URSA-PHF-036: Post-Inpatient Primary Care Visit within 7 Days

  • Published on Apr 23, 2026
  • 31 minute(s) read
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Measure Description

Among hospital inpatient admissions resulting in a discharge to home or home with home health, the percentage with a primary care office visit within 7 days of discharge.

Metadata

  • Measure Identifier: URSA-PHF-036
  • Measure Type: Rate Measure
  • Temporal Structure: Event
  • Component Class: Normal-Form
  • Denominator Case Field: Inpatient Encounter
  • Target Direction: Up

Denominator Description

Hospital Inpatient Discharges where the CMS patient discharge status code indicates the patient was discharged home or home with home health for patients with active plan membership; excludes discharges home with planned readmissions.

Numerator Description

Primary Care Clinician Office Visits occurring within 7 days of discharge from the index admission.

Published Fields

  • Data Model Keys

    • Inpatient Encounter
    • 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)
    • Encounter Primary Payor ID -- Data model key for the primary payor documented in the billing for an encounter.
    • Encounter Primary Plan ID -- Data model key for the primary plan documented in the billing for an encounter.
    • Facility Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the facility provider. (See also [URSA-CORE] Facility Provider)
    • Attending Provider ID -- The internal database identifier (used, e.g., for joins and primary keys) for the attending provider. (See also [URSA-CORE] Attending Provider)
    • Primary HCPCS Procedure Provider ID
    • Prior Hospital IP Encounter ID
    • 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 ID -- The identifier for the health insurance plan product that is the first party responsible for payment.
    • Primary Plan Attributee Provider ID
    • Empirical Attributee Primary Care Individual Provider ID
    • Empirical Attributee Primary Care Provider Group Provider ID

  • Date Fields

    • Encounter Start Date
    • Encounter Patient Inpatient Status Start Date
    • Encounter End Date
    • Encounter Start Date Day of Week
    • Inpatient Status Start Date Day of Week
    • Encounter End Date Day of Week
    • Prior Hospital IP Encounter End Date
    • Elapsed Days from Prior Hospital IP Encounter End Date
    • Is Hospital IP Discharge in Prior 30 Days
    • Period Start Date -- The date identifying the start of a period of time. Period Start Date values are inclusive; e.g., a period with Period Start Date = January 1 would begin be considered to begin at 00:00 on January 1.
    • Period End Date -- The date identifying the end of an period of time. Period End Date values are exclusive; e.g., a period with Period End Date = January 1 would begin be considered to end at precisely 00:00 on January 1 (meaning that the period did not include any time on January 1).
    • 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)

  • Encounter Fields

    • Is Emergency Department Visit Parent Encounter -- Value of "1" if true that the hospital inpatient admission is connected to a Department Visit Parent Encounter during which the patient received care in an emergency room setting; operationally defined by the presence of one or more of the following: (1) a qualifying revenue center code value on an institutional claim or bill; (2) a qualifying HCPCS code on an institutional claim or bill; or (3) an EMR encounter record flagged as an ED visit (i.e., Is Encounter Type ED Visit = 1). Encounters can be nested; that is, one “parent” encounter can contain one or more “child” encounters.
    • Is Observation Stay Parent Encounter -- Indicates the patient received care in a hospital observation setting. In the context of Hospital Inpatient Admission Encounters, this field will identify IP Admits that came from an observation stay as a part of the Hospital Inpatient Admission Encounter (True = "1"). (See also [URSA-CORE] Encounter)
    • Inpatient LOS Category Tier 1 -- Classifies the encounter based on the length of stay in elapsed midnights between the encounter inpatient status start date (or encounter start date when inpatient status start date is unavailable) and the encounter end date (patient discharge from inpatient status).
    • Is Inpatient LOS < 2 Midnights
    • Inpatient LOS in Elapsed Midnights
    • Inpatient LOS in Distinct Calendar Days
    • Is IRF Parent Encounter
    • Is LTCH Parent Encounter
    • Is IPF Parent Encounter
    • Is Discharge Status Home or Home with Home Health
    • Is Routine Discharge Home
    • Is Discharged Home with Home Health

