The intent of VTE-1 is to capture VTE prophylaxis that was given during an inpatient stay. As such VTE-1 prophylaxis started in the ED or observation before a patient is admitted to inpatient is not currently captured as this is not part of the inpatient stay. We recognize that for many inpatients who are admitted from the ED or observation status that VTE prophylaxis is initiated prior to the time the patient is admitted. For VTE-1 (CMS108v7) effective with 2019 reporting period, CQL logic allows capture of VTE prophylaxis for inpatients that is started prior to admission time with logic that supports "VTE Prophylaxis Received on Day of or Day After Admission or Procedure."

Measure logic not allowing VTE 1 measure to accurately reflect the care we are giving our patients. We're a Critical Access Hospital. It's not unusual for us to have patients present to ED, placed in Observation status, and then admitted to Acute Care. When this happen the Teds are placed during the Observation part of the patient's stay. In these instances the Mechanical VTE Prophylaxis Applied Date and Time occurs prior to the "recognized" Date and Time of Hospital Admission. This causes these patients to "Not Meet" VTE-1.

The current standards for expressing eCQM logic have limited ability to help us capture observation status periods. After helpful input from the CRP, the final recommendation is to wait to change the logic until a new expression language, the clinical quality language (CQL) becomes available. In the meantime, we will add guidance to the affected measures recognizing the limitation of the logic in capturing observation status periods.