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: Several measure definitions have duplicative logic, which may be confusing to reporters. Because these phrases do not contribute to logic functionality, the measure steward proposes their removal.

Proposed Solution: The current measure logic contains duplicative phrases that do not contribute to functionality. These duplicative phrases will be removed, specifically the following: (1) "or MalnutritionRiskScreening.result in "Malnutrition Screening At Risk Result" )" from the definition of Encounter with Malnutrition Risk Screening (2) "and MalnutritionRiskScreening.result in "Malnutrition Screening Not At Risk Result" from the definition of Encounter with Malnutrition Screening Not At Risk Result (3) "and MalnutritionRiskScreening.result in "Malnutrition Screening At Risk Result" from the definition of Encounter with Malnutrition Screening At Risk Result Current logic: define "Encounter with Malnutrition Risk Screening and Identified Result":   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionRiskScreening       such that Coalesce(start of Global."NormalizeInterval"(MalnutritionRiskScreening.relevantDatetime, MalnutritionRiskScreening.relevantPeriod), MalnutritionRiskScreening.authorDatetime)during Global."HospitalizationWithObservation" ( GlobalMalnutritionEncounter )         and ( MalnutritionRiskScreening.result in "Malnutrition Screening Not At Risk Result"             or MalnutritionRiskScreening.result in "Malnutrition Screening At Risk Result"         ) define "Encounter with Malnutrition Screening Not At Risk Result":   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionRiskScreening       such that Coalesce(start of Global."NormalizeInterval"(MalnutritionRiskScreening.relevantDatetime, MalnutritionRiskScreening.relevantPeriod), MalnutritionRiskScreening.authorDatetime)during Global."HospitalizationWithObservation" ( GlobalMalnutritionEncounter )         and MalnutritionRiskScreening.result in "Malnutrition Screening Not At Risk Result" define "Encounter with Malnutrition Screening At Risk Result":   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionRiskScreening       such that Coalesce(start of Global."NormalizeInterval"(MalnutritionRiskScreening.relevantDatetime, MalnutritionRiskScreening.relevantPeriod), MalnutritionRiskScreening.authorDatetime)during Global."HospitalizationWithObservation" ( GlobalMalnutritionEncounter )         and MalnutritionRiskScreening.result in "Malnutrition Screening At Risk Result" Proposed logic: define "Encounter with Malnutrition Risk Screening and Identified Result":   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionRiskScreening       such that Coalesce(start of Global."NormalizeInterval"(MalnutritionRiskScreening.relevantDatetime, MalnutritionRiskScreening.relevantPeriod), MalnutritionRiskScreening.authorDatetime)during Global."HospitalizationWithObservation" ( GlobalMalnutritionEncounter )         and ( MalnutritionRiskScreening.result in "Malnutrition Screening Not At Risk Result"            ) define "Encounter with Malnutrition Screening Not At Risk Result":   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionRiskScreening       such that Coalesce(start of Global."NormalizeInterval"(MalnutritionRiskScreening.relevantDatetime, MalnutritionRiskScreening.relevantPeriod), MalnutritionRiskScreening.authorDatetime)during Global."HospitalizationWithObservation" ( GlobalMalnutritionEncounter )         define "Encounter with Malnutrition Screening At Risk Result":   "Global Malnutrition Encounter" GlobalMalnutritionEncounter     with ["Assessment, Performed": "Malnutrition Risk Screening"] MalnutritionRiskScreening       such that Coalesce(start of Global."NormalizeInterval"(MalnutritionRiskScreening.relevantDatetime, MalnutritionRiskScreening.relevantPeriod), MalnutritionRiskScreening.authorDatetime)during Global."HospitalizationWithObservation" ( GlobalMalnutritionEncounter ) Rationale for Change: Simplifying the measure logic streamlines interpretation and decreases implementer confusion.