  • Patient Fields

    • Is Patient Alive
    • 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.
    • Patient Last Name
    • 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.
    • 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
    • Is Patient Sex Female -- Indicates the patient's sex is female. 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 patient sex documented on that particular type of record in the source data.
    • Is Patient Sex Male -- Indicates the patient's sex is male. 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 patient sex documented on that particular type of record in the source data.
    • Count Hospital Inpatient Admissions in Last 12 Months
    • Count ED Visits Without Inpatient Admissions in Last 12 Months
    • PCP Attribution Category
    • Primary Care Engagement Category
    • Count Primary Care Visits in Last 36 Months
    • Specialty Care Engagement Category
    • Count Specialty Care Office Visits in Last 36 Months
    • Primary or Specialty Care Engagement Category
    • Count Clinician Office Visits in Last 3 Years
    • Patient ZIP Code 5-Digit

  • Numerator Fields

    • PCP Office Encounter ID
    • PCP Office Service Provider ID
    • PCP Office Provider Group Provider ID
    • PCP Office Facility Provider ID
    • PCP Office Encounter Date
    • Is PCP Office Qualifying Preventive Primary Care Service
    • Is PCP Office Qualifying Primary Care Service Provider
    • Is PCP Office Qualifying Primary Care Provider Group
    • PCP Office Qualifying Preventive Primary Care HCPCS Code
    • Days Elapsed from Index Admission Discharge to Visit
    • Is PCP Office Annual Wellness Visit
    • Is PCP Office Urgent Care Visit
    • PCP Office Principal Discharge Diagnosis ICD-10-CM Code
    • PCP Office Principal Discharge Diagnosis ICD-10-CM Description
    • PCP Office Principal Discharge Diagnosis WHO ICD-10 Chapter Description
    • PCP Office Principal Discharge Diagnosis WHO ICD-10 Block Description
    • PCP Office Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • PCP Office Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • PCP Office Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • PCP Office Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
    • PCP Office Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
    • PCP Office Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description
    • PCP Office Service Provider Provider NPI
    • PCP Office Service Provider Provider Description
    • PCP Office Service Provider Primary NUCC Provider Taxonomy Code
    • PCP Office Service Provider Primary NUCC Provider Taxonomy Description
    • PCP Office Ursa Service Provider Specialty Type Category
    • PCP Office Qualifying Preventive Primary Care HCPCS Code Description
    • PCP Office CMS Place of Service Code
    • PCP Office CMS Place of Service Description
    • PCP Office Primary Plan Allowed Amount
    • PCP Office Primary Plan Paid Amount
    • PCP Office Total Plan Paid Amount from All Plans
    • PCP Office Patient Paid Amount
    • Is PCP Office Qualifying Primary Care Attending Provider
    • Is PCP Office Qualifying Primary Care Facility Provider

