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    URSA-QUALITY-PCR: Plan All-Cause Readmission (PCR)
    • 18 Jul 2025
    • 4 Minutes to read
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    URSA-QUALITY-PCR: Plan All-Cause Readmission (PCR)

    • Updated on 18 Jul 2025
    • 4 Minutes to read
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    Article summary

    Measure Description

    For members 18 years of age and older, the number of acute inpatient and observation stays during the measurement year that were followed by an unplanned acute readmission for any diagnosis within 30 days and the predicted probability of an acute readmission. Unadjusted Certified Measure 6b31623b-cc5c-46d5-9bd6-a4011c8fbfb0

    Metadata

    • Measure Type: Rate Measure
    • Temporal Structure: Entity
    • Component Class: Long-Form
    • Denominator Case Field: Index Episode IHS Episode ID, Index Episode Output NCQA Payer Type Code
    • Target Direction: Down

    Denominator Description

    Acute inpatient and observation stays for patients 18+

    Numerator Description

    Unplanned acute readmission within 30 days

    Published Fields

    • Data Model Keys

      • Index Episode Record ID
      • Index Episode Patient ID
      • Index Episode Episode Last Encounter Master Document ID
      • Index Episode IHS Episode ID
      • Primary Payor ID
      • Primary Plan ID

    • Patient Fields

      • Index Episode Is Aged 65+
      • Index Episode Patient Age Integer
      • Index Episode Is Patient Sex Female
      • Index Episode Is Patient Sex Male
      • Patient Age Integer
      • Patient Operational ID
      • Patient Date of Birth
      • Is Patient Sex Female
      • Is Patient Sex Male
      • Patient State Abbreviation
      • Patient ZIP Code 5-Digit
      • Patient Date of Death

    • Date Fields

      • Index Episode IHS Episode First Encounter Admission Date
      • Index Episode IHS Episode Last Encounter Discharge Date
      • 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)
      • Snapshot Date -- The date, evaluated at 00:00:00 AM, giving the moment the state of the world will be set to for the purposes of an analysis. The snapshot date does not represent the freshness of the data, or the date in real time at which an analysis was executed.

    • Provider Fields

      • Primary Plan Attributee Provider ID
      • Primary Plan Attributee Provider Description
      • Primary Plan Attributee Primary NUCC Provider Taxonomy Description

    • Insurance Fields

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

    • Diagnosis Fields

      • Index Episode IHS Episode Last Encounter Principal Discharge Diagnosis ICD-10-CM Code

    • Denominator Fields

      • Is Continuous Membership Criterion Met
      • Is Eligible Population
      • Is Any Required Exclusion
      • Is Required Exclusion for Hospice
      • Is Required Exclusion for Patient Death
      • Is Plan Population
      • Denominator Performance Period Start Date
      • Is Outlier
      • Is Event Discharged to SNF
      • Plan Payer Output NCQA Payer Type Code
      • Is Any Numerator Episode Exclusion

    • Numerator Fields

      • Numerator Component Contribution
      • Numerator Admit Date
      • Numerator Episode Last Encounter Master Document ID
      • Is Numerator Qualifying Using Standard End-of-Year Timing
      • Numerator Component Contribution Using Standard End-of-Year Timing

    • Metadata Fields

      • Denominator NCQA Performance Period Start Date
      • Report Designated Control for Expanded Denominator Performance Period Start Date
      • Is Parameter Set to Override Continuous Enrollment Criteria
      • Is Parameter Set to Override Payor Criteria
      • Index Episode Payor Parent Type Code
      • Index Episode NCQA PCR Reporting Indicator Code
      • Index Episode Is Any Commercial Output NCQA Payer Type Code
      • Index Episode Is Any Medicare Output NCQA Payer Type Code
      • Index Episode Is Any Medicaid Output NCQA Payer Type Code
      • Index Episode Is Any Exchange Output NCQA Payer Type Code
      • Index Episode Is Any SNP Output NCQA Payer Type Code
      • Index Episode Is Any MMP Output NCQA Payer Type Code

    • Validation Only Fields

      • Denominator Event Rank within Numerator Event
      • Count Ppayer Codes within Patient | Snapshot
      • Ppayer Concat
      • Count IHS Payer Codes within Patient | Snapshot
      • IHS Payer Concat
      • Are IHS Payers and PPayers The Same
      • Is IHS | PPayer Combination to Exclude
      • Continuous Membership Criterion Period Start Date
      • Continuous Membership Criterion Period End Date
      • Is Continuous Membership Criterion Met in 365 Days Prior to IP Visit
      • Is Continuous Membership Criteria Met in 30 Days After IP Visit
      • Event Rank within Patient ID
      • Count of Events within Patient ID and Snapshot
      • Index Episode Is Episode Last Encounter with Observation Stay
      • Index Episode Is Surgery Episode

    • Measure Fields

      • Denominator
      • Numerator

    • Module Fields

      • Index Episode Is Single-Day Episode
      • Index Episode Is SNF Admission After Episode Discharge
      • Index Episode Is Exclusion for Principal Diagnosis Pregnancy
      • Index Episode Is Exclusion for Principal Diagnosis Perinatal Conditions
      • Index Episode Is Exclusion for Principal Diagnosis Chemotherapy
      • Index Episode Is Exclusion for Patient Death
      • Index Episode Is Exclusion for Principal Diagnosis Rehabilitation
      • Index Episode Is Exclusion for Kidney Transplant
      • Index Episode Is Exclusion for Bone Marrow Transplant
      • Index Episode Is Exclusion for Organ Transplant Other Than Kidney
      • Index Episode Is Exclusion for Introduction of Autologous Pancreatic Cells
      • Index Episode Is Exclusion for Potentially Planned Procedures Without Acute Condition
      • Index Episode Output NCQA Payer Type Code
      • Index Episode Is Commercial Output NCQA Payer Type Code
      • Index Episode Is Medicare Output NCQA Payer Type Code
      • Index Episode Is Medicaid Output NCQA Payer Type Code
      • Index Episode Is Exchange Output NCQA Payer Type Code
      • Index Episode Is SNP Output NCQA Payer Type Code
      • Index Episode Is MMP Output NCQA Payer Type Code

    • NCQA Cert Fields

      • Patient Age Integer Unbounded by Death
      • NCQA Race Code
      • NCQA Ethnicity Code
      • NCQA Gender Code

    • Risk Adjustment Fields

      • Observation Stay Standard PCR Variable Weight
      • Surgery Standard PCR Variable Weight
      • Discharge Condition 1 CC Code
      • Discharge Condition 1 Standard PCR Variable Weight
      • Discharge Condition 2 CC Code
      • Discharge Condition 2 Standard PCR Variable Weight
      • Discharge Condition 3 CC Code
      • Discharge Condition 3 Standard PCR Variable Weight
      • COVID Standard PCR Variable Weight
      • Comorbidities Standard PCR Variable Weight
      • Patient Demographics Standard PCR Variable Weight
      • Observation Stay SNF PCR Variable Weight
      • Surgery SNF PCR Variable Weight
      • Discharge Condition 1 SNF PCR Variable Weight
      • Discharge Condition 2 SNF PCR Variable Weight
      • Discharge Condition 3 SNF PCR Variable Weight
      • COVID Standard SNF Variable Weight
      • Comorbidities SNF PCR Variable Weight
      • Patient Demographics SNF PCR Variable Weight

    • [No Field Group]

      • Measure ID
      • Measure Name
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