URSA-CKD-002: Spending in First 6 Months of Chronic Dialysis

Measure Description

Among lifetime first chronic dialysis starts lasting at least 180 days, the total plan spending in the first 180 days following dialysis start

Metadata

• Measure Type: Rate Measure
• Temporal Structure: Event
• Component Class: Long-Form
• Denominator Case Field: Episode ID
• Target Direction: Down

Denominator Description

Lifetime dialysis starts with ongoing dialysis lasting at least 180 days; dialysis episodes must include at least one outpatient dialysis treatment.

Numerator Description

Plan spending in the first 180 days of the denominator episode.

Published Fields

• Data Model Keys

  • Episode ID
  • Patient ID
  • First Encounter ID
  • Primary Plan ID
  • Primary Payor ID
  • Primary Plan Attributee Provider ID
  • Empirical Attributee Individual Nephrology Provider ID
  • Empirical Attributee Nephrology Group Provider ID
  • Empirical Attributee Primary Care Individual Provider ID
  • Empirical Attributee Primary Care Provider Group Provider ID

• Date Fields

  • Episode Start Date
  • Episode End Date
  • 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)

• Module Fields

  • CKD Stage Category
  • Is CKD Stage 1
  • Is CKD Stage 2
  • Is CKD Stage 3
  • Is CKD Stage 4
  • Is CKD Stage 5
  • Is ESRD
  • Is CKD Stage Unknown
  • Is CKD Stage 3 or Higher
  • Is CKD Stage 4 or Higher
  • Is Chronic Dialysis Patient
  • Is History of Kidney Transplantation
  • Is CCW CKD

• Encounter Fields

  • First Encounter Setting Category
  • Is First Encounter Setting Home or Outpatient Dialysis Facility
  • Is First Encounter Setting Home
  • Is First Encounter Setting Outpatient Dialysis Facility
  • Is First Encounter Setting Inpatient
  • Is First Encounter Setting Outpatient Non-Dialysis Facility
  • First Encounter Qualifying Document HCPCS Code
  • Is First Encounter Hospital Inpatient Admission Encounter
  • Is First Encounter Emergency Department Visit Parent Encounter
  • Is First Encounter Observation Stay Parent Encounter
  • Count Hospital Inpatient Admission Encounters with Dialysis
  • Count Emergency Department Visit Parent Encounters with Dialysis
  • Count Home Dialysis Encounters
  • Count Inpatient Dialysis Encounters
  • Count Outpatient Dialysis Facility Dialysis Encounters
  • Count Outpatient Non-Dialysis Facility Dialysis Encounters

• Patient Fields

  • Patient Date of Birth
  • Is Patient Alive
  • Patient Age Integer
  • Patient Age Category Tier 1
  • Patient Age Category Tier 2
  • Patient Sex Category
  • Count Hospital Inpatient Admissions in Last 12 Months
  • Count ED Visits Without Inpatient Admissions in Last 12 Months

• Provider Fields

  • CKD Physician Management Category
  • Plan Attributee Provider Description
  • Count Nephrology Provider Visits in Last 12 Months
  • Empirical Attributee Individual Nephrology Provider Description
  • Empirical Attributee Nephrology Group Provider Description
  • Count Primary Care Visits for CKD in Last 12 Months
  • Primary Care Engagement Category
  • Count Primary Care Visits in Last 36 Months
  • Empirical Attributee Primary Care Provider Group Description
  • Empirical Attributee Individual Primary Care Provider Description
  • Count Visits with Attributee Individual Primary Care Provider in Last 36 Months
  • Count Visits with Attributee Primary Care Provider Group in Last 36 Months

• Location Fields

  • Patient ZIP Code 5-Digit
  • UW HIP ADI Quintile Category
  • CDC SVI Overall Quintile Category

• Insurance Fields

  • Is Any Current Plan Membership
  • Primary Plan Description
  • Primary Plan Financial Class Description

• Clinical Services Fields

  • First Encounter Dialysis Modality Category
  • Is First Encounter Dialysis Modality Hemodialysis
  • Is First Encounter Dialysis Modality Peritoneal Dialysis
  • Count Documented Hemodialysis Encounters
  • Count Documented Peritoneal Dialysis Encounters
  • Last Encounter Date with Documented Hemodialysis
  • Last Encounter Date with Documented Peritoneal Dialysis
  • First Encounter Vascular Access Type Category
  • Is First Encounter Vascular Access Type Any Catheter
  • Is First Encounter Vascular Access Type Graft Without Catheter
  • Is First Encounter Vascular Access Type Fistula Only
  • Is Hospice in Last 12 Months

• Diagnosis Fields

  • Count CCW Conditions
  • Is CCW System Behavioral Health
  • Is CCW System Cardiovascular
  • Is CCW System Genitourinary
  • Is CCW System Musculoskeletal
  • Is CCW System Pulmonary
  • Is CCW COPD and Bronchiectasis
  • Is CCW Diabetes
  • Is CCW Hyperlipidemia
  • Is CCW Hypertension

• Numerator Fields

  • Numerator Document ID
  • Numerator Claim ID
  • Numerator Claim Service Line Item ID
  • Numerator Patient ID
  • Numerator Billing Provider ID
  • Numerator Payor ID
  • Numerator Plan ID
  • Numerator Source 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 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

• [No Field Group]

  • Ursa Serial ID

• Episode Fields

  • Episode Length Days

• Measure Fields

  • Denominator
  • Numerator