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    URSA-PHARM-014: Hospital Encounters per 1000 Member-Years
    • 27 Jun 2025
    • 7 Minutes to read
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    URSA-PHARM-014: Hospital Encounters per 1000 Member-Years

    • Updated on 27 Jun 2025
    • 7 Minutes to read
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    Article summary

    Measure Description

    Among active membership periods for patients with 1 or more medication fills in the last 12 months, the rate of inpatient and outpatient hospital encounters per 1000 member-years. Hospital encounters include; (1) Emergency Department Visits without Admissions, (2) Hospital Observation Stays without Admission, (3) Hospital Inpatient Admissions, (4) Hospital Outpatient Surgery Encounters, and (5) Other Hospital Outpatient Department Encounters.

    Metadata

    • Measure Type: Rate Measure
    • Temporal Structure: Interval
    • Component Class: Long-Form
    • Denominator Case Field: Patient ID
    • Target Direction: Down

    Denominator Description

    The elapsed patient-months among active membership periods for patients with one or more medication fill in the last 12 months

    Numerator Description

    The count of hospital encounters occurring during qualifying denominator membership periods. Hospital encounters include; (1) Emergency Department Visits without Admissions, (2) Hospital Observation Stays without Admission, (3) Hospital Inpatient Admissions, (4) Hospital Outpatient Surgery Encounters, and (5) Other Hospital Outpatient Department Encounters.

    Published Fields

    • Data Model Keys

      • Patient ID
      • Primary Payor ID
      • Primary Plan ID
      • Primary Plan Attributee Provider ID
      • Empirical Attributee Primary Care Individual Provider ID
      • Empirical Attributee Primary Care Provider Group Provider ID

    • Encounter Fields

      • Ursa Surgery Encounter Type Category

    • Patient Fields

      • Patient Date of Birth
      • Patient Age Integer
      • Patient Age Category Tier 1
      • Patient Age Category Tier 2
      • Patient Sex Category
      • Is Patient Sex Female
      • Is Patient Sex Male
      • PCP Attribution Category
      • Primary Care Engagement Category
      • Count Primary Care Visits in Last 36 Months
      • Specialty Care Engagement Category
      • Count Specialty Care Office Visits in Last 36 Months
      • Primary or Specialty Care Engagement Category
      • Count Clinician Office Visits in Last 3 Years
      • Count Hospital Inpatient Admissions in Last 12 Months
      • Count ED Visits Without Inpatient Admissions in Last 12 Months

    • Date Fields

      • Current Continuous Primary Payor Membership Episode Start Date
      • Current Continuous Primary Payor Membership Episode End Date
      • Current Continuous Pharmacy Claim Data Coverage Episode Start Date
      • Current Continuous Pharmacy Claim Data Coverage Episode End Date
      • Segment Start Date -- The start date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
      • Segment End Date -- The end date of the reporting segment. (See also [URSA-CORE] Reporting Segment)
      • Segmented Period Start Date
      • Segmented Period End Date

    • Provider Fields

      • Count Distinct Filling Providers Last 12 Months
      • Count Distinct Prescribing Providers Last 12 Months
      • Count Distinct Opioid Prescribing Providers in Last 6 Months
      • Count Distinct Opioid Filling Providers in Last 6 Months
      • Count Distinct Opioid Prescribing Providers in Last 12 Months
      • Count Distinct Opioid Filling Providers in Last 12 Months
      • Empirical Attributee PCP Provider NPI
      • Empirical Attributee PCP Provider Description
      • Empirical Attributee Primary Care Provider Group Provider NPI
      • Empirical Attributee Primary Care Provider Group Provider Description
      • Count Visits with Attributee Individual Primary Care Provider in Last 36 Months
      • Count Visits with Attributee Primary Care Provider Group in Last 36 Months

    • Location Fields

      • Patient State Abbreviation
      • Patient ZIP Code 5-Digit
      • UW HIP Area Deprivation Index National Percentile
      • UW HIP ADI Quintile Category
      • CDC SVI Overall Quintile Category
      • CDC SVI Socioeconomic Theme National Percentile
      • CDC SVI Socioeconomic Quintile Category
      • CDC SVI Household / Disability Theme National Percentile
      • CDC SVI Household / Disability Quintile Category
      • CDC SVI Minority / Language Theme National Percentile
      • CDC SVI Minority / Language Quintile Category
      • CDC SVI Housing / Transportation Theme National Percentile
      • CDC SVI Housing / Transportation Quintile Category

