Thank you for your inquiry regarding CMS871, Hospital Harm - Severe Hyperglycemia. At this time, the measure does not include an exclusion for inpatient hospitalizations where patients may refuse blood glucose testing, insulin administration, or other aspects of glycemic management. Because regular glucose checks and glycemic management efforts, such as insulin administration, are considered to be integral care for patients who are at high risk of experiencing a hyperglycemic event, it is not appropriate to exclude inpatient hospitalizations for patients who refuse a glucose check or insulin administration. The measure assesses inpatient hospitalizations for the occurrence of a severe hyperglycemic event among patients who are most at risk for experiencing a severe hyperglycemic event. Specifically, the measure's denominator includes inpatient hospitalizations for patients who have a diagnosis of diabetes that starts before the end of the hospitalization, who are administered at least one dose of insulin or any hypoglycemic medication during the hospitalization, or who have at least one glucose value >=200 mg/dL at any time during the hospitalization.