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

  • Published on Apr 10, 2026
  • 7 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 Identifier: URSA-PHU-003
  • 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 -- The internal database identifier (used, e.g., for joins and primary keys) for the encounter. (See also [URSA-CORE] Encounter)
    • Patient ID -- The internal database identifier (used, e.g., for joins and primary keys) for the patient. This value is typically mastered, i.e., all records for the same patient, regardless of the source data system from which that record originated, should have the same Patient ID value. (Note that while the mastered Patient ID value might resemble a local identifier used in one of the upstream data sources, this does not indicate any special priority of that source system in determining the characteristics of the patient.) (See also [URSA-CORE] Patient)
    • Facility Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the facility provider. (See also [URSA-CORE] Facility Provider)
    • Prior Admission Facility Provider ID
    • Prior ED Visit Facility Provider ID
    • Prior SNF Stay Facility Provider ID

  • Patient Fields

    • UW HIP ADI Quintile Category -- The UW HIP Area Deprivation Index National Percentile grouped into 5 levels, each spanning 20 percentile points (ADI 1 is percentile scores from 1 to 20 while ADI 5 is scores from 81 to 100). Higher scores indicate more deprivation, so ADI 1 is the least deprived while ADI 5 is the most deprived. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling. (See also [URSA-CORE] UW HIP Area Deprivation Index National Percentile)
    • CDC SVI Overall Quintile Category -- The CDC SVI Overall National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. Quintiles are frequently used in health research. They give larger sample sizes per group and are easier to plot and interpret. Quintiles also carry less information and group more dissimilar patients. Quintiles are good for descriptive analyses while the original percentile measure is preferable for predictive modeling.
    • CDC SVI Socioeconomic Quintile Category -- The CDC SVI Socioeconomic Theme National Percentile grouped into 5 levels, each spanning 20 percentile points (the first quintile is percentile scores from 1 to 20 while the fifth is scores from 81 to 100). Higher scores indicate more vulnerability, so the first quintile is the least vulnerable while the fifth is the most vulnerable. (See also [URSA-CORE] CDC SVI Socioeconomic Theme National Percentile )
    • 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 -- A hospital inpatient admission with one or more of the following: (1) prior ED visit within 7 days prior to admission; (2) prior hospital inpatient admission with discharge date within 7 days prior to admission or within 30 days prior to admission and with similar principal discharge diagnoses; or (3) prior SNF stay with discharge date within 14 days prior to admission.
    • 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 -- The 10-digit National Provider Identifier for the facility provider. (See also [URSA-CORE] Facility Provider)
    • Facility Provider Description -- The natural language description of the facility provider. (See also [URSA-CORE] Facility Provider)
    • 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 -- The maximum amount that the payor agrees to pay the provider for a service or product, typically governed by a contract. The Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount (which is typically negative) to the Charge Amount. Adding the total Non-Contractual Adjustment Amount to the Allowed Amount yields the Total Due Amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Allowed Amount, Secondary Plan Allowed Amount, and Tertiary Plan Allowed Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively. (See also [URSA-CORE] Charge Amount, [URSA-CORE] Contractual Adjustment Amount, [URSA-CORE] Non-Contractual Adjustment Amount, [URSA-CORE] Total Due Amount)
    • Primary Plan Paid Amount -- The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.
    • Total Plan Paid Amount from All Plans
    • Patient Paid Amount -- The amount paid by the patient to the provider for health care services or products.

  • Numerator Fields

    • Numerator Document ID
    • Numerator Claim ID
    • Numerator Document Effective Date
    • 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 NDC Code
    • Numerator Label 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 Document Allowed Amount
    • Numerator Document Plan Paid Amount
    • Numerator Document Patient Paid Amount
    • Numerator Document Type Category
    • Numerator Claim Class Category
    • Numerator Ursa Encounter Type Tier 1 Category
    • Numerator Ursa Encounter Type Tier 2 Category
    • Numerator Ursa Surgery Encounter Type Category
    • Numerator Ursa Setting Tier 1 Description
    • Numerator Ursa Service Type Tier 1 Description
    • Numerator AHFS Therapeutic Class Tier 1 Description
    • Numerator AHFS Therapeutic Class Tier 2 Description

  • 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 -- Indicates that the patient meets at least one of the following criteria: (1) 3 or emergency department visits in the last 3 months; or (2) 6 or more emergency department visits in the last 6 months. (See also [URSA-PHU] Is New ED High-Utilizer)
    • Is New ED High-Utilizer -- Indicates that the patient is only recently qualified as a ED High-Utilizer; defined as meeting both of the following criteria: (1) the patient meets the definition of an ED High Utilizer; and (2) all the patient's emergency room visits in the last 12 months have occurred within the last 3 months. (See also [URSA-PHU] Is ED High-Utilizer)

  • [No Field Group]