    • Insurance Fields

      • Primary Payor Description
      • Primary Plan Description
      • Primary Plan Financial Class Description
      • Is Primary Plan Financial Class Commercial
      • Is Primary Plan Financial Class Medicare Advantage
      • Is Primary Plan Financial Class Medicaid
      • Is CMS ESRD Status
      • Is CMS Hospice Status
      • Count Active Plan Memberships
      • Is Dual Medicare-Medicaid Enrolled

    • Diagnosis Fields

      • CCW Count Category
      • Count CCW Conditions
      • Is CCW Asthma
      • Is CCW CKD
      • Is CCW COPD and Bronchiectasis
      • Is CCW Depression
      • Is CCW Diabetes
      • Is CCW Heart Failure
      • Is CCW Schizophrenia or Other Psychotic Disorders
      • Is CCW Bipolar Disorder
      • Is CCW Acquired Hypothyroidism
      • Is CCW Acute Myocardial Infarction
      • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome
      • Is CCW Alzheimers Disease
      • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia
      • Is CCW Anemia
      • Is CCW Anxiety Disorders
      • Is CCW Atrial Fibrillation
      • Is CCW Autism Spectrum Disorder
      • Is CCW Benign Prostatic Hyperplasia
      • Is CCW Blindness and Visual Impairment
      • Is CCW Breast Cancer
      • Is CCW Cataract
      • Is CCW Cerebral Palsy
      • Is CCW Colorectal Cancer
      • Is CCW Cystic Fibrosis and Other Metabolic Disorder
      • Is CCW Deafness and Hearing Impairment
      • Is CCW Depressive Disorders
      • Is CCW Endometrial Cancer
      • Is CCW Epilepsy
      • Is CCW Fibromyalgia and Chronic Pain and Fatigue
      • Is CCW Glaucoma
      • Is CCW Hip or Pelvic Fracture
      • Is CCW Hyperlipidemia
      • Is CCW Hypertension
      • Is CCW Intellectual Disability
      • Is CCW Ischemic Heart Disease
      • Is CCW Learning Disability
      • Is CCW Leukemia
      • Is CCW Lung Cancer
      • Is CCW Migraine and Chronic Headache
      • Is CCW Mobility Impairment
      • Is CCW Multiple Sclerosis
      • Is CCW Muscular Dystrophy
      • Is CCW Obesity
      • Is CCW Osteoporosis
      • Is CCW Other Developmental Delay
      • Is CCW Personality Disorder
      • Is CCW Pressure or Chronic Ulcer
      • Is CCW Prostate Cancer
      • Is CCW PTSD
      • Is CCW PVD
      • Is CCW Rheumatoid Arthritis or Osteoarthritis
      • Is CCW Schizophrenia
      • Is CCW Stroke or Transient Ischemic Attack
      • CCW Systems Category
      • Count CCW Systems
      • Is CCW System Behavioral Health
      • Is CCW System Cardiovascular
      • Is CCW System Congenital
      • Is CCW System Endocrine/Metabolic
      • Is CCW System Genitourinary
      • Is CCW System Hematologic
      • Is CCW System Musculoskeletal
      • Is CCW System Neurological
      • Is CCW System Oncologic
      • Is CCW System Ophthalmologic
      • Is CCW System Pulmonary
      • Is CCW System Other

    • Metadata Fields

      • Random Integer 1 to 1000

    • [No Field Group]

      • Ursa Serial ID

    • Operations Support Fields

      • Patient Operational ID
      • Primary Payor Operational ID
      • Primary Plan Operational ID

    • Medication Fields

      • Is Patient with any Active Chronic Medications
      • Count of Fills in Last 12 Months Category
      • Count of Fills Last 12 Months
      • Count Opioid Fills in Last 6 Months
      • Count Opioid Fills in Last 12 Months
      • Aggregate Opioid Days Supply in Last 6 Months
      • Aggregate Opioid Days Supply in Last 12 Months

    • Financial Fields

      • Medication Plan Paid Amount in Last 12 Months
      • Medication Patient Paid Amount in Last 12 Months
      • Total Medication Paid Amount Last 12 Months
      • Cumulative Calendar Year Rx Plan Paid Amount
      • Cumulative Calendar Year Rx Patient Paid Amount

