documentation:next_cdm:single_cost
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documentation:next_cdm:single_cost [2016/02/10 00:12] jenniferduryea |
documentation:next_cdm:single_cost [2016/03/08 19:09] 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. |
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| + | 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. | ||
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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.txt · Last modified: 2016/03/08 19:09 by jenniferduryea
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