--- title: "URSA-CKD-002: Spending in First 6 Months of Chronic Dialysis" slug: "ursa-ckd-002-spending-in-first-6-months-of-chronic-dialysis" updated: 2026-10-08T03:13:08Z published: 2026-10-08T03:13:08Z canonical: "docs.ursahealth.com/ursa-ckd-002-spending-in-first-6-months-of-chronic-dialysis" --- > ## Documentation Index > Fetch the complete documentation index at: https://docs.ursahealth.com/llms.txt > Use this file to discover all available pages before exploring further. # 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 Identifier**: URSA-CKD-002 - **Measure Type**: Rate Measure - **Temporal Structure**: Event - **Component Class**: Long-Form - **Denominator Case Field**: Episode ID - **Denominator Observation 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 -- 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) - First Encounter ID - Primary Plan ID -- The identifier for the health insurance plan product that is the first party responsible for payment. - Primary Payor ID -- The internal database identifier (used, e.g., for joins and primary keys) for the Primary Payor. (See also [URSA-CORE] Primary Payor) - 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 -- The start date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. (See also [URSA-CORE] Continuous Primary Payor Membership Episode) - Current Continuous Primary Payor Membership Episode End Date -- The end date of the Continuous Primary Payor Membership Episode in effect as of the (potentially historical) period covered by the record. Values follow the standard exclusive convention for Period End Dates. (See also [URSA-CORE] Continuous Primary Payor Membership Episode, [URSA-CORE] Period 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 -- The stage of a patient’s chronic kidney disease (CKD), for stage 1 through stage 5 and ESRD. Stage is only calculated for patients already meeting the criteria for CKD. Stage is determined by a combination of the following: (1) ICD-10-CM codes specific to a particular stage; (2) eGFR lab results within certain bands associated with a stage (see below); (3) identification of the patient in a CMS Monthly Membership Report as an ESRD beneficiary; (4) documentation of a prior kidney transplantation surgery; and/or (5) status as a chronic dialysis patient. The patient’s CKD stage can change over time, so a patient timeline data structure is appropriate. The following eGFR bands are used: GFR >= 90: Stage 1; 60 <= GFR < 90: Stage 2; 30 <= GFR < 60: Stage 3; 15 <= GFR < 30: Stage 4; GFR < 15: Stage 5. The appropriate race-specific eGFR lab is used when the patient's race is known. (See also [URSA-CKD] Is Chronic Dialysis Patient, [URSA-CKD] Kidney Transplantation Surgery Encounter) - Is CKD Stage 1 -- The stage of a patient’s chronic kidney disease (CKD), for stage 1 through stage 5 and ESRD. Stage is only calculated for patients already meeting the criteria for CKD. Stage is determined by a combination of the following: (1) ICD-10-CM codes specific to a particular stage; (2) eGFR lab results within certain bands associated with a stage (see below); (3) identification of the patient in a CMS Monthly Membership Report as an ESRD beneficiary; (4) documentation of a prior kidney transplantation surgery; and/or (5) status as a chronic dialysis patient. The patient’s CKD stage can change over time, so a patient timeline data structure is appropriate. The following eGFR bands are used: GFR >= 90: Stage 1; 60 <= GFR < 90: Stage 2; 30 <= GFR < 60: Stage 3; 15 <= GFR < 30: Stage 4; GFR < 15: Stage 5. The appropriate race-specific eGFR lab is used when the patient's race is known. (See also [URSA-CKD] Is Chronic Dialysis Patient, [URSA-CKD] Kidney Transplantation Surgery Encounter) - Is CKD Stage 2 -- The stage of a patient’s chronic kidney disease (CKD), for stage 1 through stage 5 and ESRD. Stage is only calculated for patients already meeting the criteria for CKD. Stage is determined by a combination of the following: (1) ICD-10-CM codes specific to a particular stage; (2) eGFR lab results within certain bands associated with a stage (see below); (3) identification of the patient in a CMS Monthly Membership Report as an ESRD beneficiary; (4) documentation of a prior kidney transplantation surgery; and/or (5) status as a chronic dialysis patient. The patient’s CKD stage can change over time, so a patient timeline data structure is appropriate. The following eGFR bands are used: GFR >= 90: Stage 1; 60 <= GFR < 90: Stage 2; 30 <= GFR < 60: Stage 3; 15 <= GFR < 30: Stage 4; GFR < 15: Stage 5. The appropriate race-specific eGFR lab is used when the patient's race is known. (See also [URSA-CKD] Is Chronic Dialysis Patient, [URSA-CKD] Kidney Transplantation Surgery Encounter) - Is CKD Stage 3a - Is CKD Stage 3b - Is CKD Stage 4 -- The stage of a patient’s chronic kidney disease (CKD), for stage 1 through stage 5 and ESRD. Stage is only calculated for patients already meeting the criteria for CKD. Stage is determined by a combination of the following: (1) ICD-10-CM codes specific to a particular stage; (2) eGFR lab results within certain bands associated with a stage (see below); (3) identification of the patient in a CMS Monthly Membership Report as an ESRD beneficiary; (4) documentation of a prior kidney transplantation surgery; and/or (5) status as a chronic dialysis patient. The patient’s CKD stage can change over time, so a patient timeline data structure is appropriate. The following eGFR bands are used: GFR >= 90: Stage 1; 60 <= GFR < 90: Stage 2; 30 <= GFR < 60: Stage 3; 15 <= GFR < 30: Stage 4; GFR < 15: Stage 5. The appropriate race-specific eGFR lab is used when the patient's race is known. (See also [URSA-CKD] Is Chronic Dialysis Patient, [URSA-CKD] Kidney Transplantation Surgery Encounter) - Is CKD Stage 5 -- The stage of a patient’s chronic kidney disease (CKD), for stage 1 through stage 5 and ESRD. Stage is only calculated for patients already meeting the criteria for CKD. Stage is determined by a combination of the following: (1) ICD-10-CM codes specific to a particular stage; (2) eGFR lab results within certain bands associated with a stage (see below); (3) identification of the patient in a CMS Monthly Membership Report as an ESRD beneficiary; (4) documentation of a prior kidney transplantation surgery; and/or (5) status as a chronic dialysis patient. The patient’s CKD stage can change over time, so a patient timeline data structure is appropriate. The following eGFR bands are used: GFR >= 90: Stage 1; 60 <= GFR < 90: Stage 2; 30 <= GFR < 60: Stage 3; 15 <= GFR < 30: Stage 4; GFR < 15: Stage 5. The appropriate race-specific eGFR lab is used when the patient's race is known. (See also [URSA-CKD] Is Chronic Dialysis Patient, [URSA-CKD] Kidney Transplantation Surgery Encounter) - Is ESRD -- The stage of a patient’s chronic kidney disease (CKD), for stage 1 through stage 5 and ESRD. Stage is only calculated for patients already meeting the criteria for CKD. Stage is determined by a combination of the following: (1) ICD-10-CM codes specific to a particular stage; (2) eGFR lab results within certain bands associated with a stage (see below); (3) identification of the patient in a CMS Monthly Membership Report as an ESRD beneficiary; (4) documentation of a prior kidney transplantation surgery; and/or (5) status as a chronic dialysis patient. The patient’s CKD stage can change over time, so a patient timeline data structure is appropriate. The following eGFR bands are used: GFR >= 90: Stage 1; 60 <= GFR < 90: Stage 2; 30 <= GFR < 60: Stage 3; 15 <= GFR < 30: Stage 4; GFR < 15: Stage 5. The appropriate race-specific eGFR lab is used when the patient's race is known. (See also [URSA-CKD] Is Chronic Dialysis Patient, [URSA-CKD] Kidney Transplantation Surgery Encounter) - Is CKD Stage Unknown - Is CKD Stage 3 or Higher - Is CKD Stage 4 or Higher - Is Chronic Dialysis Patient -- Indicates that the patient has either (1) documentation in the last 12 months of a chronic dialysis status code; or (2) is currently undergoing regular episode as part of an episode that contains at least one non-inpatient dialysis encounter. - Is History of Kidney Transplantation - Is CCW CKD -- Indicates