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    URSA-PHF-006b: ASC Encounter PMPM Plan Spending
    • 17 Jul 2025
    • 4 Minutes to read
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    URSA-PHF-006b: ASC Encounter PMPM Plan Spending

    • Updated on 17 Jul 2025
    • 4 Minutes to read
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    Article summary

    Measure Description

    Among active plan membership patient-periods, the per-member-per-month plan spending on Ambulatory Center encounter.

    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-months of active plan membership periods during which the patient was alive and had medical claims data coverage.

    Numerator Description

    Total plan spending for claims associated with an ambulatory surgical center encounter and 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
      • Primary Payor ID
      • Primary Plan ID

    • Patient Fields

      • Patient Age Integer
      • Patient Age Category Tier 1
      • Patient Age Category Tier 2
      • Patient Sex Category
      • Is Patient Sex Female
      • Is Patient Sex Male
      • Count Hospital Inpatient Admissions in Last 12 Months
      • Count ED Visits Without Inpatient Admissions in Last 12 Months
      • Primary Care Engagement Category
      • Specialty Care Engagement Category
      • Primary or Specialty Care Engagement Category

    • Date Fields

      • 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

      • Primary Plan Attributee Provider Description

    • Location Fields

      • Patient State Abbreviation
      • Patient ZIP Code 5-Digit
      • UW HIP Area Deprivation Index National Percentile
      • UW HIP ADI Quintile Category
      • CDC SVI Overall Quintile Category
      • CDC SVI Socioeconomic Quintile Category
      • CDC SVI Household / Disability Quintile Category
      • CDC SVI Minority / Language Quintile Category
      • CDC SVI Housing / Transportation Quintile Category

    • Insurance Fields

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

    • Diagnosis Fields

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

    • Numerator Fields

      • Encounter ID
      • Facility Provider ID
      • Attending Provider ID
      • Primary HCPCS Procedure Provider ID
      • Encounter LOS in Elapsed Midnights
      • Is Same Day Discharge
      • Encounter Start Date
      • Encounter End Date
      • Is Patient Discharged Home or Home with Home Health
      • Is MSK Related Encounter
      • Facility Provider Description
      • Facility Provider Primary NUCC Provider Taxonomy Description
      • Facility Provider Practice Address State Abbreviation
      • Facility Provider Practice Address ZIP Code 5-Digit
      • Primary HCPCS Procedure HCPCS Code
      • Primary HCPCS Short Description
      • Is Primary HCPCS Procedure Surgical
      • Primary Surgical Procedure HCPCS Category
      • Is Primary HCPCS Surgical Procedure of Musculoskeletal System
      • Primary HCPCS MSK Surgical Procedure Category
      • Primary HCPCS AHRQ CCS Single-Level Procedure Category Code
      • Primary HCPCS AHRQ CCS Single-Level Procedure Category Description
      • Principal ICD Procedure ICD-10-PCS Code
      • Principal ICD Procedure ICD-10-PCS Description
      • Is Principal ICD-10-PCS Operation of Musculoskeletal System
      • Principal ICD-10-PCS AHRQ CCS Single-Level Procedure Category Code
      • Principal ICD-10-PCS AHRQ CCS Single-Level Procedure Category Description
      • Principal ICD-10-PCS AHRQ CCS Multi-Level Procedure Category Tier 1 Code
      • Principal ICD-10-PCS AHRQ CCS Multi-Level Procedure Category Tier 1 Description
      • Surgery Encounter Hip-Knee Category
      • Principal Discharge Diagnosis ICD-10-CM Code
      • Principal Discharge Diagnosis ICD-10-CM Description
      • Is Principal Discharge Diagnosis Musculoskeletal System
      • 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
      • Primary Plan Allowed Amount
      • Primary Plan Paid Amount
      • Total Plan Paid Amount from All Plans
      • Patient Paid Amount

    • Measure Fields

      • Denominator
      • Numerator

    • [No Field Group]

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