  • Provider Fields

    • Facility Provider Description -- The natural language description of the facility provider. (See also [URSA-CORE] Facility Provider)
    • Facility Provider Primary NUCC Provider Taxonomy Code
    • Facility Provider Primary NUCC Provider Taxonomy Description
    • Facility Provider State Abbreviation
    • Facility Provider ZIP Code 5-Digit
    • Attending Provider Description -- The natural language description of the attending provider; typically, the name of the provider. (See also [URSA-CORE] Attending Provider)
    • Attending Provider Primary NUCC Provider Taxonomy Code
    • Attending Provider Primary NUCC Provider Taxonomy Description
    • Primary Plan Attributee Provider Description
    • Primary Plan Attributee Primary NUCC Provider Taxonomy Description
    • Empirical Attributee Primary Care Individual Provider Description
    • Empirical Attributee Primary Care Individual Primary NUCC Provider Taxonomy Description
    • Empirical Attributee Primary Care Provider Group Provider Description
    • Empirical Attributee Primary Care Provider Group Primary NUCC Provider Taxonomy 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 County Description
    • UW HIP Area Deprivation Index National Percentile -- A value between 1 and 100 representing the composite measure of socioeconomic deprivation from University of Wisconsin’s School of Medicine and Public Health. Scores are for Census Block Group geographic level, which generally contains between 600 and 3,000 people. Higher scores indicate more deprivation, so a score of 1 indicates the least deprivation while a score of 100 indicates the most deprivation. Percentiles are constructed by ranking the ADI from low to high for the nation and grouping the block groups into bins corresponding to each 1% range of the ADI. The 2019 ADI was constructed using the 2015-2019 5-year estimates from the US Census' American Community Survey and includes 17 component measures that span the domains of income, education, employment, and housing quality. It may be linked with the 9-digit ZIP code crosswalk, which was built to correspond directly to Census block groups. The 2019 ADI was released on 07/14/2021 and is the most recent version as of 02/02/22.
    • 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.
    • CDC SVI Socioeconomic Quintile Category -- The CDC SVI Socioeconomic Theme 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. (See also [URSA-CORE] CDC SVI Socioeconomic Theme National Percentile )
    • CDC SVI Household / Disability Quintile Category -- The CDC SVI Household/Disability Theme 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. (See also [URSA-CORE] CDC SVI Household / Disability Theme National Percentile )
    • CDC SVI Minority / Language Quintile Category -- The CDC SVI Minority/Language Theme 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. (See also [URSA-CORE] CDC SVI Minority / Language Theme National Percentile)
    • CDC SVI Housing / Transportation Quintile Category -- The CDC SVI Housing/Transportation Theme 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. (See also [URSA-CORE] CDC SVI Housing / Transportation Theme National Percentile)

  • Insurance Fields

    • Encounter Primary Payor Description
    • Encounter Primary Plan Description
    • Encounter Primary Plan Financial Class Description
    • Is Encounter Primary Plan Financial Class Commercial
    • Is Encounter Primary Plan Financial Class Medicare FFS
    • Is Encounter Primary Plan Financial Class Medicare Advantage
    • Is Encounter Primary Plan Financial Class Medicaid
    • Count Active Plan Memberships
    • Primary Payor Description
    • Primary Plan Description

