Brief description of measure ​CMS986: Global Malnutrition Composite Score: This measure assesses the percentage of hospitalizations for adults aged 65 years and older prior to the start of the measurement period with a length of stay equal to or greater than 24 hours who received optimal malnutrition care during the current inpatient hospitalizations where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are screened for malnutrition risk, assessed to confirm findings of malnutrition risk, and if identified with a "moderate" or "severe"  malnutrition status in the current performed malnutrition assessment, receive a current "moderate" or "severe" malnutrition diagnosis and have a current nutrition care plan performed. Description of issue The measure developer recommends updating the clinical eligibility of the Nutrition Assessment component (Measure Observation 2), which is currently with an identified "Malnutrition Screening At Risk Result" from the "Malnutrition Risk Screening" (Measure Observation 1). In the hospital setting, the "Nutrition Assessment" is also initiated by a physician or eligible clinician order or consultation request for a nutritionist. This change permits an evaluation of the "Nutrition Assessment", "Malnutrition Diagnosis", and "Nutrition Care Plan" (Measure Observations 2, 3, & 4 respectively) if the "Malnutrition Risk Screening" (Measure Observation 1) is not performed or the "Malnutrition Screening Result Identified" is not documented.   Goal of review Obtain technical feedback

Proposed solution Add a new value set and definition for "Hospital Dietician Referral" to be linked with "Nutrition Assessment" (Measure Observation 2). PROPOSED NEW "HOSPITAL DIETICIAN REFERRAL" VALUE SET 103699006: Patient referral to dietitian (procedure) 306163007: Referral to dietetics service (procedure) 306165000: Referral to hospital-based dietetics service (procedure) 306354000: Referral to hospital-based dietitian (procedure) 428461000124101: Referral to nutrition professional (procedure) PROPOSED "HOSPITAL DIETICIAN REFERRAL" DEFINITION define "Encounter with Hospital Dietician Referral":   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Intervention, Order": "Hospital Dietician Referral"] HospitalDieticianReferral       such that HospitalDieticianReferral.relevantDatetime during GlobalMalnutritionEncounter.relevantPeriod CURRENT MEASURE OBSERVATION 2 FUNCTION Measure Observation 2(Encounter "Encounter, Performed") if ( ( "Encounter with Malnutrition Screening At Risk Result" contains Encounter )     and ( "Encounter with Malnutrition Assessment" contains Encounter ) ) then 1   else 0   PROPOSED MEASURE OBSERVATION 2 FUNCTION Measure Observation 2(Encounter "Encounter, Performed") if ( ( "Encounter with Malnutrition Screening At Risk Result" contains Encounter )          or ( "Encounter with Hospital Dietician Referral" contains Encounter )     and ( "Encounter with Nutrition Assessment" contains Encounter ) ) then 1   else 0 Rationale for change In the hospital setting, a "Nutrition Assessment" (Measure Observation 2) is initiated by an "at risk for malnutrition" screening result or an order or consultation request from a physician or eligible clinician. By updating the clinical eligibility of the "Nutrition Assessment" to also include an order or consultation request from a physician or eligible clinician, the clinical eligibility aligns to care delivery activities and also permits the evaluation of the "Nutrition Assessment", "Malnutrition Diagnosis", and "Nutrition Care Plan" ((Measure Observations 2, 3, & 4 respectively) if the "Malnutrition Risk Screening" (Component 1) is not performed or the "Malnutrition Screening Result Identified" is not documented.