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

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]

  • Ursa Serial ID