URSA-PHF-011: Spending per URSA-CORE Encounter

Measure Description

The total plan spending per URSA-CORE encounter; encounter types include: hospital inpatient admission encounters; clinician office visit encounters; ED visit parent encounters; observation stay parent encounters; SNF encounters; and other hospital outpatient encounters.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Event
• Component Class: Normal-Form
• Denominator Case Field: Encounter ID
• Target Direction: Down

Denominator Description

One per encounter meeting the definition for one or more URSA-CORE encounter types: hospital inpatient admission encounters; clinician office visit encounters; ED visit parent encounters; observation stay parent encounters; SNF encounters; and other hospital outpatient encounters;

Numerator Description

Total plan spending for the encounter.

Published Fields

• Data Model Keys

  • Encounter ID
  • Patient ID
  • Encounter Primary Payor ID
  • Encounter Primary Plan ID
  • Facility Provider ID
  • Attending Provider ID
  • Service Provider ID
  • Provider Group Provider ID
  • Primary HCPCS Procedure Provider ID

• Date Fields

  • Encounter Start Date
  • Encounter End Date
  • Encounter LOS in Elapsed Midnights
  • Encounter LOS in Distinct Calendar Days
  • Is Multi-Day Encounter
  • 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)

• Encounter Fields

  • Is Surgery Encounter
  • Is Ambulatory Surgical Center Encounter
  • Is Clinician Office Visit Encounter
  • Is Emergency Department Visit Parent Encounter
  • Is Hospital Inpatient Admission Encounter
  • Is Hospital Observation Stay Parent Encounter
  • Is Hospital Outpatient Surgery Encounter
  • Is Other Hospital Outpatient Encounter
  • Is SNF Encounter
  • Is Birthing Center Encounter
  • Ursa Encounter Type Tier 1 Category
  • Ursa Encounter Type Tier 2 Category
  • Ursa Surgery Encounter Type Category
  • Is Any Hospital Encounter Type
  • Is Primary Care Clinician Office Visit
  • Is Urgent Care Visit

• Provider Fields

  • 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
  • Service Provider Description
  • Service Provider Taxonomy Code
  • Service Provider Taxonomy Description
  • Provider Group Provider Description
  • Provider Group Taxonomy Code
  • Provider Group Taxonomy Description
  • Primary HCPCS Procedure Provider Description
  • Primary HCPCPS Procedure Provider Taxonomy Code
  • Primary HCPCPS Procedure Provider Taxonomy Description

• Clinical Services Fields

  • 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

• Diagnosis Fields

  • 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
  • Principal Discharge Diagnosis WHO ICD-10 Chapter Description
  • Principal Discharge Diagnosis WHO ICD-10 Block Description

• Billing and Claims Fields

  • 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 MDC Code
  • APR-DRG MDC Description
  • Is APR-DRG Medical Surgical Type Surgical
  • 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

• Financial Fields

  • 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