Urgent Care and Measure Denominator Inclusion
Creation date: 6/17/2025 4:33 PM
Updated: 6/17/2025 4:33 PM
Two things to establish first:
- Clinics are assigned to a measure based on the specialties indicated to be offered at the clinic during registration. Urgent Care is not currently an eligible specialty for any measure, so if a clinic was registered with Urgent Care as a specialty, the clinic would not be assigned to a measure based on that specialty. If the clinic was registered with Urgent Care and Family Medicine, however, the clinic would be assigned to all measures where Family Medicine is an eligible specialty.
- Denominator 'Event' criteria (typically 'At least one established patient office or telehealth visit performed or supervised by an eligible provider in an eligible specialty for any reason during the measurement period') looks at the provider's board certified specialty as indicated on the submitted encounter from the Encounter file. Currently, Emergency Medicine is not an eligible specialty for any measure, so if an encounter is submitted with a specialty code of 14 (Emergency Medicine), that encounter would not be considered to be from an eligible specialty and therefore not be considered compliant for the 'Event' criteria.
For the majority of measures, the PIPE logic first determines eligibility for the measure population. When evaluating the 'Event' criteria for each patient, PIPE combines the event criteria determination and the clinic attribution process.
- The logic checks if the patient has a PCP clinic ID in the Demographic data. If they do, and the clinic of their PCP is assigned to the measure (was registered with a specialty eligible for the measure), then the logic looks for an encounter that meets Event criteria (eligible visit code, eligible provider type, eligible provider specialty). PIPE does not consider whether the clinic ID on the encounter record is assigned to the measure when evaluating encounters against Event criteria. If an encounter is found that meets Event criteria and they pass the remainder of the inclusion checks (age, disease dx where applicable), then they are assigned to the clinic of their PCP.
- If the patient's PCP clinic in the Demographic data isn't assigned to the measure - or they don't have PCP data in the Demographic file - the logic identifies all of the patient's encounters that meet Event criteria (eligible visit code, eligible provider type, eligible provider specialty). PIPE does not consider whether the clinic ID in the encounter record is assigned to the measure when evaluating encounters against Event criteria. It then looks at all of the encounters that meet Event criteria and if one of those encounters is from a clinic that is assigned to the measure then the patient passes the Event criteria check. If the patient passes the rest of the inclusion criteria checks (age, disease dx where applicable), then PIPE uses an encounter counting process for clinic attribution. There is a flow chart demonstrating the clinic attribution process here.
- Once the eligible population is identified using these steps, then exclusions are applied to identify the denominator. If the measure has an 'Urgent Care Only' exclusion, the logic looks at all of the patient's encounters for the year. If all of the encounters have Place of Service Code 17 (Walk-in Retail Health) or 20 (Urgent Care), the patient is excluded from the measure.