  • Diagnosis Fields

    • Principal Discharge Diagnosis ICD-10-CM Code
    • Principal Discharge Diagnosis ICD-10-CM Description
    • Prior Admit Principal Discharge Diagnosis ICD-10-CM Code
    • Prior Admit Principal Discharge Diagnosis ICD-10-CM Description
    • Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
    • Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
    • Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
    • Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
    • Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
    • Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description
    • Discharge Diagnosis WHO ICD-10 Chapter Description
    • Discharge Diagnosis WHO ICD-10 Block Description
    • CCW Count Category
    • 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 Acquired Hypothyroidism -- 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 Acute Myocardial Infarction -- At least 1 inpatient claim with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW ADHD, Conduct Disorders, and Hyperkinetic Syndrome -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Alzheimers Disease -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.
    • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 3 years.
    • Is CCW Anemia -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Anxiety Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Asthma -- 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 Atrial Fibrillation -- At least 1 inpatient OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set as the first or second diagnosis position in the prior 1 year.
    • Is CCW Autism Spectrum Disorder -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Benign Prostatic Hyperplasia -- 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. Exclusion: If any of the qualifying claims also have an ICD-10 DX of D29.1, then it is excluded.
    • Is CCW Bipolar Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Blindness and Visual Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Breast Cancer -- At least 1 inpatient, SNF OR 2 HOP or Carrier claims with one or more of the DX codes from the corresponding CCW value set in prior 1 year.
    • Is CCW Cataract -- At least 1 HOP or Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.
    • Is CCW Cerebral Palsy -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes over the last 2 years (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • 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.
    • Is CCW Colorectal Cancer -- At least 1 inpatient, SNF 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 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 Cystic Fibrosis and Other Metabolic Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Deafness and Hearing Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Depression -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • Is CCW Depressive Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • 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 Endometrial Cancer -- At least 1 inpatient, SNF 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 Epilepsy -- At least 1 inpatient claim OR 2 other non-drug claims of any service type during the two-year period (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW Fibromyalgia and Chronic Pain and Fatigue -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Glaucoma -- At least 1 Carrier claim with one or more of the DX codes from the corresponding CCW value set as the principal diagnosis position in the prior 1 year.
    • Is CCW Heart Failure -- At least 1 inpatient, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Hip or Pelvic Fracture -- At least 1 inpatient or SNF claim with one or more of the DX codes from the corresponding CCW value set in the prior 1 year.
    • 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.
    • Is CCW Intellectual Disability -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Ischemic Heart Disease -- At least 1 inpatient, SNF, HHA, HOP, or Carrier claim with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Learning Disability -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Leukemia -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Lung Cancer -- At least 1 inpatient, SNF 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 Migraine and Chronic Headache -- At least 1 inpatient claim OR 2 non-inpatient claims with DX codes within a 2 year period. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • Is CCW Mobility Impairment -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Multiple Sclerosis -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Muscular Dystrophy -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Obesity -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Osteoporosis -- 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 Other Developmental Delay -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Personality Disorder -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Pressure or Chronic Ulcer -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Prostate Cancer -- At least 1 inpatient, SNF 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 PTSD -- At least 1 inpatient OR 2 other nondrug claims of any service type with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW PVD -- At least 1 inpatient OR 2 non-inpatient claims with one or more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Rheumatoid Arthritis or Osteoarthritis -- At least 2 inpatient, SNF, HHA, 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 Schizophrenia -- At least 1 inpatient claim OR 2 other non-drug claims of any service type with DX codes at least one day apart in the prior within the 2 year reference period. Qualifying codes can also be found as a subset of those in the CCW "Schizophrenia or Other Psychotic Disorders". (See also [URSA-CORE] Is CCW Schizophrenia or Other Psychotic Disorders)
    • Is CCW Schizophrenia or Other Psychotic Disorders -- At least 1 inpatient OR 2 other nondrug claims of any service type with one ore more of the DX codes from the corresponding CCW value set in the prior 2 years.
    • Is CCW Stroke or Transient Ischemic Attack -- At least 1 inpatient 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.
      EXCLUSIONS: If any of the qualifying claims have : 800 <= DX Code <=
      804.9, 850 <= DX Code <= 854.1 in any DX position OR DX V57xx as the principal DX Code, then the claim is excluded.
    • CCW Systems Category
    • Count CCW Systems -- The count of distinct systems of the body with one or more active CCW Condition. CCW Systems are as a parent category to the individual CCW Conditions grouping them based primarily on the human body system they impact such as; Behavioral Health, Cancers, Cardiovascular, Cerebrovascular, Endocrine, Genitourinary, Musculoskeletal, and Pulmonary. (See also [URSA-CORE] CMS Chronic Condition Warehouse (CCW))
    • 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 Congenital -- Indicates the patient has one or more of the following CCW conditions; Cerebral Palsy, Cystic Fibrosis and Other Metabolic Disorder, Intellectual Disability, Learning Disability, Muscular Dystrophy, or Other Developmental Delays.
    • Is CCW System Endocrine/Metabolic -- Indicates the patient has one or more of the following CCW conditions; Diabetes, Acquired Hypothyroidism, Hyperlipidemia, or Obesity.
    • 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 Hematologic -- Indicates the patient has one or more of the following CCW conditions; Anemia.
    • 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 Neurological -- Indicates the patient has one or more of the following CCW conditions; Alzheimer's Disease, Alzheimer's Disease and Related Disorders or Senile Dementia, Stroke or Transient Ischemic Attack, Epilepsy, Migraine and Chronic Headache, Mobility Impairment, Multiple Sclerosis, or Deafness and Hearing Impairment.
    • Is CCW System Oncologic -- Indicates the patient has one or more of the following CCW conditions; Breast Cancer, Colorectal Cancer, Endometrial Cancer, Lung Cancer, Prostate Cancer, or Leukemia.
    • Is CCW System Ophthalmologic -- Indicates the patient has one or more of the following CCW conditions; Cataract, Glaucoma, or Blindness and Visual Impairment.
    • 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 System Other -- Indicates the patient has one or more of the following CCW conditions; Fibromyalgia and Chronic Pain and Fatigue, Pressure or Chronic Ulcer.

