URSA-PHF-038: Observation Discharge 60-Day IP Plan Spending

Measure Description

Among hospital observation stay discharges, the total plan spending on hospital inpatient admits in the following 60 days

Metadata

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

Denominator Description

Observation stays where the patient was not admitted to inpatient, transferred, or expired.

Numerator Description

The plan paid amount on all Hospital Inpatient Admissions occurring within 60 days of the discharge from the denominator observation stay

Published Fields

• Data Model Keys

  • Observation Encounter ID
  • Patient ID
  • Observation Facility 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
  • 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

• Date Fields

  • Observation Encounter Start Date
  • Observation Encounter 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

  • Observation LOS in Elapsed Midnights
  • Is Observation Encounter LOS >= 2 Midnights
  • Observation Principal Discharge Diagnosis ICD-10-CM Code
  • Observation Principal Discharge Diagnosis ICD-10-CM Description
  • Observation Ursa Observation Stay Principal Diagnosis Category
  • Is Observation Principal Discharge Diagnosis Chest Pain
  • Is Observation Principal Discharge Diagnosis CHF
  • Is Observation Principal Discharge Diagnosis Asthma
  • Observation Principal Discharge Diagnosis WHO ICD-10 Chapter Description
  • Observation Principal Discharge Diagnosis WHO ICD-10 Block Description
  • Observation Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
  • Observation Principal Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
  • Observation Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
  • Observation Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
  • Observation Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Code
  • Observation Principal Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 2 Description

• Location Fields

  • Patient ZIP Code 5-Digit
  • UW HIP ADI Quintile Category
  • UW HIP ADI Decile Category

• Insurance Fields

  • Primary Payor Description
  • Primary Plan Description

• Diagnosis Fields

  • CCW Count Category
  • Count CCW Conditions
  • Is CCW Acquired Hypothyroidism
  • Is CCW Acute Myocardial Infarction
  • Is CCW Alzheimers Disease and Related Disorders or Senile Dementia
  • Is CCW Asthma
  • Is CCW Atrial Fibrillation
  • Is CCW CKD
  • Is CCW COPD and Bronchiectasis
  • Is CCW Depression
  • Is CCW Depressive Disorders
  • Is CCW Diabetes
  • Is CCW Heart Failure
  • Is CCW Hyperlipidemia
  • Is CCW Hypertension
  • Is CCW Ischemic Heart Disease
  • Is CCW PVD
  • 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

• Billing and Claims Fields

  • Observation CMS Patient Discharge Status Code
  • Observation CMS Patient Discharge Status Description

• Financial Fields

  • Observation Total Plan Paid Amount from All Plans

• Numerator Fields

  • HIA Encounter ID
  • HIA Facility Provider ID
  • HIA Encounter Start Date
  • HIA Encounter End Date
  • Days Elapsed from Index Admission Discharge to Readmission
  • Inpatient Admit Timing Category
  • Is Inpatient Admit to Observation Stay Facility
  • Is Inpatient Admit Diagnosis Match to Observation AHRQ CCS Single Level
  • Is Inpatient Admit Diagnosis Match to Observation AHRQ CCS T1
  • Is Inpatient Admit Diagnosis Match to Observation AHRQ CCS T2
  • HIA Ursa Hospital Admission Condition-Treatment Type Tier 1 Category
  • HIA Inpatient LOS Category Tier 1
  • HIA Principal Discharge Diagnosis ICD-10-CM Code
  • HIA Principal Discharge Diagnosis ICD-10-CM Description
  • HIA Prior Admit Principal Discharge Diagnosis ICD-10-CM Code
  • HIA Prior Admit Principal Discharge Diagnosis ICD-10-CM Description
  • HIA Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Code
  • HIA Discharge Diagnosis AHRQ CCS Single-Level Diagnosis Category Description
  • HIA Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Code
  • HIA Discharge Diagnosis AHRQ CCS Multi-Level Diagnosis Category Tier 1 Description
  • HIA Total Plan Paid Amount from All Plans

• Measure Fields

  • Denominator
  • Numerator

• [No Field Group]