Venous Thromboembolism Patients with Anticoagulation Overlap Therapy

Last updated: January 31, 2017

CMS Measure ID: CMS73v5
Version: 5
NQF Number: 0373
Measure Description:

This measure assesses the number of patients diagnosed with confirmed VTE who received an overlap of parenteral (intravenous [IV] or subcutaneous [subcu]) anticoagulation and warfarin therapy. For patients who received less than five days of overlap therapy, they should be discharged on both medications or have a reason for discontinuation of overlap therapy. Overlap therapy should be administered for at least five days with an international normalized ratio (INR) greater than or equal to 2 prior to discontinuation of the parenteral anticoagulation therapy, discharged on both medications or have a reason for discontinuation of overlap therapy.

Initial Patient Population:

Patients age 18 and older discharged from hospital inpatient acute care during the measurement period with a length of stay less than or equal to 120 days and a diagnosis of venous thromboembolism (VTE)

Denominator Statement:

Patients with VTE confirmed through a diagnostic test who received warfarin

Denominator Exclusions:
  • Patients with comfort measures documented
  • Patients discharged to a health care facility for hospice care
  • Patients discharged to home for hospice care
  • Patients who expired
  • Patients who left against medical advice
  • Patients discharged to an acute care facility
Numerator Statement:

Patients who received overlap therapy (warfarin and parenteral anticoagulation):

  • Five or more days, with an INR greater than or equal to 2 prior to discontinuation of parenteral therapy OR
  • Five or more days, with an INR less than 2 and discharged on overlap therapy OR
  • Less than five days and discharged on overlap therapy OR
  • With documentation of reason for discontinuation of parenteral therapy OR
  • With documentation of a reason for no overlap therapy
Numerator Exclusions:

Not Applicable

Denominator Exceptions:

None

Measure Steward: The Joint Commission
Domain: Effective Clinical Care
Short Name: VTE3
Previous Version: Venous Thromboembolism Patients with Anticoagulation Overlap Therapy
Improvement Notation:

Improvement noted as an increase in the rate

Guidance:

CMS recognizes the difficulty in capturing the VTE confirmed concept required in this measure and suggests eligible hospitals participating in the Medicare & Medicaid EHR Incentive Programs consider selecting alternative electronic clinical quality measures (eCQMs) to meet program requirements for meaningful use. If suitable alternatives are unavailable, CMS will accept a 0 denominator submission for the eCQM version only for this measure.

In the numerator logic, overlap therapy duration uses four days (instead of five) as a threshold because the subtraction doesn't take into account one of the dates. For example, for a patient started on overlap therapy on 01/01/2016 who was last administered a parenteral anticoagulant on 01/05/2016, the difference between the dates is 4 days, but the number of days the patient was on overlap therapy was 5.

The denominator logic identifies the first confirmatory VTE diagnostic test because there are logic criteria dependent on the timing of the initial confirmation of the VTE diagnosis. Subsequent references to the VTE diagnostic test use occurrencing to ensure that the first confirmatory VTE diagnostic test is consistently used throughout the logic.

Specifications

Release Notes

Header

  • Updated Copyright.

    Section: Copyright

    Source: Annual Update

  • Revised statement to better align with logic content.

    Section: Denominator

    Source: JIRA (CQM-1756)

  • Removed two statements to align with denominator exclusions logic. The related logic is found in the denominator logic, and not the denominator exclusions logic.

    Section: Denominator Exclusions

    Source: JIRA (CQM-1756)

  • Incremented eMeasure Version number.

    Section: eMeasure Version number

    Source: Measure Lead

  • Added guidance statement to clarify use of 'First' operator for VTE diagnostic test.

    Section: Guidance

    Source: Measure Lead

  • Added guidance to clarify threshold used for overlap therapy duration calculation (4 days) vs. Numerator narrative (5 days).

    Section: Guidance

    Source: JIRA (CQM-1632)

  • Removed unit of measurement language from Guidance. HQMF now has a header field, 'measure item count', where the unit of measurement can be identified in a computable fashion.

    Section: Guidance

    Source: Measure Lead

  • Revised statement to align with initial population statements in other VTE eCQMs.

    Section: Initial Population

    Source: Measure Lead

Logic

  • Added First operator to diagnostic study, performed, to ensure the first VTE confirmatory test is used throughout the eCQM logic.

    Section: Denominator

    Source: Measure Lead

  • Added new attribute 'diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic.

    Section: Initial Population

    Source: QDM Standards

  • Introduced the operator 'Intersection of' to condense logic and reduce complexity.

    Section: Initial Population

    Source: Measure Lead

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Initial Population

    Source: QDM Standards

  • Reformatted logic surrounding the use of the First operator to clarify its scope of applicability.

    Section: Numerator

    Source: JIRA (CQM-1755)

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: Numerator

    Source: QDM Standards

  • Added new attribute 'diagnosis' to 'Encounter, performed' datatype to conform to QDM 4.2 changes and provide more accurate logic.

    Section: QDM Data Elements

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Data Elements

    Source: QDM Standards

  • Replaced datatypes 'Diagnosis, Active; with the re-specified 'Diagnosis' datatype to conform to QDM 4.2 changes.

    Section: QDM Variables

    Source: QDM Standards

Value Set

  • Value set Dabigatran (2.16.840.1.113762.1.4.1110.4): Added 1 RXNORM code (1723476).

    Section: None

    Source: None

  • Value set Medical Reason (2.16.840.1.113883.3.117.1.7.1.473): Deleted 1 SNOMEDCT code (161590003).

    Section: None

    Source: None

  • Value set Oral Factor Xa Inhibitor for VTE Prophylaxis or VTE Treatment (2.16.840.1.113883.3.117.1.7.1.134): Added 3 RXNORM codes (1599543, 1599551, 1599555).

    Section: None

    Source: None

  • Value set Parenteral Anticoagulant (2.16.840.1.113883.3.117.1.7.1.266): Added 5 RXNORM codes (1658637, 1658717, 1658720, 1659195, 1659197) and deleted 13 RXNORM codes.

    Section: None

    Source: JIRA (CQM-1482)

  • Value set Thrombocytopenia (2.16.840.1.113762.1.4.1045.45): Removed ICD9CM extensional value set (2.16.840.1.113762.1.4.1045.44) including 7 codes.

    Section: None

    Source: None

  • Value set VTE Diagnostic Test (2.16.840.1.113883.3.117.1.7.1.276): Deleted 12 LOINC codes.

    Section: None

    Source: None

External Resources