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 adding a value set, definition, and logic for "Malnutrition Screening Result Not At Risk" to differentiate between a negative malnutrition risk screening (i.e., no malnutrition risk identified) and no documented findings of the "Malnutrition Risk Screening" results. To link this new content with the measure, the measure developers will also add a new definition for "Nutrition Assessment Result Identified", and propose revisions to the "Nutrition Assessment" definition and "Measure Observation 1" function. Goal of review Obtain technical feedback

Proposed solution Add a new value set and definition for "Malnutrition Screening Not At Risk Result", add a proposed new definition for "Malnutrition Screening Result Identified", and propose revisions for the "Malnutrition Risk Screening" definition and "Measure Observation 1" function.   PROPOSED "MALNUTRITION SCREENING NOT AT RISK RESULT" VALUE SET 445361000124101: Able to manage nutrition (finding) CURRENT LOGIC: define "Encounter with Malnutrition Risk Screening"   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionRiskScreening       such that MalnutritionRiskScreening.authorDatetime during GlobalMalnutritionEncounter.relevantPeriod define "Encounter with Malnutrition Screening At Risk Result"   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Screening At Risk Result"] MalnutritionScreeningResult       such that MalnutritionScreeningResult.authorDatetime during GlobalMalnutritionEncounter.relevantPeriod define function "Measure Observation 1(Encounter "Encounter, Performed")"   if ( ( "Encounter with Malnutrition Risk Screening" contains Encounter ) then 1     else 0 PROPOSED LOGIC: define "Encounter with Malnutrition Risk Screening"   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": Malnutrition Risk Screening"] MalnutritionRiskScreening           such that MalnutritionRiskScreening.relevantPeriod during GlobalMalnutritionEncounter.relevantPeriod              and MalnutritionScreeningResultIdentified.relevantPeriod during GlobalMalnutritionEncounter.relevantPeriod define "Encounter with Malnutrition Screening At Risk Result"   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Screening At Risk Result"] MalnutritionScreeningAtRiskResult       such that MalnutritionScreeningAtRiskResult.authorDatetime during GlobalMalnutritionEncounter.relevantPeriod define "Encounter with Malnutrition Screening Not At Risk Result"   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Screening Not At Risk Result"] MalnutritionScreeningNotAtRiskResult       such that MalnutritionScreeningAtRiskResult.relevantDatetime during GlobalMalnutritionEncounter.relevantPeriod define "Encounter With Malnutrition Screening Result Identified"   ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionScreeningResultIdentified     where ( MalnutritionScreeningResultIdentified.result in "Malnutrition Screening Not At Risk Result"       or MalnutritionScreeningResultIdentified.result in "Malnutrition Screening At Risk Result"  ) define function "Measure Observation 1(Encounter "Encounter, Performed")"   if ( ( "Encounter with Malnutrition Risk Screening" contains Encounter )       and ( "Encounter With Malnutrition Screening Result Identified" contains Encounter ) ) then 1     else 0 Rationale for change The current definition for the "Encounter with Malnutrition Risk Screening" does not include identification of a Malnutrition Screening Risk Result for the Assessment, performed. In the current logic, hospitalizations for patients who are "not at risk for malnutrition" and those "without documentation of malnutrition risk result" would both not meet the Measure Observation for Population 2 Criteria, meaning they would not be clinically eligible for Measure Observation 2 "Nutrition Assessment".  By adding the "Malnutrition Screening Not At Risk Result" value set, definition, and logic and linking it to the "Encounter with Malnutrition Risk Screening" definition, implementers will be able to identify hospitalizations for patients who are clinically eligible for the "Nutrition Assessment", and subsequent clinically eligible components (i.e., "Malnutrition Diagnosis" and "Nutrition Care Plan"), as well as hospitalizations that did not perform all clinically eligible Measure Observations.