Brief Description of Measure: CMS122: Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period Description of Issue: This update is being made in conjunction with another proposed update to add glucose management indicator (GMI) as option to meet Numerator criteria ( https://oncprojectracking.healthit.gov/support/browse/CQM-6416 ). In previous versions of the measure, the intent of the measure was to monitor glycemic levels using HbA1c lab values only. With the transition to include GMI alongside HbA1c multiple glycemic assessments may occur on the same day (HbA1c or GMI), although this scenario is uncommon. To promote effective compliance with Numerator criteria, the measure developer proposes to update the measure such that providers are able to prioritize the lowest result obtained on the same day. This way, there is no implication of a preference for one type of glycemic status assessment over the other as the objective is to optimize the quality of care without favoring a particular assessment method.

Proposed Solution: //Added the following statement to the Guidance section: "If multiple glycemic status assessments were recorded for a single date, use the lowest result."   //Logic Before:   define "Most Recent HbA1c": Last(["Laboratory Test, Performed": "HbA1c Laboratory Test"] RecentHbA1c     where Global."LatestOf"(RecentHbA1c.relevantDatetime, RecentHbA1c.relevantPeriod)during day of "Measurement Period"    sort by start of Global."NormalizeInterval"(relevantDatetime, relevantPeriod) define "Has Most Recent ElevatedHbA1c": "Most Recent HbA1c".result > 9 '%'   define "Has Most Recent HbA1c Without Result": " Most Recent HbA1c" is not null and "Most Recent HbA1c".result is null   //Logic After:   define "Glycemic Status Assessment":  ( ["Laboratory Test, Performed": "HbA1c Laboratory Test"]   union ["Laboratory Test, Performed": "Glucose management indicator"] ) GlycemicStatus   where Global."LatestOf" ( GlycemicStatus.relevantDatetime, GlycemicStatus.relevantPeriod ) during day of "Measurement Period"   define "Most Recent Glycemic Status Date": Last(("Glycemic Status Assessment" QualifyingGlycemicStatus     return date from start of Global."NormalizeInterval"(QualifyingGlycemicStatus.relevantDatetime, QualifyingGlycemicStatus.relevantPeriod)) QualifyingGlycemicStatusDays     sort asc  )   define "Lowest Glycemic Status Assessment Reading on Most Recent Day": First("Glycemic Status Assessment" QualifyingGlycemicStatus     where Global."LatestOf"(QualifyingGlycemicStatus.relevantDatetime, QualifyingGlycemicStatus.relevantPeriod) same day as "Most Recent Glycemic Status Date"     sort by(result as Quantity)  ) define "Has Most Recent Elevated Glycemic Status Assessment": "Lowest Glycemic Status Assessment Reading on Most Recent Day".result > 9 '%'   define "Has Most Recent Glycemic Status Assessment Without Result": "Lowest Glycemic Status Assessment Reading on Most Recent Day" is not null and "Lowest Glycemic Status Assessment Reading on Most Recent Day".result is null Rationale for Change: This update grants flexibility to prioritize lowest result obtained on the same day, aligning with measure intent and reducing provider burden by allowing for broader data capture of glycemic status assessment.