Thank you for your question regarding CMS871v4, Hospital Harm – Severe Hyperglycemia. Regarding the timing of the denominator exclusions criteria, an inpatient hospitalization period includes time in the emergency department (ED) and observation when the transition between these encounters (if they exist) and the inpatient encounter are within an hour or less of each other. Therefore, if the transition time between the ED encounter and the inpatient admission is an hour or less, then the ED start date and time would be used to calculate the seven-hour period that is evaluated in the denominator exclusions criteria (one hour prior to the start of the ED encounter to six hours after the start of the ED encounter). Regarding the glucose results, the measure logic looks specifically for results that are >=1,000 mg/dL. A patient with a glucose result of “>600 mg/dL” but less than 1000 mg/dL within one hour prior to the start of the encounter to six hours after the start of the encounter would not meet the denominator exclusions criteria. However, we will consider your feedback about glucose test workflows in future updates to the measure.

Denominator Exclusion: Inpatient hospitalizations for patients with a glucose result of >=1000 mg/dL anytime between 1 hour prior to the start of the encounter to 6 hours after the start of the encounter. What date/time is used for the 1-hour and 6-hour windows? ED Start Date/Time or Inpatient Start Date/Time?