HERC: Using the Managerial Cost Accounting 4-Character National Code (CHAR4) File for Program Evaluation
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Using the Managerial Cost Accounting 4-Character National Code (CHAR4) File for Program Evaluation

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The Managerial Cost Accounting (MCA) CHAR4 is a National Data Extract cost file produced by the MCA office. The CHAR4 file reports costs of outpatient encounters for specific clinics or types of clinics using a 4-Character National Code.

National CHAR4 data allow analysts to identify care provided under specific clinics across stop codes and sites. For example, PLTR is used to identify polytrauma care; ACUP is used for acupuncture services; APRI has been used to identify a specific team in primary care --Primary Care Team A; NURS, TECH, and NPRN are codes used to identify a provider type. Codes can be used both locally and nationally. MCA publishes the list of 4-character national codes on their website.  A clinical program or evaluation team interested in assigning CHAR4 codes to outpatient care can submit a request for a new CHAR4 code to the national MCA CHAR4 council.

The CHAR4 NDE is produced in conjunction with the MCA Outpatient (OUT) NDE and can be accessed via Sql Server Management Studio (VHACDWA06 → CDWWork → DSS.CHAR4) or via the SAS grid (CDW Raw: DSS Data → CHAR4). All outpatient encounters that have at least one record with a CHAR4 value will be recorded in the CHAR4 NDE. The total costs of care associated with a CHAR4 code is reported in the TCOST variable. The remaining component of the encounter not associated with a specific CHAR4 code will have a CHAR4 code reported as ‘0000’ (4 zeros). The sum of the variable, TCOST, for an encounter in the CHAR4 NDE, will equal the ACTTOTCOST of the corresponding encounter in the OUT NDE.

Analysts working with the CHAR4 file should be aware of limitations with the file. CHAR4 codes are mapped to clinics locally within each VISN, so it is possible that codes can be mapped incorrectly or not updated at all sites at the same time. This can lead to underreporting. Also, the CHAR4 variable is populated via the NATIONALCHAR4 variable found in Dim.DSSLocationStopCode, which is updated regularly. It is a real time variable, which one must keep in mind if doing a retrospective search. CHAR4 records can be linked to CDW production data via LocationName and LocationSID. Pulling utilization records on the production side based on CHAR4 codes of interest requires linking 3 dim tables –Dim.DSSLocationStopCode (contains variable, NationalChar4) which links to Dim.DSSLocation (for variables LocationSID, PrimaryStopCode, and SecondaryStopCode). This table allows linking to Dim.Location which contains the variable LocationName. Lastly, linking patient records between utilization and costs would require a crosswalk since MCA NDEs use SCRSSN while CDW extracts use PatientSID. More information regarding the CHAR4 NDE can be found in the MCA NDE Technical Guide (Ch. 22), metadata and record layouts (Intranet-only: http://vaww.dss.med.va.gov/nationalrptg/nr_extracts.asp), program codes documents (Intranet-only: http://vaww.dss.med.va.gov/programdocs/pd_fourcc.asp), as well as the HSRD Listserv archive.