URSA-QUALITY-PCR: Plan All-Cause Readmission Non Risk

Measure Description

For members 18 years of age and older, the number of acute inpatient and observation stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission.

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Entity
• Component Class: Long-Form
• Denominator Case Field: Patient ID, Index Episode Master Document ID, Index Episode IHS Output NCQA Payer Type Code (IHS NCQA Payer Type Code)
• Target Direction: Down

Denominator Description

None

Numerator Description

None

Published Fields

• Data Model Keys

  • Index Episode Patient ID
  • Primary Payor ID
  • Primary Plan ID

• Patient Fields

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

• 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.

• Provider Fields

  • Primary Plan Attributee Provider ID
  • Primary Plan Attributee Provider Description
  • Primary Plan Attributee Primary NUCC Provider Taxonomy Description

• Insurance Fields

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

• Denominator Fields

  • Is Continuous Membership Criterion Met
  • Is Eligible Population
  • Is Any Required Exclusion
  • Is Required Exclusion for Hospice
  • Is Required Exclusion for Patient Death
  • Index Episode Master Document ID
  • Index Episode Parent Document Effective End Date
  • Is Plan Population
  • Denominator Performance Period Start Date
  • Is Outlier
  • Is Event Discharged to SNF
  • Plan Payer Output NCQA Payer Type Code
  • Is Any Numerator Episode Exclusion

• Numerator Fields

  • Numerator Component Contribution
  • Numerator Admit Date
  • Numerator Document iD
  • Is Numerator Qualifying Using Standard End-of-Year Timing
  • Numerator Component Contribution Using Standard End-of-Year Timing

• Metadata Fields

  • Denominator NCQA Performance Period Start Date
  • Report Designated Control for Expanded Denominator Performance Period Start Date
  • Is Parameter Set to Override Continuous Enrollment Criteria
  • Is Parameter Set to Override Payor Criteria

• Validation Only Fields

  • Numerator Rank within Snapshot Date
  • Count Ppayer Codes within Patient | Snapshot
  • Ppayer Concat
  • Count IHS Payer Codes within Patient | Snapshot
  • IHS Payer Concat
  • Are IHS Payers and PPayers The Same
  • Is IHS | PPayer Combination to Exclude
  • Continuous Membership Criterion Period Start Date
  • Continuous Membership Criterion Period End Date
  • Is Continuous Membership Criterion Met in 365 Days Prior to IP Visit
  • Is Continuous Membership Criteria Met in 30 Days After IP Visit
  • Event Rank within Patient ID
  • Count of Events within Patient ID and Snapshot

• Measure Fields

  • Denominator
  • Numerator

• Module Fields

  • IHS NCQA Payer Type Code

• NCQA Cert Fields

  • Patient Age Integer Unbounded by Death
  • NCQA Race Code
  • NCQA Ethnicity Code
  • NCQA Gender Code

• [No Field Group]

  • Measure ID
  • Measure Name
  • Ursa Serial ID