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    URSA-PHU-007: PMPY on all IP and ED Encounters
    • 27 Jun 2025
    • 6 Minutes to read
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    URSA-PHU-007: PMPY on all IP and ED Encounters

    • Updated on 27 Jun 2025
    • 6 Minutes to read
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    Article summary

    Measure Description

    Among active plan membership periods, the per-member-per-year Plan Paid Amount on all Hospital Inpatient and ED Visits

    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-years of active plan membership periods during which the patient is alive.

    Numerator Description

    Total patient spending for claims with covered start date falling within the observation period start and end dates.

    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

    • Patient Fields

      • Is Patient Alive
      • Is Hospice in Last 12 Months
      • Patient Date of Birth
      • Patient Age Integer
      • Patient Age Category Tier 1
      • Patient Age Category Tier 2
      • Patient First Name
      • Patient Last Name
      • Patient State Abbreviation
      • Patient ZIP Code 5-Digit
      • Patient County Description
      • UW HIP Area Deprivation Index National Percentile
      • UW HIP ADI Quintile Category
      • UW HIP ADI Decile Category
      • CDC SVI Overall National Percentile
      • CDC SVI Overall Quintile Category
      • CDC SVI Socioeconomic Theme National Percentile
      • CDC SVI Socioeconomic Quintile Category
      • CDC SVI Household / Disability Theme National Percentile
      • CDC SVI Household / Disability Quintile Category
      • CDC SVI Minority / Language Theme National Percentile
      • CDC SVI Minority / Language Quintile Category
      • CDC SVI Housing / Transportation Theme National Percentile
      • CDC SVI Housing / Transportation Quintile Category
      • Census ACS Percentage Below Poverty
      • Census ACS Unemployment Rate
      • Census ACS Per Capita Income
      • Census ACS Percentage Without HS Diploma
      • Census ACS Percentage 65 and Older
      • Census ACS Percentage Aged 17 and Younger
      • Census ACS Percentage with Disability
      • Census ACS Percentage Single-Parent Households
      • Census ACS Percentage Minority
      • Census ACS Percentage Speak English Less Than Well
      • Census ACS Percentage Households Without Vehicle
      • Census ACS Percentage Uninsured
      • Patient Sex Category
      • Is Patient Sex Female
      • Is Patient Sex Male
      • Is Patient Race American Indian or Alaska Native
      • Is Patient Race Asian
      • Is Patient Race Black or African American
      • Is Patient Race Native Hawaiian or Other Pacific Islander
      • Is Patient Race White
      • Is Patient Race Other
      • Is Patient Ethnicity Hispanic or Latino

    • Date Fields

      • Period Start Date
      • Period End Date
      • Last Continuous Primary Payor Membership Episode Start Date
      • Last Continuous Primary Payor Membership Episode End Date
      • Next Continuous Primary Payor Membership Episode Start Date
      • Next Continuous Primary Payor Membership Episode End Date
      • Current Continuous Primary Payor Membership Episode Start Date
      • Current Continuous Primary Payor Membership Episode End Date
      • Current Non-Membership Episode Start Date
      • Current Non-Membership Episode End Date
      • Current Continuous Medical Claim Data Coverage Episode End Date
      • Current Continuous Pharmacy Claim Data Coverage Episode Start Date
      • Current Continuous Pharmacy Claim Data Coverage Episode End Date
      • Current Continuous Medical Claim Data Coverage Episode Start Date
      • Most Recent Prior Primary Care Visit Last 12 Months Encounter 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

      • Is Patient with Primary Care Visit Last 12 Months
      • PCP Attribution Category
      • Primary Care Engagement Category
      • Count Primary Care Visits in Last 36 Months
      • Primary Plan Attributee Provider Description
      • Empirical Attributee Primary Care Individual Provider Description
      • Empirical Attributee Primary Care Provider Group Provider Description
      • Count Visits with Attributee Primary Care Provider Group in Last 36 Months
      • Count Primary Care Visits Last 12 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
      • Count Visits with Attributee Individual Primary Care Provider in Last 36 Months

    • Insurance Fields

      • Is Any Current Plan Membership
      • Count Active Plan Memberships
      • Primary Plan Financial Class Description
      • Is Any Plan Financial Class Commercial
      • Is Any Plan Financial Class Medicare FFS
      • Is Any Plan Financial Class Medicare Advantage
      • Is Any Plan Financial Class Medicaid
      • Is CMS Hospice Status
      • Is CMS ESRD Status

