CMS871/HH-02: Hospital Harm- Severe Hyperglycemia:
This measure assesses the number of inpatient hospital days with a hyperglycemic event (harm) per the total qualifying inpatient hospital days for patients 18 years of age or older at admission.
CMS816/HH-01: Hospital Harm- Severe Hypoglycemia:
The proportion of inpatient hospitalizations for patients 18 years of age or older at admission, who were administered at least one hypoglycemic medication during the encounter, who suffer the harm of a severe hypoglycemic event during the encounter.
Harm (numerator) is defined as a laboratory or point-of-care (POC) test for blood glucose with a result less than 40 mg/dL, where the hypoglycemic medication was given within the 24 hours prior to the start of the low blood glucose event (and administered during the encounter). Only one severe hypoglycemic event is counted per inpatient hospitalization encounter.
Glucose lab test results are evaluated in the CMS 816 Hypoglycemia measure's numerator, and in the CMS 871 Hyperglycemia measure's denominator and numerator. Currently, the measures use the value set Glucose lab test (OID 2.16.840.1.1137188.8.131.525.134) which includes code concepts of a blood glucose specimen (e.g., 2345-7 Glucose [Mass/volume] in Serum or Plasma) and are not based on the device used, as the criteria is looking to capture just the result.
IMPAQ received feedback from pre-rulemaking public comment requesting we consider including in our measures the glucose results from interstitial fluid via a continuous glucose monitoring (CGM) device, and that the guidance on the measures be revised to include this concept.
IMPAQ seeks to obtain additional information on the use of CGM specimens (interstitial fluid) in the monitoring of glucose levels during inpatient hospitalizations. This feedback will assist in our consideration to include this concept in the measures and to determine if it aligns with measure intent.
Please provide feedback on the following:
1) Are results from CGMs consistently used in all hospital settings to monitor the patient's glucose levels?
2) What is the workflow/process if CGM results are monitored and recorded, e.g., where and how are the results documented? Are they documented discretely (i.e., as CGM glucose, interstitial glucose fluid, or body fluid)? How frequently are the results recorded, given they are continuous?
3) For out of range or critical low/high results, is there an alert and are the clinicians in the hospital notified?
4) Does point of care testing still occur on a patient with a CGM device? If there are differences between the two results, which value is used for clinical decision-making?
Including glucose values from interstitial fluid will align with those hospitals that have adopted CGM as a tool to monitor glucose levels.