CMS1061-Numerator systematically undercounts postoperative VTE due to cross-facility attribution gap

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Resolved
    • Priority: Moderate
    • Component/s: None
    • None
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      9/22/2026:
      Thank you again for your inquiry regarding CMS106v1 Hospital Harm - Postoperative Venous Thromboembolism.

      The measure logic does not restrict the subsequent inpatient encounter in Criterion C based on CMS Certification Number (CCN), facility, or reporting-quarter boundaries. Criterion C evaluates whether a qualifying inpatient encounter is followed by a subsequent inpatient encounter with a VTE diagnosis and anticoagulant therapy within 30 days of the first surgical procedure. However, calculation and reporting of the measure depend on the clinical data available to the systems performing measure calculation and generating the QRDA Category I file, consistent with applicable CMS reporting requirements. Therefore, if a postoperative VTE is diagnosed and treated during a subsequent encounter and the data from that encounter are not available to the system performing measure calculation, the subsequent VTE would not be identified through Criterion C.

      [For follow-up questions submitted more than 30 days after the "Solution Posted On" date, please submit a new Jira ticket.]


      8/5/2026:
      Thank you for your inquiry regarding CMS106v1 Hospital Harm - Postoperative Venous Thromboembolism. Considering this eCQM has been proposed, but not yet finalized for reporting, we will respond to this inquiry following the publication of the CY 2027 Inpatient Prospective Payment System​ (IPPS) final rule. Thank you for your patience.
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      9/22/2026: Thank you again for your inquiry regarding CMS106v1 Hospital Harm - Postoperative Venous Thromboembolism. The measure logic does not restrict the subsequent inpatient encounter in Criterion C based on CMS Certification Number (CCN), facility, or reporting-quarter boundaries. Criterion C evaluates whether a qualifying inpatient encounter is followed by a subsequent inpatient encounter with a VTE diagnosis and anticoagulant therapy within 30 days of the first surgical procedure. However, calculation and reporting of the measure depend on the clinical data available to the systems performing measure calculation and generating the QRDA Category I file, consistent with applicable CMS reporting requirements. Therefore, if a postoperative VTE is diagnosed and treated during a subsequent encounter and the data from that encounter are not available to the system performing measure calculation, the subsequent VTE would not be identified through Criterion C. [For follow-up questions submitted more than 30 days after the "Solution Posted On" date, please submit a new Jira ticket.] 8/5/2026: Thank you for your inquiry regarding CMS106v1 Hospital Harm - Postoperative Venous Thromboembolism. Considering this eCQM has been proposed, but not yet finalized for reporting, we will respond to this inquiry following the publication of the CY 2027 Inpatient Prospective Payment System​ (IPPS) final rule. Thank you for your patience.
    • cms1061v1
    • Not measure related
    • CMS0071v15
    • CMS0071v14
    • CMS0071v13

      Numerator criterion "Encounters With Subsequent VTE Encounter Within 30 Days PostOp" does not account for the nature of file transmission for CMS reporting. A readmission for VTE can only be satisfied if the readmission itself appears in the submitting hospital's own QRDA I file. These files are CCN- and quarter-specific. VTE events diagnosed and treated at any other facility within the 30-day window, even if the encounter occurred at a facility sharing the same EHR instance, must not be reported, thereby producing systematic false negatives. Hospitals with higher out-of-network follow-up care will appear to perform better than hospitals with high patient retention, independent of actual care quality.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Alex Liu
            Votes:
            4 Vote for this issue
            Watchers:
            8 Start watching this issue

              Created:
              Updated:
              Resolved:
              Solution Posted On: