URSA-PHU-003: Spending per 90-Day PPHE Episode

  • Published on Jul 17, 2025
  • 2 minute(s) read
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Measure Description

Among potentially preventable hospital encounters, the total plan spending within 90 days of the index encounter start

Metadata

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

Denominator Description

Potentially preventable hospital encounters

Numerator Description

Total plan spending within 90 days of the index encounter start date

Published Fields

  • Data Model Keys

    • Encounter ID
    • Patient ID
    • Facility Provider ID
    • Prior Admission Facility Provider ID
    • Prior ED Visit Facility Provider ID
    • Prior SNF Stay Facility Provider ID

  • Patient Fields

    • UW HIP ADI Quintile Category
    • CDC SVI Overall Quintile Category
    • CDC SVI Socioeconomic Quintile Category
    • Patient Sex Category

  • Date Fields

    • Encounter Start Date
    • Encounter 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)

  • Encounter Fields

    • PPHE Category
    • Is ACS Hospital Inpatient Admission
    • Is Hospital Inpatient Admission with Prior Related Encounter
    • Is High Probability Preventable ED Visit with Inpatient Admission
    • Is High Probability Preventable ED Visit without Inpatient Admission
    • ACS Admission PQI Category
    • Prior Encounter Scenario Category
    • Preventable ED Visit Scenario Category
    • Encounter LOS in Elapsed Midnights
    • Is Encounter LOS < 2 Midnights
    • Encounter LOS Category Tier 1
    • Encounter LOS in Distinct Calendar Days

  • Provider Fields

    • Facility Provider NPI
    • Facility Provider Description
    • Facility Provider NUCC Taxonomy Code
    • Facility Provider Primary NUCC Provider Taxonomy Description
    • Facility Provider State Abbreviation
    • Facility Provider ZIP Code 5-Digit
    • Prior Admission Facility Provider Description
    • Prior ED Visit Facility Provider Description
    • Prior SNF Stay Facility Provider Description
    • Is Patient with Primary Care Visit Last 12 Months
    • Primary Care Engagement Category
    • Count Primary Care Visits in Last 36 Months
    • Count Primary Care Visits Last 12 Months

  • Diagnosis Fields

    • Principal Discharge Diagnosis ICD-10-CM Code
    • Principal Discharge Diagnosis ICD-10-CM Description
    • Principal Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • Principal Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • Principal Diagnosis WHO ICD-10 Block Description
    • Principal Diagnosis WHO ICD-10 Chapter Description
    • Principal Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • Principal Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
    • Principal Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
    • Principal Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description

  • Financial Fields

    • Primary Plan Allowed Amount
    • Primary Plan Paid Amount
    • Total Plan Paid Amount from All Plans
    • Patient Paid Amount

  • Numerator Fields

    • Numerator Document ID
    • Numerator Claim ID
    • Numerator Document Effective Date
    • Numerator Document Type Category
    • Numerator Claim Class Category
    • Numerator Ursa Setting Tier 1 Description
    • Numerator Ursa Encounter Type Tier 1 Category
    • Numerator Ursa Encounter Type Tier 2 Category
    • Numerator Ursa Surgery Encounter Type Category
    • Numerator Ursa Service Type Tier 1 Description
    • Numerator Billing Provider Description
    • Numerator CMS Type of Bill Code
    • Numerator CMS Place of Service Code
    • Numerator CMS Place of Service Description
    • Numerator HCPCS Code
    • Numerator HCPCS Description
    • Numerator CMS Revenue Center Code
    • Numerator CMS Revenue Center Description
    • Numerator Principal Diagnosis ICD-10-CM Code
    • Numerator Principal Diagnosis ICD-10-CM Description
    • Numerator Principal Diagnosis AHRQ CCS Diagnosis Category Tier 1 Description
    • Numerator Principal Diagnosis AHRQ CCS Diagnosis Category Tier 2 Description
    • Numerator NDC Code
    • Numerator Label Description
    • Numerator AHFS Therapeutic Class Tier 1 Description
    • Numerator AHFS Therapeutic Class Tier 2 Description
    • Numerator Document Allowed Amount
    • Numerator Document Plan Paid Amount
    • Numerator Document Patient Paid Amount

  • Measure Fields

    • Denominator
    • Numerator

  • Module Fields

    • Is PPHE in Last 12 Months
    • Is ED High-Utilizer with PPHE in Last 12 Months
    • Is ED High-Utilizer
    • Is New ED High-Utilizer

  • [No Field Group]