GMCS M.O. #2 (Malnutrition Assessment) > Allowable Reasons for "Not applicable"

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    • Type: Hosp Inpt eCQMs - Hospital Inpatient eCQMs
    • Resolution: Answered
    • Priority: Moderate
    • Component/s: None
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      Thank you for your inquiry regarding CMS986v5, the Malnutrition Care Score. The intent of Measure Observation #2 is to capture whether a nutrition assessment was performed, as well as the result. Within the Value Set OID 2.16.840.1.113762.1.4.1095.96 “Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished,” the concepts represented (Well Nourished or Not/Mildly Malnourished), indicate that an assessment was conducted and a nutrition status was determined. Therefore, the definition for the Well Nourished code is not synonymous with not applicable.

      Example #1 reflects the measure’s hospice exclusion. This means that when the patient is changed to a hospice status, the measure will no longer include them in the score. Even though the patient will not be included in the MCS calculation, the RD/RDN is still expected to use clinical judgment to continue the level of care expected based on the patient's care goals at the time of the transfer.

      For example #2, that patient will be included in the scoring of the measure. If a patient screens at nutrition risk or a dietitian consult is ordered (Measure Observation #1), a nutrition assessment is expected and included in Measure Observation #2. If the patient has a malnutrition diagnosis, the nutrition care plan will be individualized to the goals of care and documented as such. The Measure Developer recommends that implementers also follow guidelines and regulations established by CMS and state/local agencies.
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      Thank you for your inquiry regarding CMS986v5, the Malnutrition Care Score. The intent of Measure Observation #2 is to capture whether a nutrition assessment was performed, as well as the result. Within the Value Set OID 2.16.840.1.113762.1.4.1095.96 “Nutrition Assessment Status Finding of Well Nourished or Not Malnourished or Mildly Malnourished,” the concepts represented (Well Nourished or Not/Mildly Malnourished), indicate that an assessment was conducted and a nutrition status was determined. Therefore, the definition for the Well Nourished code is not synonymous with not applicable. Example #1 reflects the measure’s hospice exclusion. This means that when the patient is changed to a hospice status, the measure will no longer include them in the score. Even though the patient will not be included in the MCS calculation, the RD/RDN is still expected to use clinical judgment to continue the level of care expected based on the patient's care goals at the time of the transfer. For example #2, that patient will be included in the scoring of the measure. If a patient screens at nutrition risk or a dietitian consult is ordered (Measure Observation #1), a nutrition assessment is expected and included in Measure Observation #2. If the patient has a malnutrition diagnosis, the nutrition care plan will be individualized to the goals of care and documented as such. The Measure Developer recommends that implementers also follow guidelines and regulations established by CMS and state/local agencies.
    • CMS0986v5
    • We need to satisfy Valueset OID: 2.16.840.1.113762.1.4.1095.9 for qualifying GMCS episodes, yet clarification is needed to ensure the selection of the only SNOMED code available for this OID are applicable to certain scenarios.

      For GMCS measure observation #2 (Malnutrition Assessment), I'd like to clarify allowable reasons for Valueset OID: 2.16.840.1.113762.1.4.1095.9 ("Nutrition Assessment Status Finding of Well Nourished or Not/Mildly Malnourished").

      Since this Valueset consolidates 3 responses, and only one SNOMED code is applicable, we are using the synonymous selection criteria of "Not applicable" for the clinical documentation and for simplicity to the end-user (Dietitian).

      Clarifying some acceptable reasons (below) for this Valueset OID are needed to ensure they qualify because in certain circumstances, the assessment could not physically be performed, it is truly not applicable, or there is a grey area, while there still being a need to satisfy measure observation #2 as "assessment performed." Examples are:

      1) Patient transferred to hospice. In a scenario like this, our Dietitians are unable to perform a malnutrition assessment after receiving a nutrition consult referral (or it is not appropriate).

      2) Assessment not appropriate due to clinical circumstances or goals of care (e.g., similar to example #1, like comfort care, cognitive impairment, patient refusal).

      As you can see, there are times when a qualifying GMCS episode is initiated, and we need to satisfy measure observation #2 ("assessment performed"), yet there are clearly circumstances where that cannot take place and there are no other applicable selections available at this time.

      Looking forward to your feedback.

      Thank you.

            Assignee:
            Mathematica EH eCQM Team
            Reporter:
            Greg Thomas
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