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.
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.
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.
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.
| 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.
| 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).
| 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.
| 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).
| 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).
| 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.
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
When combining TRICARE data from DaVINCI with VA facility cost data, there can be overlap of VA facility outpatient or inpatient care reimbursed by TRICARE. To avoid double counting of cost, researchers should either subtract VA facility hospitalizations or visits where the payer is TRICARE or subtract TRICARE payments to VA facilities.
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.
Resources
Dismuke-Greer CE. Estimating the Cost of Treatment Using VA and DoD Data. HERC Cost Effectiveness Analysis Seminar. February 7, 2024.
Dismuke-Greer CE. Understanding Cost Variables in DoD DaVINCI databases. HERC Health Economics Seminar. April 13, 2022.
Dismuke-Greer CE, Richard P. Understanding the impact of COVID-19 on hospitalization costs in DoD and VA. Technical Report 39. Health Economics Resource Center, U.S. Department of Veterans Affairs. March 2022.
Dismuke-Greer CE, Richard P. Comparing VA and DoD Health Services Cost Data: An example using COVID-19 inpatient admissions. HERC Health Economics Seminar. October 20, 2021.
DaVINCI Data Academy (VA intranet only).
VHA Data Portal DaVINCI page (VA intranet only).
Military Health System’s Tricare page: (https://www.health.mil/Military-Health-Topics/Access-Cost-Quality-and-Safety/Health-Care-Program-Evaluation/Annual-Evaluation-of-the-TRICARE-Program)
Last updated: March 19, 2024