    • Diagnosis Fields

      • Count CCW Conditions
      • Is CCW Acquired Hypothyroidism
      • Is CCW Acute Myocardial Infarction
      • Is CCW Alzheimers Disease
      • Is CCW Anemia
      • Is CCW Asthma
      • Is CCW Atrial Fibrillation
      • Is CCW Benign Prostatic Hyperplasia
      • Is CCW Breast Cancer
      • Is CCW Cataract
      • Is CCW CKD
      • Is CCW COPD and Bronchiectasis
      • Is CCW Colorectal Cancer
      • Is CCW Depression
      • Is CCW Diabetes
      • Is CCW Endometrial Cancer
      • Is CCW Glaucoma
      • Is CCW Heart Failure
      • Is CCW Hip or Pelvic Fracture
      • Is CCW Hyperlipidemia
      • Is CCW Hypertension
      • Is CCW Ischemic Heart Disease
      • Is CCW Lung Cancer
      • Is CCW Osteoporosis
      • Is CCW Prostate Cancer
      • Is CCW Rheumatoid Arthritis or Osteoarthritis
      • Is CCW Stroke or Transient Ischemic Attack
      • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome
      • Is CCW Anxiety Disorders
      • Is CCW Autism Spectrum Disorder
      • Is CCW Bipolar Disorder
      • Is CCW Blindness and Visual Impairment
      • Is CCW Cerebral Palsy
      • Is CCW Cystic Fibrosis and Other Metabolic Disorder
      • Is CCW Deafness and Hearing Impairment
      • Is CCW Depressive Disorders
      • Is CCW Epilepsy
      • Is CCW Fibromyalgia and Chronic Pain and Fatigue
      • Is CCW Intellectual Disability
      • Is CCW Learning Disability
      • Is CCW Leukemia
      • Is CCW Migraine and Chronic Headache
      • Is CCW Mobility Impairment
      • Is CCW Multiple Sclerosis
      • Is CCW Muscular Dystrophy
      • Is CCW Obesity
      • Is CCW Other Developmental Delay
      • Is CCW Personality Disorder
      • Is CCW Pressure or Chronic Ulcer
      • Is CCW PTSD
      • Is CCW PVD
      • Is CCW Schizophrenia
      • Is CCW Schizophrenia or Other Psychotic Disorders
      • CCW Systems Category
      • CCW Count 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
      • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia

    • Numerator Fields

      • Is PPHE Encounter
      • Encounter ID
      • Facility Provider ID
      • Encounter Start Date
      • Encounter End Date
      • Encounter LOS in Elapsed Midnights
      • Encounter LOS in Distinct Calendar Days
      • Is Multi-Day Encounter
      • Ursa Encounter Type Tier 1 Category
      • Ursa Encounter Type Tier 2 Category
      • Is Surgery 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
      • CMS Patient Discharge Status Code
      • CMS Patient Discharge Status Description
      • Facility Provider 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
      • PPHE Category
      • ACS Admission PQI Category
      • Prior Encounter Scenario Category
      • Preventable ED Visit Scenario Category

    • Metadata Fields

      • Is Medical Claim Data Coverage
      • Is Pharmacy Claim Data Coverage
      • Random Integer 1 to 1000

    • Measure Fields

      • Denominator
      • Numerator

    • Module Fields

      • Is PPHE in Last 12 Months
      • ED PPHE Count Category
      • ACS PPHE Count Category
      • Admits with Prior Related Encounter Count Category
      • Is ED High-Utilizer with PPHE in Last 12 Months
      • Count Hospital Inpatient Admissions in Last 12 Months
      • Count ED Visits Without Inpatient Admissions in Last 12 Months
      • Is ED High-Utilizer
      • Is New ED High-Utilizer
      • Count ED Visits in Last 3 Months
      • Count ED Visits in Last 12 Months
      • Count Potentially Preventable ED Visits in Last 12 Months
      • Count Potentially Preventable ED Visits Due to Preventable Condition in Last 12 Months
      • Count Potentially Preventable ED Visits Due to Inappropriate Setting in Last 12 Months
      • Count Ambulatory Care Sensitive Admissions in Last 12 Months
      • Count Admissions with Prior Related Encounter in Last 12 Months
      • Count Potentially Preventable ED Visits Without Admissions in Next 12 Months
      • Count Potentially Preventable Inpatient Admissions in Next 12 Months
      • Count Ambulatory Care Sensitive Admissions in Next 12 Months
      • Count Admissions with Prior Related Encounter in Next 12 Months
      • Total Paid Amount for Potentially Preventable Hospital Encounters in Next 12 Months

    • [No Field Group]

      • Ursa Serial ID
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