Thank you for your question. This issue is currently under review and requires discussion with additional stakeholders to determine the best response. Thank you for your patience. Update June 24/2014 This issue has been previously forwarded to the Logic Harmonization Work Group and the steward for further consideration. Additional updates will be posted as feedback is received. Thank you for your patience. Solution update: 6/26/14 Thank your for your patience as this situation was reviewed. The steward has determined your concern is specific to VTE-1 and not VTE-3 since it is specific to surgical encounters. The context to VTE-1 surgical encounters focuses on VTE prophylaxis following hospital admission, since that’s when the patient will need VTE prophylaxis. If a patient has a surgery the day of or day after admission, that may delay VTE prophylaxis initiation, which is why the surgical scenario is modeled to allow for “extra time” for prophylaxis initiation. To address your concerns, the steward response indicates “. . .the start of the inpatient encounter always corresponds to admission datetime. This is how the measure is written and it was written as intended.” Regarding the stated concerns, “a patient is never excluded from the measure based on whether a surgery occurred before or after admission; simply for patients who had a surgery before admission, the timeframe for VTE prophylaxis will be the day of or day after admission.” The 2014 eCQM specs look for surgeries that ended on the day of or day after admission; this is a departure from the original specs, but allows accounting for surgeries that may have started before the patient was admitted. Based on the steward recommendations, no further action will be taken at this time. Soulution Update- SCIP measures: July 2, 2014 Thank you for your patience while the steward considered your concerns.The following guidance was provided:      For surgical candidates that are not admitted before surgery, the trigger for the inpatient encounter should occur when the surgery begins and only proceed if the admission status changes to inpatient. _____________ Additiona steward input 6/7/14: The start of the inpatient encounter can only be determined by the halthcare facility. If the facilty chooses to roll back the admission time to 'prior to surgery' and this is acceptable per the Medicare Conditions of Participation, they can do that. Many facilities choose this approach so that the payment is bigger. If there are additional concerns about the admission time, the vendor will need to coordinate with the billing/claims department for the healthcare facility.   If the facility chooses to make the inpatient admission time after the surgery, the case will be excluded. The incidence of this occurring will be low compared to the number of planned inpatient surgeries. The exclusion will not affect the calculation of the measure.