    • Numerator Fields

      • Encounter ID
      • Facility Provider ID
      • Attending Provider ID
      • Encounter Start Date
      • Encounter End Date
      • Encounter LOS in Elapsed Midnights
      • Encounter LOS in Distinct Calendar Days
      • Ursa Encounter Type Tier 1 Category
      • Ursa Encounter Type Tier 2 Category
      • Is Surgery Encounter
      • Is Any Hospital Encounter Type
      • Is Hospital Inpatient Admission Encounter
      • Is Hospital Observation Stay Parent Encounter
      • Is Emergency Department Visit Parent Encounter
      • Is Hospital Outpatient Surgery Encounter
      • Is Other Hospital Outpatient Encounter
      • Primary HCPCS Procedure HCPCS Code
      • Primary HCPCS Procedure Short Description
      • Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Code
      • Primary HCPCS Procedure AHRQ CCS Single-Level Procedure Category Description
      • Principal Discharge Diagnosis ICD-10-CM Code
      • Principal Discharge Diagnosis ICD-10-CM Description
      • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
      • Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
      • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
      • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
      • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
      • Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description
      • MS-DRG Code
      • MS-DRG Description
      • MS-DRG MDC Code
      • MS-DRG MDC Code Description
      • Is CMS DRG Medical-Surgical Type Surgical
      • Is CMS DRG Medical-Surgical Type Medical
      • APR-DRG Code
      • APR-DRG Description
      • APR-DRG Severity of Illness Code
      • APR-DRG Risk of Mortality Code
      • CMS Admit Source Code
      • CMS Admit Source Description
      • CMS Admit Type Code
      • CMS Admit Type Description
      • CMS Patient Discharge Status Code
      • CMS Patient Discharge Status Description
      • CMS Place of Service Code
      • CMS Place of Service Description
      • Facility Provider Description
      • Facility Provider Taxonomy Code
      • Facility Provider Taxonomy Description
      • Facility Practice Address State Abbreviation
      • Facility Practice Address ZIP Code 5-Digit
      • Attending Provider Description
      • Attending Provider Taxonomy Code
      • Attending Provider Taxonomy Description
      • Primary HCPCS Procedure Provider Description
      • Primary HCPCPS Procedure Provider Taxonomy Code
      • Primary HCPCPS Procedure Provider Taxonomy Description
      • Primary Plan Allowed Amount
      • Primary Plan Paid Amount
      • Total Plan Paid Amount from All Plans
      • Patient Paid Amount

    • Measure Fields

      • Denominator
      • Numerator

    • Module Fields

      • Medication Management Trigger Category
      • Is Patient with Active Medication Management Trigger
      • Count Active Medication Management Trigger Categories
      • Is High Medication Spend
      • Is Very High Medication Spend
      • Is High Number of Prescribing Providers
      • Is High Number of Filling Providers
      • Is Multiple Opioid Prescribing Providers Last 6 Months
      • Is Multiple Opioid Filling Providers Last 6 Months
      • Is Active Chronic Opioid Episode
      • Is High Number of Chronic Medications
      • Count Active Chronic Medications
      • Active High Risk Medication Episode Category
      • Is Any Active High Risk Medication Episode
      • Count Active High Risk Medication Types
      • Count Active Oral Antiplatelets
      • Count Active Anticoagulants
      • Count Active Cardiac Glycosides
      • Count Active Opioids
      • Count Active Oral Hypoglycemics
      • Count Active Insulins
      • Active Priority Adherence Medication Type Category
      • Is Any Priority Adherence Medication Active
      • Count Active Priority Adherence Medications
      • Count Active Priority Medication Types
      • Count Active Antidepressants
      • Count Active Antidiabetics
      • Count Active Oral Antidiabetics
      • Count Active Antineoplastics
      • Count Active Beta Blockers
      • Count Active Oral ACEI/ARBs
      • Count Active Statins
      • Active PDC Medication Type Category
      • Is Patient with Any Active PDC Medications
      • Count Active PDC Medication Types
      • Is Active Oral Antidiabetic PDC Medication
      • Is Active Oral ACEI/ARB PDC Medication
      • Is Active Statin PDC Medication
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