Brief Description of Measure: CMS986/GMCS: Global Malnutrition Composite Score This measure assesses the percentage of hospitalizations for adults aged 65 years and older at the start of the inpatient encounter during the measurement period with a length of stay equal to or greater than 24 hours who received optimal malnutrition care during the current inpatient hospitalization 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 or for a hospital dietitian referral order, 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: Current measure logic does not count Hospital Dietitian Referral for completion of Measure Observation 1. Updated logic will assign a score of 1 for Measure Observation 1 "Malnutrition Risk Screening" if there is a Hospital Dietitian Referral ordered or a Malnutrition Risk Screening performed with an identified result. Hospital protocols do not require a Nutrition Risk Screening if there is clinical judgement applied and a Hospital Dietitian Referral has been ordered. This proposed update would allow for a Hospital Dietician Referral to meet measure criteria, reflecting the clinical judgement of eligible clinicians.

Proposed Solution: We are proposing the addition of logic to define "Encounter with Malnutrition Risk Screening and Identified Result or with Hospital Dietitian Referral" to include the addition of "or exists ( "Encounter with Hospital Dietitian Referral" )". Current logic: define function "Measure Observation 1"(Encounter "Encounter, Performed"):   if ( "Encounter with Malnutrition Risk Screening and Identified Result or with Hospital Dietitian Referral" contains Encounter       and ( "Encounter with Malnutrition Screening Not At Risk Result" contains Encounter           or ( "Encounter with Malnutrition Screening At Risk Result" contains Encounter )       )   ) then 1     else 0 Proposed logic: define function "Measure Observation 1"(Encounter "Encounter, Performed"):   if ( "Encounter with Malnutrition Risk Screening and Identified Result or with Hospital Dietitian Referral" contains Encounter       and ( "Encounter with Malnutrition Screening Not At Risk Result" contains Encounter           or ( "Encounter with Malnutrition Screening At Risk Result" contains Encounter )       )       or exists ( "Encounter with Hospital Dietitian Referral" )   ) then 1     else 0 Rationale for Change: When Hospital Dietitian Referrals are ordered, clinicians are following established protocols or clinical judgement with concern for the nutritional status of the patient. This update is in alignment with the intent of Measure Observation 1 "Nutrition Risk Screening."