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    URSA-PHF-009b: Hospital Encounter PMPM Plan Spending
    • 28 Jun 2025
    • 4 Minutes to read
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    URSA-PHF-009b: Hospital Encounter 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 any of the URSA-CORE hospital encounter types: (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 of active plan membership periods during which the patient was alive and had medical claims data coverage.

    Numerator Description

    Total plan spending associated with an URSA-CORE Hospital Encounter with encounter start date falling within the observation period start and end dates; URSA-CORE 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 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
      • Is Patient Sex Female
      • Is Patient Sex Male
      • 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
      • Attending Provider ID
      • Encounter Start Date
      • Encounter End Date
      • Encounter LOS in Elapsed Midnights
      • Encounter LOS in Distinct Calendar Days
      • Is Multi-Day Encounter
      • Ursa Encounter Type Tier 1 Category
      • Ursa Encounter Type Tier 2 Category
      • Is Surgery 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
      • 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
      • 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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