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  1. eCQM Issue Tracker
  2. CQM-871

Clarification needed for Numerator criteria for VTE-3 Venous Thromboembolism Patients with Anticoagulation Overlap Therapy

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    • Icon: EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals EH/CAH eCQMs - Eligible Hospitals/Critical Access Hospitals
    • Resolution: Answered
    • Icon: Minor Minor
    • Guidance, Measure
    • Phyllis Browne
    • 410-796-6231
    • Press Ganey Associates
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      Thank you for your question. This was reviewed with the steward and the steward’s response was:

      "The INR labs in the ED are not checked because the patient has not undergone at least 4 days of overlap. A case will only meet the measure if overlap is >= 4 days AND INR>=2, so if < 4 days and INR >=2 wouldn’t qualify for the numerator (which would be where the INR in the ED scenario would fall). Also, overlap therapy >= 4 days BUT INR <2 wouldn’t be a numerator criterion either".
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      Thank you for your question. This was reviewed with the steward and the steward’s response was: "The INR labs in the ED are not checked because the patient has not undergone at least 4 days of overlap. A case will only meet the measure if overlap is >= 4 days AND INR>=2, so if < 4 days and INR >=2 wouldn’t qualify for the numerator (which would be where the INR in the ED scenario would fall). Also, overlap therapy >= 4 days BUT INR <2 wouldn’t be a numerator criterion either".
    • CMS73v1/NQF0373
    • Clarification of Numerator criteria for VTE-3

      In the Numerator criteria, within the first AND statement (first OR statement under that), related to the Difference between dates >= 4 day(s) of:, the second part lists that the MOST RECENT Medication, Administered: Parenteral Anticoagulant can occur during: "Occurrence A of Encounter, Performed, Emergency Department Visit."

      (as well as in the Inpatient Encounter but the ED part is what is pertinent to the question)

      However, when you get to the next part of this section (next AND statement) it only references Laboratory Test results being after medication administered as an Inpatient :

      Laboratory Test Result INR(result > = 2) < = 1 day(s) starting before the start of ("Medication, Administered: Parenteral Anticoagulant" during "Occurrence A of Encounter, Performed: Inpatient Encounter.")

      There is no corresponding reference for doing the same Laboratory test before getting the medication in the ED, so how is it possible for the most recent medication to be in the ED but the next part of the algorithm reference only medications administered as an Inpatient?

      And since CQM-631 indicates that with the next release of the measure, the words "MOST RECENT" will be added back in front of Medication Administered in the second section, it is even more confusing to indicate that the most recent medication could have been in the ED but then indicate the Laboratory Test Result had to be started before the most recent medication administered as an Inpatient.

      Can you explain/clarify the intent of this part of the Numerator criteria for VTE-3.

            cynthial.barton Cynthia L. Barton (Inactive)
            pbrowne Phyllis Browne (Inactive)
            Phyllis Browne (Inactive)
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