URSA-PHF-007: SNF Stay PMPM Plan Spending

Measure Description

Among active plan membership patient-periods, the per-member-per-month plan spending on SNF Stays.

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 is alive, has active plan coverage, and medical claim data coverage.

Numerator Description

Total plan spending for claims associated with a SNF Stay 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 Date of Birth
  • 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
  • Primary Care Engagement Category

• 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)
  • 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
  • Patient County Description
  • UW HIP ADI Quintile Category
  • UW HIP ADI Decile 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

  • SNF Encounter ID
  • SNF Facility Provider ID
  • SNF Encounter Start Date
  • SNF Encounter End Date
  • SNF CMS Patient Discharge Status Code
  • SNF MS-DRG Code
  • SNF Principal Discharge Diagnosis ICD-10-CM Code
  • SNF Principal Discharge Diagnosis ICD-10-CM Description
  • SNF Primary Plan Allowed Amount
  • SNF Primary Plan Paid Amount
  • SNF Total Plan Paid Amount from All Plans
  • SNF Patient Paid Amount
  • SNF Encounter LOS in Distinct Calendar Days
  • SNF Encounter Calendar Days LOS Category Tier 1
  • Is SNF LOS in Days > 100
  • Is SNF Discharge Status Home or Home with Home Health
  • SNF Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
  • SNF Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
  • SNF Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
  • SNF Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
  • SNF MS-DRG Description
  • SNF MS-DRG MDC Code
  • SNF MS-DRG MDC Description
  • Is SNF CMS DRG Medical-Surgical Type Medical
  • Is SNF CMS DRG Medical-Surgical Type Surgical
  • SNF CMS DRG Weight
  • SNF Facility Provider Description
  • SNF Facility Provider Primary NUCC Provider Taxonomy Description
  • SNF Facility Provider Practice Address ZIP Code 5-Digit
  • SNF Facility Provider Practice Address State Abbreviation
  • SNF Facility Provider Dartmouth Atlas HRR Description
  • SNF CMS Patient Discharge Status Description
  • SNF Encounter Total Plan Paid Amount Category

• Measure Fields

  • Denominator
  • Numerator

• [No Field Group]