CMS986v4 Metadata Section/Guidance for Observations do not match the logic

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
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      Thank you for your inquiry regarding CMS986v4, the Global Malnutrition Composite Score (GMCS). The logic and guidance represent the same clinical intent but are described differently. The case you presented - Malnutrition NOT At Risk’ Result was identified AND ‘Hospital Dietitian Referral’ - will result in a denominator of 2 if a Nutrition Assessment status is either Not Malnourished or Mildly Malnourished.

      To simplify the logic, the Not At Risk function is not explicitly included because, if the Hospital Dietitian Referral exists, then the “Malnutrition Risk Screening” result is irrelevant, as the presence of a Hospital Dietitian Referral overrides the screening result.

      In other words, if EITHER the patient is screened has an “At Risk” result, OR the presence of a Hospital Dietitian Referral”, AND ALSO the patient’s Nutrition Assessment status is either Not Malnourished/Well Nourished/Mildly Malnourished or in the absence of a completed nutrition assessment, then the Eligible Occurrence = 2.

      Additionally, if there is a completed Nutrition Assessment with a “Moderately Malnourished” OR “Severely Malnourished” result, the Eligible Occurrence = 4. In the case of a “Malnutrition Risk Screening” that has an “At Risk” result, OR the presence of a Hospital Dietitian Referral”, the eligible occurrence would 2, only if:

      the result for the Nutrition Assessment would have to be “Well Nourished”
      OR

       “Not Malnourished” OR in the absence of a completed assessment.
      You are correct that if there is a completed Nutrition Assessment with a “Moderately Malnourished” OR “Severely Malnourished” result, the Eligible Occurrence = 4; however, there would have to ALSO be a “At Risk Malnutrition screening” OR a “Hospital Dietitian Referral” present.

      To ensure the above is correct, we have corroborated with a test case as shown in the example screenshot attached showing when the eligible occurrence would be 2. The MD will consider reviewing the language in the Guidance section for future Annual Update cycles to promote better understanding.
      Show
      Thank you for your inquiry regarding CMS986v4, the Global Malnutrition Composite Score (GMCS). The logic and guidance represent the same clinical intent but are described differently. The case you presented - Malnutrition NOT At Risk’ Result was identified AND ‘Hospital Dietitian Referral’ - will result in a denominator of 2 if a Nutrition Assessment status is either Not Malnourished or Mildly Malnourished. To simplify the logic, the Not At Risk function is not explicitly included because, if the Hospital Dietitian Referral exists, then the “Malnutrition Risk Screening” result is irrelevant, as the presence of a Hospital Dietitian Referral overrides the screening result. In other words, if EITHER the patient is screened has an “At Risk” result, OR the presence of a Hospital Dietitian Referral”, AND ALSO the patient’s Nutrition Assessment status is either Not Malnourished/Well Nourished/Mildly Malnourished or in the absence of a completed nutrition assessment, then the Eligible Occurrence = 2. Additionally, if there is a completed Nutrition Assessment with a “Moderately Malnourished” OR “Severely Malnourished” result, the Eligible Occurrence = 4. In the case of a “Malnutrition Risk Screening” that has an “At Risk” result, OR the presence of a Hospital Dietitian Referral”, the eligible occurrence would 2, only if: the result for the Nutrition Assessment would have to be “Well Nourished” OR  “Not Malnourished” OR in the absence of a completed assessment. You are correct that if there is a completed Nutrition Assessment with a “Moderately Malnourished” OR “Severely Malnourished” result, the Eligible Occurrence = 4; however, there would have to ALSO be a “At Risk Malnutrition screening” OR a “Hospital Dietitian Referral” present. To ensure the above is correct, we have corroborated with a test case as shown in the example screenshot attached showing when the eligible occurrence would be 2. The MD will consider reviewing the language in the Guidance section for future Annual Update cycles to promote better understanding.
    • CMS0986v4

      Hello - when determining the Eligible Occurrences/Denominators for Observation 6 the Note from MetaData/Guidance Section does not align with the Total Malnutrition Composite Score Eligible Occurrences(Encounter "Encounter, Performed") ** function.

      The Total Malnutrition Composite Score Eligible Occurrences(Encounter "Encounter, Performed") function states: 

      • If the encounter has a Malnutrition Not At Risk Result and does NOT have a Hospital Dietitian Referral the Eligible Occurrence/denom is 1.
      • The Eligible Occurrence/denom is a 2 if:
         The encounter has a Malnutrition At Risk Result OR a Hospital Dietitian Referral AND a Nutrition Assessment Status Not or Mildly Malnourished OR the Nutrition Assessment Status was not identified/completed.
      • Anything else will have an Eligible Occurrence/denom of 4.


       However, in the MetaData/Guidance Section it states if a Malnutrition NOT At Risk Result was identified AND Hospital Dietitian Referral was ordered the Eligible Occurrence/denom will be a 2. But if a Nutrition assessment is complete with a result of Moderately Malnourished OR Severely Malnourished shouldn't the eligible occurrence be a 4?
      We think the function and the Metadata/Guidance section are confusing and not clear. Maybe the function needs updated in the future to include the high lighted scenario below and for that scenario the Nutrition Assessment was not performed or the nutrition assessment was performed with a result of Not or Mildly Malnourished.  

      We plan to follow the function (attached) in the CQL logic counting Eligible Occurrence/Denom as 4. Please let us know what the expectation is and any plans to either update the Guidance section or the CQL logic in the future. 
         

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Talisa Williams
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