  • Financial Fields

    • Primary Plan Allowed Amount -- The maximum amount that the payor agrees to pay the provider for a service or product, typically governed by a contract. The Allowed Amount for a claim or billing record is calculated by adding the Contractual Adjustment Amount (which is typically negative) to the Charge Amount. Adding the total Non-Contractual Adjustment Amount to the Allowed Amount yields the Total Due Amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Allowed Amount, Secondary Plan Allowed Amount, and Tertiary Plan Allowed Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively. (See also [URSA-CORE] Charge Amount, [URSA-CORE] Contractual Adjustment Amount, [URSA-CORE] Non-Contractual Adjustment Amount, [URSA-CORE] Total Due Amount)
    • Primary Plan Paid Amount -- The amount actually paid by the health plan to the provider for a service or product. Subtracting the plan paid amount from the total due amount typically yields the patient responsibility amount. On billing records, which may identify up to three plans responsible for payment, the Primary Plan Paid Amount, Secondary Plan Paid Amount, and Tertiary Plan Paid Amount fields identify the amounts paid by the primary, secondary, and tertiary plans listed on the bill, respectively; the total paid by any and all plans on a bill is identified by the Any Plan Paid Amount field.
    • Total Plan Paid Amount from All Plans
    • Patient Paid Amount -- The amount paid by the patient to the provider for health care services or products.

