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documentation:next_cdm:single_cost

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documentation:next_cdm:single_cost [2016/02/10 00:06] – jenniferduryeadocumentation:next_cdm:single_cost [2016/03/08 19:09] (current) – jenniferduryea
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 Proposal to consolidate all current cost tables (Procedure_Cost, Drug_Cost, Device_Cost, Visit_Cost) in V5.0 into one single table. The table could be connected to any of the Domain tables (Procedure_Occurrence, Condition_Occurrence, Drug_Exposure, Device_Exposure, Observation, Measurement).  Proposal to consolidate all current cost tables (Procedure_Cost, Drug_Cost, Device_Cost, Visit_Cost) in V5.0 into one single table. The table could be connected to any of the Domain tables (Procedure_Occurrence, Condition_Occurrence, Drug_Exposure, Device_Exposure, Observation, Measurement). 
  
-Instead of generating additional cost tables, each tied to a specific domain, perhaps we create a single, unified cost table to capture costs for all domains. visit_cost and device_cost share identical columns for tracking costs. +Instead of generating additional cost tables, each tied to a specific domain, perhaps we create a single, unified cost table to capture costs for all domains. visit_cost and device_cost share identical columns for tracking costs. 
 + 
 +Change at last minute: the cost_type_concept_id field will use new concepts in the Vocabulary to designate the source of the cost data.
  
 The following description below is the proposed additional specification to the CDM. The following description below is the proposed additional specification to the CDM.
  
 === Cost Table === === Cost Table ===
-The Cost Table will house all cost information from source data.  Any information reporting money or currency amounts will be stored in this table.  We distinguish three types of cost: 1) paid or reimbursed amounts, 2) charges or list prices, and 3) costs incurred by the provider.  +The Cost Table will house all cost information from source data.  Any information reporting money or currency amounts will be stored in this table.  We distinguish three types of cost data: 1) paid or reimbursed amounts, 2) charges or list prices, and 3) costs or expenses incurred by the provider.  
  
