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: In the current measure logic, when Measure Observation 1 "Nutrition Risk Screening" is documented with an "At Risk" status, OR there is a Hospital Dietitian Referral ordered, but there is no “Nutrition Assessment” documented in Measure Observation 2, the measure executes with an eligible denominator for the composite score of 4. However, the measure intent is for the composite score to reflect a “Malnutrition Diagnosis” (Measure Observation 3) and “Nutrition Care Plan” (Measure Observation 4) only for those patients identified as Moderately or Severely Malnourished. The measure will be updated to adjust the eligible denominator in this scenario to 2, reflecting the fact that no Measure Observation 2 “Nutrition Assessment” is documented.

Proposed Solution: Current logic: define function "TotalMalnutritionCompositeScore Eligible Denominators"(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     )       and not ( "Encounter with Hospital Dietitian Referral" contains Encounter )   ) then 1     else 4 Proposed logic: define function "TotalMalnutritionCompositeScore Eligible Denominators"(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     )       and not ( "Encounter with Hospital Dietitian Referral" contains Encounter )   ) then 1     else if ( ( "Encounter with Malnutrition Risk Screening and Identified Result or with Hospital Dietitian Referral" contains Encounter         and "Encounter with Malnutrition Screening At Risk Result" contains Encounter     )       or ( "Encounter with Hospital Dietitian Referral" contains Encounter )   )     and ( "Encounter with Nutrition Assessment and Identified Status" contains Encounter         and "Encounter with Nutrition Assessment Status Not or Mildly Malnourished" contains Encounter     )     or not ( "Encounter with Nutrition Assessment and Identified Status" contains Encounter ) then 2     else 4 Rationale for Change: This update aligns with the intent of the measure by applying “Malnutrition Diagnosis” (Measure Observation 3) and “Nutrition Care Plan” (Measure Observation 4) only for patients with Moderate or Severe Malnutrition Identified.