Cost Variables (SIDR)
Variable Description
FCANCLAB Ancillary laboratory portion of full cost
FCANCRAD Ancillary radiology portion of full cost
FCCLNSAL Clinician salary portion of full cost
FCICU Intensive care unit portion of full cost
FCOTHANC Other ancillary (non-lab or radiology) portion of full cost
FCOTHSAL Non-clinician salary portion of full cost
FCSUPPRT Support portion of full cost
FCSURG Surgery portion of full cost

The Inpatient (SIDR) and Outpatient (CAPRER) files also contain information about variable costs, which are a component of the full cost. These costs can vary with the volume and intensity of services provided. The variable cost variables available in the SIDR file are listed in Table 2. 

Table 2. Inpatient MTF Care Cost Variables – Variable Costs (SIDR)
Variable Description
Variable_Cost Total of all components of variable cost
VCANCLAB Ancillary laboratory portion of variable cost
VCANCRAD Ancillary radiology portion of variable cost
VCCLNSAL Clinical salary portion of variable cost
VCICU Intensive care unit portion of variable cost
VCOTHANC Other ancillary (non-lab or radiology) portion of variable cost
VCSUPPRT Support portion of variable cost
VCSURG Surgery portion of variable cost
VCDIRECT The direct portion of variable cost, less clinician salary

The TED-I file contains information on the amount paid by Tricare as well as other third-party payers for inpatient hospitalizations. TED-I contains two cost variables: one for the amount paid by Tricare and another for the amount paid by another third-party payer (Table 3). 

Table 3. Inpatient Tricare Cost Variables (TED-I)
Variable Description
TOTAL_AMOUNT_PAID Amount paid on the inpatient admission claim by Tricare
amtohi Amount paid by another third-party payer (not Tricare)

Outpatient Cost Data

Outpatient cost data can be found in Src.DaVINCI_CAPER and Src.DaVINCI_TEDNI.

  • CAPER is the primary source for MTF outpatient care (i.e., direct care) data
  • TED-NI is the primary source for data on outpatient care received through Tricare (i.e., purchased care).

 

CAPER contains a total cost variable for the outpatient encounter (Full Cost). It also contains cost variables for specific components of care. Table 4 lists the full cost variables available in the CAPER file. 

Table 4. Outpatient MFT Care Cost Variables (CAPER)
Variable Description
FullCost Total cost of outpatient encounter
FullCostClinSal Clinician salary portion of total cost
FullCostLab Laboratory portion of total cost
FullCostPharm Pharmacy portion of total cost
FullCostRad Radiology portion of total cost
FullCostOtherAnc Non-laboratory and non-radiology ancillary amount of total cost
FullCostOtherSal Non-clinical salary portion of total cost
FullCostOther Other (not included in the other categories) portion of total cost

CAPER also contains variables to identify outpatient variable costs (Table 5). 

Table 5. Outpatient MTF Care Cost Variables – Variable Costs (CAPER)
Variable Description
VarCost Total variable cost of the outpatient encounter
VarCostClinSal Clinician salary portion of the variable cost
VarCostLab Ancillary laboratory portion of the variable cost
VarCostPharm Pharmacy portion of the variable cost
VarCostRad Ancillary radiology portion of the variable cost
VarCostOtherAnc Non-laboratory and non-radiology ancillary portion of the variable cost
VarCostOtherSal Non-clinical salary portion of the variable cost
VarCostOther Portion of the variable cost not included in other categories

The TED-NI data contains information on the amount paid by Tricare as well as other third-party payers for outpatient encounters. Much like TED-I (inpatient), TED-NI (outpatient) contains two cost variables: one for the amount paid by Tricare and another for the amount paid by another third-party payer (Table 6). 

Table 6. Outpatient Tricare Cost Variables in (TED-NI)
Variable Description
TotalAmountPaid Amount paid for the outpatient encounter by Tricare
amtohiraw Amount paid for the outpatient encounter by other health insurance

Pharmacy Cost Data

Pharmacy cost data is available for outpatient direct care (care at MTFs). The variable FullCostPharm in the CAPER file indicates the pharmacy portion of the total cost.

Pharmacy costs are not separated in the inpatient data. Pharmacy costs are also not available for care received through Tricare.

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Linking to VA Administrative Data

DaVINCI data can be linked to OMOP and other VA administrative data. Although the primary patient identifier in DaVINCI data is EDIPI, which is unique to DaVINCI, the data also contain three linking variables:

  • Person_ID: link to VHA OMOP tables
  • PatientSID: link to CDW data
  • PatientICN: link to CDW data

 

Additional key variables in both VA and inpatient DaVINCI databases:

  • diagnosis related group (MSDRG)
  • fiscal month, year and calendar year
  • age and sex
  • length of stay

 

See Technical Report 39: Understanding the impact of COVID-19 on hospitalization costs in DoD and VA for an example of a VA and DoD cost comparison using COVID-19 hospitalizations as the driving example.

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Resources

Dismuke-Greer CE, Richard P. Understanding the impact of COVID-19 on hospitalization costs in DoD and VA. Technical Report 39. Menlo Park, CA. VA Palo Alto Health Economics Resource Center; March 2022.

DaVINCI Data Academy (VA intranet only).

VHA Data Portal DaVINCI page (VA intranet only).

Military Health System’s Tricare page: https://health.mil/I-Am-A/TRICARE-Beneficiary.

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Last updated: March 16, 2022