that the patient meets the CMS Chronic Condition Warehouse criteria for chronic kidney disease; i.e., 2 or more qualifying outpatient or professional ICD codes in the prior 2 years, or 1 or more non-outpatient institutional claim ICD codes in the prior 2 years. - **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 -- The patient's date of birth. On the Patients Natural Object, this field reflects the "best" known value for the patient available from all data sources; on other Natural Objects, e.g., MMR Member-Months, the value faithfully reflects the date of birth found on that particular type of record in the source data. - Is Patient Alive - Patient Age Integer -- Patient age, expressed as an integer, as of a reference date or interval. - Patient Age Category Tier 1 -- Non-overlapping ranges of the patient age in years into three categories; [01] Pediatrics < 19, [02] Adults 19 - 64, and [03] Older Adults >= 65. Coarser grain to the Patient Age Category Tier 2. (See also [URSA-CORE] Patient Age Category Tier 2) - Patient Age Category Tier 2 -- Non-overlapping ranges of the patient age in years representing finer grain categories than the Patient Age Category Tier 1. This field incorporates findings from publications on defining meaningful age groups in the context of disease. These ranges closely, but not exactly, align with standard age ranges such as those defined by the Medical Subject Headings (MeSH). See results of K-Means simple clustering method at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3825015/ (See also [URSA-CORE] Patient Age Category Tier 1) - 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 State Abbreviation - Patient ZIP Code 5-Digit - 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. - **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 -- Evidence of CMS hospice status or evidence of hospice services in the last 12 months. Typically used as a denominator exclusion. - **Diagnosis Fields** - Count CCW Conditions -- The total of both Chronic Conditions and Potentially Disabling Events included in the CMS Chronic Condition Warehouse (CCW) library. (See also [URSA-CORE] CCW Comorbidity Category, [URSA-CORE] Count Potentially Disabling Events, [URSA-CORE] CMS Chronic Condition Warehouse (CCW), [URSA-CORE] Count Chronic Conditions) - Is CCW System Behavioral Health -- Indicates the patient has one or more of the following CCW conditions; ADHD, Conduct Disorders, and Hyperkinetic Syndrome, Anxiety Disorders, Autism Spectrum Disorder, Bipolar Disorder, Depression, Depressive Disorders, Personality Disorders, PTSD, Schizophrenia, or Schizophrenia and Other Psychotic Disorders. - Is CCW System Cardiovascular -- Indicates the patient has one or more of the following CCW conditions; Acute Myocardial Infarction (AMI), Atrial Fibrillation, Heart Failure, Hypertension, Ischemic Heart Disease, or Peripheral Vascular Disease (PVD). - Is CCW System Genitourinary -- Indicates the patient has one or more of the following CCW conditions; Benign Prostatic Hyperplasia or Chronic Kidney Disease (CKD). - Is CCW System Musculoskeletal -- Indicates the patient has one or more of the following CCW conditions; Hip or Pelvic Fracture, Rheumatoid Arthritis or Osteoarthritis, or Osteoporosis. - Is CCW System Pulmonary -- Indicates the patient has one or more of the following CCW conditions; Asthma, or Chronic Obstructive Pulmonary Disease (COPD) and Bronchiectasis. - Is CCW COPD and Bronchiectasis -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year. - Is CCW Diabetes -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years. - Is CCW Hyperlipidemia -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year. - Is CCW Hypertension -- At least 1 inpatient, SNF, HHA OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in the prior 1 year. - **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 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 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 - **[No Field Group]** - Ursa Serial ID - **Episode Fields** - Episode Length Days - **Measure Fields** - Denominator