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  2. CQM-6067

eCQM CMS108 VTE Medication - Eliquis

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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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      Thank you for your question. To clarify, it is still a correct statement that Apixaban is NOT listed in the value set as a medication for VTE prophylaxis. This means that it is not unioned with other VTE prophylaxis medication in the definition below:

      Pharmacological or Mechanical VTE Prophylaxis Received

       
      ( ["Medication, Administered": "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication
          where VTEMedication.route in "Subcutaneous route"
      )
        union ["Medication, Administered": "Low Molecular Weight Heparin for VTE Prophylaxis"]
        union ["Medication, Administered": "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]
        union ["Medication, Administered": "Warfarin"]
        union ["Medication, Administered": "Rivaroxaban for VTE Prophylaxis"]......
      There are total of 5 conditions that meet the numerator population in VTE-1, as identified in the numerator logic:
      "Encounter with VTE Prophylaxis Received From Day of Start of Hospitalization To Day After Admission or Procedure"
        union ( "Encounter with Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"
            intersect ( "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Prior Diagnosis of VTE"
                union "Encounter with Prior or Present Procedure of Hip or Knee Replacement Surgery"
            )
        )
        union "Encounter with Low Risk for VTE or Anticoagulant Administered"
        union "Encounter with No VTE Prophylaxis Due to Medical Reason"
        union "Encounter with No VTE Prophylaxis Due to Patient Refusal"
      In summary, for numerator scenario 1, if a patient is given Apixaban for VTE prophylaxis, the patient will not meet the numerator, as Apixaban is not included in any of the value sets. The only scenario that would count toward the numerator is a case in which a patient was given Apixaban during the qualifying timeframe and has either a diagnosis of atrial fibrillation or prior diagnosis of VTE or previous hip/knee replacement.
      Show
      Thank you for your question. To clarify, it is still a correct statement that Apixaban is NOT listed in the value set as a medication for VTE prophylaxis. This means that it is not unioned with other VTE prophylaxis medication in the definition below: Pharmacological or Mechanical VTE Prophylaxis Received   ( ["Medication, Administered": "Low Dose Unfractionated Heparin for VTE Prophylaxis"] VTEMedication     where VTEMedication.route in "Subcutaneous route" )   union ["Medication, Administered": "Low Molecular Weight Heparin for VTE Prophylaxis"]   union ["Medication, Administered": "Injectable Factor Xa Inhibitor for VTE Prophylaxis"]   union ["Medication, Administered": "Warfarin"]   union ["Medication, Administered": "Rivaroxaban for VTE Prophylaxis"]...... There are total of 5 conditions that meet the numerator population in VTE-1, as identified in the numerator logic: "Encounter with VTE Prophylaxis Received From Day of Start of Hospitalization To Day After Admission or Procedure"   union ( "Encounter with Medication Oral Factor Xa Inhibitor Administered on Day of or Day After Admission or Procedure"       intersect ( "Encounter with Prior or Present Diagnosis of Atrial Fibrillation or Prior Diagnosis of VTE"           union "Encounter with Prior or Present Procedure of Hip or Knee Replacement Surgery"       )   )   union "Encounter with Low Risk for VTE or Anticoagulant Administered"   union "Encounter with No VTE Prophylaxis Due to Medical Reason"   union "Encounter with No VTE Prophylaxis Due to Patient Refusal" In summary, for numerator scenario 1, if a patient is given Apixaban for VTE prophylaxis, the patient will not meet the numerator, as Apixaban is not included in any of the value sets. The only scenario that would count toward the numerator is a case in which a patient was given Apixaban during the qualifying timeframe and has either a diagnosis of atrial fibrillation or prior diagnosis of VTE or previous hip/knee replacement.
    • CMS0108v11
    • Unclear understanding of when eliquis can be used in accordance with this measure.

      We continue to have questions about the correct and/or acceptable uses of Eliquis for this measure. A statement in the measure specs (see attachement) state that and Oral Factor Xa inhibitor can be used with prior or present dx of Afib or prior dx of VTE.

      In a previous case we were told that Eliquis could NOT be used for VTE prophylaxis and treament.(see additional attached document)

      If the patient has a history of PE will eliquis meet the measure. Currently these patients are failing for us.

      We are confused on when Eliquis can and can NOT be used.

      Could you please clearly explain for what scenarios it is acceptable for Eliquis to be considered?

        1. eliquis spec statement.docx
          20 kB
        2. CQM-5480 (002).doc.htm
          131 kB

            JLeflore Joelencia Leflore
            jcargile Jason Cargile (Inactive)
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