HERC: VA Community Care
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VA Community Care

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Overview

VA Community Care datasets report claims level information on non-VA care that was paid by a VA facility, including care provided to Veterans at military facilities. Community care datasets are derived from claims; therefore, they contain financial information related to the billed service but limited clinical detail. The files exclude most care provided through sharing agreements at university affiliates and services at state Veterans homes.

As VA has expanded access to community care with the passage of the Veterans Access, Choice, and Accountability Act (2014-2019) and the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act (2018-present), the types and content of community care data available has also grown. There are multiple sources of VA Community Care data within the Corporate Data Warehouse (CDW). Researchers may need to use a combination of community care data sources to gain a complete picture of non-VA care use. 

Additional information about VA Community Care data and the available data sources is available on the VHA Data Portal. 

Data Sources

IVC CDS: The primary data source for VA community care data is the VHA Office of Integrated Veteran Care Consolidated Data Set (IVC CDS). IVC CDS contains claims data from CCRS, eCAMS, FBCS, and Fee domains. Data is available for claims processed on or after October 1, 2018. Projects looking to include community care data before FY 2019 will need to include additional data sources. 

IVC CDS: Learn More

PIT (archived): Beginning in 2013, VA introduced the Non-VA Care Program Integrity Tools (PIT) system, which is a comprehensive set of tools that aggregates many sources of data to check for fraud, waste, and abuse in the VA Community Care program. PIT data are comprised of multiple claims data sources, including CCRS and eCAMS. PIT provides comprehensive data on all Veteran family member programs, and Choice and MISSION Act utilization.

On February 21, 2023, the Office of Integrity and Compliance (OIC) paused PIT operations, and no claims are available past this date. An archived copy of PIT is available for research data use only. 

PIT (archived): Learn More

CDW Purchased Care (FEE) domain: Data in the CDW Purchased Care domain comes from VistA. It includes an authorized domain, with information about non-VA care pre-authorized by VA, and an unauthorized domain, with information about non-VA care without prior authorization (e.g., emergency department visits). 

The FEE domain, along with SAS Fee (below) were the primary source of VA Community Care data before the onset of PIT. With the shift to PIT, the FEE domain became the source mainly for dental claims and contract nursing claims (http://vaww.virec.research.va.gov/Notebook/RNB/RNB17-CDW-Community-Care-Data-Sources-CY20.pdf).

SAS Fee files: The SAS Fee files have similar, although not identical, data to the FEE domain. Beginning June 2019, the SAS Fee files are no longer reliably updated.

FEE Domain: Learn More

CDW Raw Domains

Data in CDW Raw are not modeled, standardized, or indexed, and therefore, may require additional data cleaning. Information about the VA Community Care CDW Raw domains, including data dictionaries, is available on the CDW-Raw Domains Page. Data contents and record and null counts for CDW raw domains are available on VIReC’s VA Care in the Community intranet page. As of December 2021, the CDW raw domains listed below (CCRA, CCRS, and eCAMS) are not available for research; they are available for operations projects only. 

Community Care Reimbursement System (CCRS): CCRS is a claims processing system for VA community care. The CCRS domain contains reimbursement data for VA community care. Note that SPatient permissions are required to access these data.

 

Electronic Claims Adjudication Management System (eCAMS): eCAMS is another claims processing system for VA Community Care (eCAMS processes different types of contracts than CCRS). The eCAMS domain also contains reimbursement data for VA community care. Note that SPatient permissions are required to access these data.

 

Community Care Referral & Authorization (CCRA): Community Care Referral and Authorization, also known as HealthShare Referral Manager, is the system in which community care is authorized. The CCRA domain contains authorizations for VA Community Care. Note that SPatient permissions are required to access these data. 

Until recently, two additional CDW Raw domains included Fee Basis Claims System (FBCS) and VACAA. As of 2020, these domains have been retired. Data can be found in the current CDW Community Care domains. 

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Pharmacy Data

In general, VA requires Veterans to get their medications from VA. As part of the VA Community Care program, Veterans can receive short-term (less than 14 day) urgent prescriptions in the community, but long-term prescriptions must be filled by VA. Visit the VHA Office of Integrated Veteran Care (IVC) website to learn more about Community Care benefits.

