URSA-QUALITY-FMC: Follow Up to ED Visit (FMC)

Measure Description

The percentage of emergency department (ED) visits for members 18 years of age and older who have multiple high-risk chronic conditions who had a follow-up service within 7 days of the ED visit.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Entity
• Component Class: Long-Form
• Denominator Case Field: Output NCQA Payer Type Code, Index ED Patient ID, Index ED Parent Document Effective Start Date
• Target Direction: Up

Denominator Description

ED Visits for patients 18 and older who have 2+ Chronic Conditions

Numerator Description

Qualifying denominator patients with a Follow Up Visit within 7 Days

Published Fields

• Data Model Keys

  • Primary Plan Attributee Provider ID
  • Primary Payor ID
  • Primary Plan ID

• 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)
  • Snapshot Date -- The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

• Patient Fields

  • Patient Age Integer at Index ED Visit
  • Patient Operational ID
  • Patient Date of Birth
  • Is Patient Sex Female
  • Is Patient Sex Male
  • Patient State Abbreviation
  • Patient ZIP Code 5-Digit

• Insurance Fields

  • Primary Payor Description
  • Primary Plan Description
  • Primary Plan Financial Class Description

• Denominator Fields

  • Index ED Parent Document Effective Start Date
  • Index ED Parent Document Effective End Date
  • Count Chronic Conditions
  • Is Denominator Event Criteria Met
  • Is Continuous Membership Criterion Met
  • Is Eligible Population
  • Is Any Required Exclusion
  • Is Required Exclusion for Hospice
  • Is Required Exclusion for Patient Death
  • Denominator Excluded Reasons Description
  • Denominator Performance Period End Date
  • Denominator Performance Period Start Date
  • ED Parent Document Effective End Date + 7 Days

• Numerator Fields

  • Numerator HCPCS Code
  • Numerator HCPCS Description
  • Numerator Document Type Description
  • Numerator Document Effective Date
  • Numerator Document ID
  • Is Numerator Qualifying Using Standard End-of-Year Timing
  • Numerator Component Contribution Using Standard End-of-Year Timing
  • Numerator Source ID

• Measure Fields

  • Denominator
  • Numerator

• NCQA Cert Fields

  • Is NCQA Numerator Criteria Met
  • Output NCQA Payer Type Code
  • Patient Age Integer Unbounded at Index ED Visit

• Validation Only Fields

  • Is Excluded Record for Dual Enrolled Patient

• [No Field Group]

  • Measure ID
  • Measure Name
  • Ursa Serial ID

• Provider Fields

  • Primary Plan Attributee Provider Description

• Metadata Fields

  • Table Last Updated Datetime