 The defined fields in the Cost Table below are variables found in almost all U.S.-based claims data sources, which is a common cost data source for researchers.  Descriptions on how to use these variables are detailed in the table below. The defined fields in the Cost Table below are variables found in almost all U.S.-based claims data sources, which is a common cost data source for researchers.  Descriptions on how to use these variables are detailed in the table below.
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 |total_charged|No|float|The total amount charged by the provider of the good/service (e.g. hospital, physician pharmacy, dme provider) billed to a payer.  This information is usually provided in claims data.| |total_charged|No|float|The total amount charged by the provider of the good/service (e.g. hospital, physician pharmacy, dme provider) billed to a payer.  This information is usually provided in claims data.|
 |total_cost|No|float|Cost of service/device/drug incurred by provider/pharmacy.  This field is more commonly derived from charge information.  Use case:  The resulting amount after the hospital charges are multiplied by the cost-to-charge ratio.  This data is currently available for [[https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp|NIS]] datasets, or any other [[https://www.hcup-us.ahrq.gov/databases.jsp|HCUP]] datasets.  See cost calculation explanation from AHRQ [[https://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp|here]].| |total_cost|No|float|Cost of service/device/drug incurred by provider/pharmacy.  This field is more commonly derived from charge information.  Use case:  The resulting amount after the hospital charges are multiplied by the cost-to-charge ratio.  This data is currently available for [[https://www.hcup-us.ahrq.gov/db/nation/nis/nisdbdocumentation.jsp|NIS]] datasets, or any other [[https://www.hcup-us.ahrq.gov/databases.jsp|HCUP]] datasets.  See cost calculation explanation from AHRQ [[https://www.hcup-us.ahrq.gov/db/state/costtocharge.jsp|here]].|
 +|total_cost_type_concept_id|Yes|integer|Shows the provenance or the source of the total_cost data: Calculated from provider revenue, calculated from cost-to-charge ratio, reported from accounting database, etc.|
 |total_paid|No|float|The total amount paid from all payers for the expenses of the service/device/drug.  This field is calculated using the following formula: paid_by_payer + paid_by_patient + paid_by_primary.  In claims data, this field is considered the calculated field the payer expects the provider to get reimbursed for the service/device/drug from the payer and from the patient, based on the payer's contractual obligations.| |total_paid|No|float|The total amount paid from all payers for the expenses of the service/device/drug.  This field is calculated using the following formula: paid_by_payer + paid_by_patient + paid_by_primary.  In claims data, this field is considered the calculated field the payer expects the provider to get reimbursed for the service/device/drug from the payer and from the patient, based on the payer's contractual obligations.|
 |paid_by_payer|No|float|The amount paid by the Payer for the service/device/drug.  In claims data, generally there is one field representing the total payment from the payer for the service/device/drug.  However, this field could be a calculated field if the source data provides separate payment information for the ingredient cost and the dispensing fee.  If the paid_ingredient_cost or paid_dispensing_fee fields are populated with nonzero values, the paid_by_payer field is calculated using the following formula:  paid_ingredient_cost + paid_dispensing_fee.   If there is more than one Payer in the source data, several cost records indicate that fact.  The Payer reporting this reimbursement should be indicated under the payer_plan_id field.| |paid_by_payer|No|float|The amount paid by the Payer for the service/device/drug.  In claims data, generally there is one field representing the total payment from the payer for the service/device/drug.  However, this field could be a calculated field if the source data provides separate payment information for the ingredient cost and the dispensing fee.  If the paid_ingredient_cost or paid_dispensing_fee fields are populated with nonzero values, the paid_by_payer field is calculated using the following formula:  paid_ingredient_cost + paid_dispensing_fee.   If there is more than one Payer in the source data, several cost records indicate that fact.  The Payer reporting this reimbursement should be indicated under the payer_plan_id field.|
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 |paid_dispensing_fee|No|float|The amount paid by the Payer to a pharmacy for dispensing a drug, excluding the amount paid for the drug ingredient.  paid_dispensing_fee contributes to the paid_by_payer field if this field is populated with a nonzero value.| |paid_dispensing_fee|No|float|The amount paid by the Payer to a pharmacy for dispensing a drug, excluding the amount paid for the drug ingredient.  paid_dispensing_fee contributes to the paid_by_payer field if this field is populated with a nonzero value.|
 |payer_plan_period_id|No|integer|A foreign key to the PAYER_PLAN_PERIOD table, where the details of the Payer, Plan and Family are stored.  Record the payer_plan_id that relates to the payer who contributed to the paid_by_payer field.| |payer_plan_period_id|No|integer|A foreign key to the PAYER_PLAN_PERIOD table, where the details of the Payer, Plan and Family are stored.  Record the payer_plan_id that relates to the payer who contributed to the paid_by_payer field.|
-|amount_allowed|No|float|The contracted amount agreed between the payer and provider.  This information is generally available in claims data.  This is similar to the total_paid amount in that it shows what the payer expects the provider to be reimbursed after the payer and patient pay.  This differs from the total_paid amount in that it is not a calculated field, but a field available directly in claims data.  Use case: This will capture non-covered services.  Noncovered services are indicated by and amount allowed and patient responsibility variables (copay, coinsurance, deductible) will be set to $0 in the source data. This means the patient is responsible for the total_charged value.  The amount_allowed field is payer specific and the payer should be indicated by the payer_plan_id field.|+|amount_allowed|No|float|The contracted amount agreed between the payer and provider.  This information is generally available in claims data.  This is similar to the total_paid amount in that it shows what the payer expects the provider to be reimbursed after the payer and patient pay.  This differs from the total_paid amount in that it is not a calculated field, but a field available directly in claims data.  Use case: This will capture non-covered services.  Noncovered services are indicated by an amount allowed and patient responsibility variables (copay, coinsurance, deductible) will be equal $0 in the source data. This means the patient is responsible for the total_charged value.  The amount_allowed field is payer specific and the payer should be indicated by the payer_plan_id field.|
 |revenue_code_concept_id|No|integer|A foreign key referring to a Standard Concept ID in the Standardized Vocabularies for Revenue codes.| |revenue_code_concept_id|No|integer|A foreign key referring to a Standard Concept ID in the Standardized Vocabularies for Revenue codes.|
 |revenue_code_source_value|No|string(50)|The source code for the Revenue code as it appears in the source data, stored here for reference.| |revenue_code_source_value|No|string(50)|The source code for the Revenue code as it appears in the source data, stored here for reference.|
documentation/next_cdm/single_cost.1455062788.txt.gz · Last modified: by jenniferduryea
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