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    URSA-PHF-003: ED Visits without Admission PMPM Plan Spending
    • 28 Jun 2025
    • 4 Minutes to read
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    URSA-PHF-003: ED Visits without Admission PMPM Plan Spending

    • Updated on 28 Jun 2025
    • 4 Minutes to read
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    Article summary

    Measure Description

    Among active plan membership patient-periods, the per-member-per-month plan spending on hospital emergency department visits not resulting in an admission

    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 of active plan membership periods during which the patient was alive and had medical claims data coverage.

    Numerator Description

    Total plan spending for claims associated with an emergency department visit not resulting in admission to inpatient status or transfer to a short-term or psychiatric hospital, and with covered start date falling within the observation period start and end dates.

    Published Fields

    • Data Model Keys

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

    • Patient Fields

      • Is Hospice in Last 12 Months
      • Patient Last Name
      • Patient Date of Birth
      • Patient Age Integer
      • Patient Age Category Tier 1
      • Patient Age Category Tier 2
      • Patient Sex Category
      • Count Hospital Inpatient Admissions in Last 12 Months
      • Count ED Visits Without Inpatient Admissions in Last 12 Months
      • 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

    • Date Fields

      • Current Continuous Primary Payor Membership Episode Start Date
      • Current Continuous Primary Payor Membership 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

      • Primary Plan Attributee 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
      • Patient County Description
      • UW HIP Area Deprivation Index National Percentile
      • UW HIP ADI Quintile Category
      • CDC SVI Overall Quintile Category
      • CDC SVI Socioeconomic Quintile Category
      • CDC SVI Household / Disability Quintile Category
      • CDC SVI Minority / Language Quintile Category
      • CDC SVI Housing / Transportation Quintile Category

    • Insurance Fields

      • Is Patient with Multiple Active Plan Memberships
      • Count Active Plan Memberships
      • Primary Payor Description
      • Primary Plan Description
      • Primary Plan Financial Class Description
      • Member HICN
      • Member MBI
      • Is CMS ESRD Status
      • Is CMS Hospice Status
      • Is Dual Medicare-Medicaid Enrolled
      • CMS Dual Status Code
      • Member Medicaid Number

    • Diagnosis Fields

      • CCW Count Category
      • Count CCW Conditions
      • 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 Asthma
      • Is CCW Atrial Fibrillation
      • Is CCW Autism Spectrum Disorder
      • Is CCW Benign Prostatic Hyperplasia
      • Is CCW Bipolar Disorder
      • Is CCW Blindness and Visual Impairment
      • Is CCW Breast Cancer
      • Is CCW Cataract
      • Is CCW Cerebral Palsy
      • Is CCW CKD
      • Is CCW Colorectal Cancer
      • Is CCW COPD and Bronchiectasis
      • Is CCW Cystic Fibrosis and Other Metabolic Disorder
      • Is CCW Deafness and Hearing Impairment
      • Is CCW Depression
      • Is CCW Depressive Disorders
      • Is CCW Diabetes
      • Is CCW Endometrial Cancer
      • Is CCW Epilepsy
      • Is CCW Fibromyalgia and Chronic Pain and Fatigue
      • Is CCW Glaucoma
      • Is CCW Heart Failure
      • 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 Schizophrenia or Other Psychotic Disorders
      • 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

    • Numerator Fields

      • Encounter ID
      • Facility Provider ID
      • Encounter Start Date
      • Encounter End Date
      • Encounter LOS in Elapsed Midnights
      • Encounter LOS in Distinct Calendar Days
      • Is Patient Admitted to Observation
      • Facility Provider Description
      • Facility Provider Primary NUCC Provider Taxonomy Code
      • Facility Provider Primary NUCC Provider Taxonomy Description
      • Attending Provider Description
      • Attending Provider Primary NUCC Provider Taxonomy Code
      • Attending Provider Primary NUCC Provider Taxonomy Description
      • Principal Discharge Diagnosis ICD-10-CM Code
      • Principal Discharge Diagnosis ICD-10-CM Description
      • Principal Discharge Diagnosis WHO ICD-10 Chapter Description
      • Principal Discharge Diagnosis WHO ICD-10 Block 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
      • CMS Admit Source Code
      • CMS Admit Source Description
      • CMS Admit Type Code
      • CMS Admit Type Description
      • CMS Place of Service Code
      • CMS Place of Service Description
      • CMS Patient Discharge Status Code
      • CMS Patient Discharge Status Description
      • Primary Plan Allowed Amount
      • Primary Plan Paid Amount
      • Total Plan Paid Amount from All Plans
      • Patient Paid Amount

    • Measure Fields

      • Denominator
      • Numerator

    • [No Field Group]

      • Ursa Serial ID
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