As of August 2023, IVC CDS does not yet include pharmacy claims. Data users interested in community care pharmacy claims will need to include alternate data sources. 

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Overlap of Community Care Data Sources

IVC CDS contains data from multiple sources. For projects using data prior to October 1, 2018, VA researchers have found overlaps and gaps in the community care data sources. Data users should consider using a combination of community care data sources, depending on the project’s needs, to gain a complete picture of non-VA care use. For an example of overlap between FEE and PIT, see preliminary results from the Women's Health Evaluation Initiative (WHEI) “Preliminary Investigation of Outpatient Community Care Use Among Veteran VHA Patients, FY18.”

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Data Access

Operations users can request access to data using the VHA NDS Access for Health Operations ePAS Form. Researchers can request data access through the DART research request process. For more information, visit the VHA Data Portal.

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History of VA Community Care

VA Directive 1663 allows VA medical centers to contract for clinical and related services with affiliated medical schools, faculty groups, hospitals, and other providers. These contracts, also called sharing agreements, are developed under several circumstances: when a clinical service cannot be provided by one VA facility and the patient cannot be transferred to another VA facility; when VA cannot recruit a needed clinician; when it is determined not to be in the best interest of the VA to hire, such as when only a portion of a clinician’s time is needed; in order to reach market-rate pay for certain highly paid subspecialists; and when it is cost-effective to share a service or space with another entity rather than to develop stand-alone capacity for VA.

Most care provided through sharing agreements does not appear in VA utilization databases. One exception is services purchased from the Department of Defense (DoD), which are recorded in the Fee Basis Claims System (FBCS) database. The data capture system is imperfect at present, although this may be remedied by a VISTA patch currently being developed. Another exception would be care provided at a VA facility by a contract provider. In such cases the provider uses VISTA and the encounter is recorded as usual. There is no plan to record sharing care from other sources in Community Care files or other utilization databases available to researchers.

A regulation change in FY2007 made it difficult for VA stations to enter into sharing agreements. Their number fell precipitously as local officials moved to purchase contract care through the VA Community Care program instead. These events may have caused an anomalous increase in non-VA medical care. Due to the considerably larger scope of VA Community Care contracts, however – more than $3 billion in FY2008 – the increase due to the FY2007 regulation change may not be noticeable. Changes in the contracting process since FY2007 have led to a substantial return to the use of sharing agreements throughout the system.

The VA Financial Management System (FMS) records spending by fiscal year, location, budget object code (BOC), and cost center. The data are stored in files at the Austin IT Center. FMS data is useful for determining summary figures, but they cannot be tied to care for individual patients. Most BOCs pertaining to contract care fall in the range of 2560-2636. Exceptions include 2674, 2692, and 2693, which contain a mixture of contract and non-contract care, and 4110 and 4120, which include payments for services related to medical care, to cemeteries, and to other veteran benefits. Most contract care falls within cost centers in the 8300 series. Again, there are exceptions, such as 8204, 8222, and 8272. The current policies defining BOCs and cost centers may be found by visiting https://www.va.gov/vapubs and searching by keyword.

Sharing agreements with DoD facilities are recorded under a single BOC. Using the vendor files in the FBCS data one could locate all paid claims for sharing care provided by DoD. The resulting figure would be less than actual spending due to incomplete reporting. FMS will not suffer from incomplete reporting, however, and so the difference between FMS and FBCS totals for DoD care should indicate the level of underreporting in the FBCS files.

In response to health care issues faced by VHA, Congress passed into law the Veterans Access, Choice and Accountability Act of 2014 (the Choice Act). The Choice Act provides care to Veterans who are unable to be scheduled for an appointment within 30 days of their preferred visit date or who live more than a specified distance from the nearest VA medical facility. Care provided under the Choice Act is considered part of VA Community Care, and in FY2015 (the first year of the program), data were included in the FBCS database. Beginning FY2016, data can be found in CDW. It is estimated that there are approximately 1.7 million Choice care claims processed each month and that Choice care claims account for approximately $5-8 billion annually. The Choice Act was replaced by the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018 in June 2019.

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Resources

 

Last updated: July 12, 2024