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  2. CQM-5998

VTE-2 (CMS-190) Thoracic surgeons want clarification on measure expectations

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
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    • Nathan Jay Currah
    • 5303327384
    • Enloe Medical Center
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      ​​Thank you for your question on CMS190, Intensive Care Unit Venous Thromboembolism Prophylaxis. If the physician felt that that patient was anticoagulated because heparin was administered during the procedure, then that needs to be documented as a reason for no pharmacological VTE prophylaxis after the procedure in order for the case to be included in the numerator. Similarly, if there is no mechanical VTE prophylaxis administered, there needs to be a documented reason for the case to be included in the numerator.


      Your suggestion to ask the providers to use a VTE Prophylaxis order set to indicate that pharmacological and mechanical VTE prophylaxis is contraindicated/not medically indicated for the first 48 hours after surgery sounds appropriate.
      Show
      ​​Thank you for your question on CMS190, Intensive Care Unit Venous Thromboembolism Prophylaxis. If the physician felt that that patient was anticoagulated because heparin was administered during the procedure, then that needs to be documented as a reason for no pharmacological VTE prophylaxis after the procedure in order for the case to be included in the numerator. Similarly, if there is no mechanical VTE prophylaxis administered, there needs to be a documented reason for the case to be included in the numerator. Your suggestion to ask the providers to use a VTE Prophylaxis order set to indicate that pharmacological and mechanical VTE prophylaxis is contraindicated/not medically indicated for the first 48 hours after surgery sounds appropriate.
    • CMS0190v11
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      Quality Management is considering rolling out education to our thoracic surgery team regarding potential use of VTE prophylactic order sets in post-op CABG patients in critical care. Pending response from this forum. Will impact if/how a high volume of our critical care patients fit into the VTE-2 measure population.
      Show
      Quality Management is considering rolling out education to our thoracic surgery team regarding potential use of VTE prophylactic order sets in post-op CABG patients in critical care. Pending response from this forum. Will impact if/how a high volume of our critical care patients fit into the VTE-2 measure population.

      There has been a historical argument (pre eCQM) that IV heparin administered during cardiac bypass surgery satisfies quality measure requirement for VTE prophylaxis by end of the second hospital day in post-op critical care patients.

      In light of the VTE-2 eCQM logic, verification has been requested regarding the following arguments to the contrary:

      1. The start time for VTE-2 begins AFTER surgery has ended (if prior to the end of admission day two).  VTE-2 is not satisfied by measures implemented during the procedure itself.
      2. IV heparin does not satisfy the VTE prophylaxis intent.  The VTE-2 measure value set includes only subcutaneous or oral pharmacological prophylaxis, or mechanical prophylaxis.

      Also, we would like assistance thinking through the following dilemma of reality vs VTE-2 measure expectations.

      Our CABG patients typically do not receive pharmacological VTE prophylaxis post-operatively, due to theoretical risks of bleeding.  Instead, and due to vein harvesting in their legs, there is a delay of 48-hours before compression hose is implemented.  This means that mechanical VTE prophylaxis is often implemented beyond the end of day two of hospitalization.

      In theory, this causes these patients to become VTE-2 measure fallouts. If this is correct, what do we need to do to prevent these patients from becoming VTE-2 measure fallouts?

      My current thinking is to ask the providers to use a VTE Prophylaxis order set to indicate that pharmacological and mechanical VTE prophylaxis is contraindicated/not medically indicated for the first 48 hours after surgery, and hope this excludes the patients from the measure population.  Does this sound reasonable?  Other suggestions?

            JLeflore Joelencia Leflore
            NCurrah Nathan Jay Currah (Inactive)
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