- 28 Jun 2025
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URSA-PHF-026: Hospital Encounters per 1000 Member-Years
- Updated on 28 Jun 2025
- 5 Minutes to read
- Print
- DarkLight
Measure Description
Among active membership periods, 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 during which the patient was alive and had medical claims data coverage, expressed in units of 1000s of patient-years.
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 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
- Empirical Attributee Primary Care Individual Provider Description
- 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
- 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
- Primary Payor Description
- Primary Plan Description
- Primary Plan Financial Class Description
- Member MBI
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
[No Field Group]
- Ursa Serial ID
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
- Ursa Surgery Encounter Type Category
- 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 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
- 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