  • Billing and Claims Fields

    • Ursa Hospital Admission Condition-Treatment Type Tier 1 Category -- A brief description, suitable for use in a chart or data table, identifying the type of admission using the Ursa Hospital Admission Condition-Treatment Type Tier 1 classification system. (See also [URSA-CORE] Ursa Hospital Admission Condition-Treatment Type)
    • MS-DRG Code -- The standard 3-digit Medicare Severity Diagnosis Related Group code; MS-DRG codes should include leading zeros.
    • MS-DRG Description -- The natural language description of a standard 3-digit Medicare Severity Diagnosis Related Group code.
    • MS-DRG MDC Code -- The two-digit numeric code representing the Major Diagnostic Category for a given DRG based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Description)
    • MS-DRG MDC Description -- The natural language description of the two-digit Major Diagnostic Category (MDC) Code that classifies DRGs based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Code)
    • Is CMS DRG Medical-Surgical Type Surgical
    • APR-DRG Code -- The standard 3-digit All Patient Refined Diagnosis Related Group code; APR-DRG codes should include leading zeros, and do not include the Severity of Illness or Risk of Mortality modifiers.
    • APR-DRG Description -- The natural language description of a standard 3-digit All Patient Refined Diagnosis Related Group code. (See also [URSA-CORE] APR-DRG Code)
    • APR-DRG MDC Code -- The two-digit numeric code representing the Major Diagnostic Category for a given DRG based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Description)
    • APR-DRG MDC Description -- The natural language description of the two-digit Major Diagnostic Category (MDC) Code that classifies DRGs based on condition type and body region; 01 = Nervous system, 02 = Eye, 03 = Ear/Nose/Throat, 04 = Respiratory System, etc. (See also [URSA-CORE] MDC Code)
    • APR-DRG Severity of Illness Code -- The standard 1-digit Severity of Illness modifier for an All Patient Refined Diagnosis Related Group code; sometimes abbreviated as SOI.
    • APR-DRG Risk of Mortality Code -- The standard 1-digit Risk of Mortality modifier for an All Patient Refined Diagnosis Related Group code; sometimes abbreviated as ROM.
    • Is APR-DRG Medical Surgical Type Medical -- Indicates the APR-DRG has been classified as a medical (non-surgical) code.
    • Is APR-DRG Medical Surgical Type Surgical -- Indicates the APR-DRG has been classified as a surgical code.
    • CMS Admit Type Code -- The standard single-digit CMS inpatient admission type code found on Inpatient and Skilled Nursing Facility claims; ; 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma Center, 9 = Information Not Available.
    • CMS Admit Type Description -- The natural language of a standard CMS Admit Type or Type of Admission Code; 1 = Emergency, 2 = Urgent, 3 = Elective, 4 = Newborn, 5 = Trauma Center, 9 = Information Not Available. (See also [URSA-CORE] CMS Admit Type Code)
    • CMS Admit Source Code -- The standard 1-character CMS Admit Source code; e.g., 1 = Physician Referral, 2 = Clinic Referral, etc.
    • CMS Admit Source Description -- The natural language description of a standard CMS Admit Source code. (See also [URSA-CORE] CMS Admit Source Code)
    • CMS Patient Discharge Status Code -- The standard 2-digit CMS Patient Discharge Status code; 01 = Discharged to Home or Self Care, etc. Patient Discharge Status codes should include leading zeros.
    • CMS Patient Discharge Status Description -- The natural language description of a standard CMS Patient Discharge Status code. (See also [URSA-CORE] CMS Patient Discharge Status Code)

  • Clinical Services Fields

    • Is Surgery Encounter -- Indicates an encounter in which the patient underwent surgery; identified by the presence, among the documents associated with an encounter, of a surgical HCPCS code or a revenue center code for operating room setting care.
    • Is Prior Hospital IP Admit Surgery Encounter
    • Primary HCPCS Procedure HCPCS Code
    • Primary HCPCS Short Description
    • Primary HCPCS Long Description
    • Is Primary HCPCS Procedure Surgical
    • 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
    • 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

  • Metadata Fields

    • Calculated MS-DRG Mean Length of Stay in Calendar Days -- Calculated from the data present in Ursa, the average length of stay experienced by a patient within a chosen MS-DRG.
    • Relative Change of Encounter LOS to Calculated MS-DRG Mean
    • Calculated APR-DRG Mean Length of Stay in Calendar Days -- Calculated from the data present in Ursa, the average length of stay experienced by a patient within a chosen APR-DRG.
    • Relative Change of Encounter LOS to Calculated APR-DRG Mean
    • CMS DRG Arithmetic Mean LOS -- The arithmetic mean length of stay (ALOS) is the average length of stay experienced by a patient within a chosen DRG. (See also [URSA-CORE] CMS DRG Geometric Mean LOS)
    • Relative Change of Encounter LOS to CMS MS-DRG Arithmetic Mean
    • CMS DRG Geometric Mean LOS -- The geometric mean length of stay or (GMLOS) is the national mean length of stay for each diagnostic related grouper (DRG) as determined and published by CMS. The geometric mean reduces the effect of very high or low values, which might bias the mean if a straight average (arithmetic mean) is used. (See also [URSA-CORE] CMS DRG Arithmetic Mean LOS)
    • Relative Change of Encounter LOS to CMS MSDRG Geometric Mean

  • Measure Fields

    • Is Visit Service Provider the Plan Attributed Provider
    • Is Visit Service Provider the Empirical Attributee Individual Provider
    • Denominator