“You can’t improve what you don’t measure,” is a mantra that has become as much a part of U.S. healthcare as it has other elements of American society. Over the past two decades quality measurement has evolved to become a central component to healthcare financing. The Centers for Medicare & Medicaid Services (CMS)—the largest payer of U.S. healthcare services—has been the primary driver of this evolution toward prioritizing healthcare value, quality of care and performance transparency across the healthcare spectrum.
Yet even though healthcare providers report hundreds of quality measures across multiple programs, no public quality reporting programs include performance measures focused on nutrition care or malnutrition. This is significant given that up to one in two older Americans is at risk for or is malnourished, and a recent Government Accountability Office report noted that, “the majority of older adults have chronic conditions and evidence shows older adults’ nutrition is associated with their health outcomes.”
The good news is this may soon change to the benefit of older adults. In late December 2020, CMS published its final 2020 Measures Under Consideration List for hospitals, which included the MUC20-0032 Global Malnutrition Composite Score. It is a first-of-its-kind composite measure fully specified for use with electronic health record data. This list includes measures CMS is considering for adoption into its portfolio of quality reporting programs across multiple settings of care. Since then, this measure has been favorably reviewed by committees under the National Quality Forum’s (NQF) Measure Application Partnership and Prevention and Population Health endorsement, with an opportunity for the public to comment on the NQF endorsement process opening on April 1, 2021.
A final NQF vote on endorsement of the Global Malnutrition Composite Score measure is expected mid-year, and the measure also may be included in CMS’ proposed policy for the 2022 Hospital Inpatient Quality Reporting Program, which is anticipated this spring.
‘Collection of malnutrition care indicators may be helpful in studying the influences of clinical malnutrition.’
Inclusion of the Global Malnutrition Composite Score into a CMS hospital quality reporting program can provide valuable information to providers, patients, families and federal stakeholders about nationwide performance on nutrition care practice standards to address this burdensome condition. There also are implications for positive clinical and economic impact as malnutrition is a critical predictor for adverse and costly inpatient outcomes, including 30-day readmissions, length of stay, complications and mortality.
Why a Global Malnutrition Composite Score and What Does it Measure?
The Academy of Nutrition and Dietetics and Avalere Health developed and tested the Global Malnutrition Composite Score to help hospitals better identify malnutrition and improve care. Research on the development and validation of the Global Malnutrition Composite Score was recently published, documenting it as a “compelling and comprehensive tool for assessing the quality of care provided to hospitalized patients, aged 65 years and older, at risk of malnutrition.” The measure summarizes the key steps in the malnutrition care workflow (malnutrition screening, assessment, diagnosis and development of a care plan) that are necessary to identify and mitigate malnutrition risk in a timely and effective manner.
The composite measure also can be a successful tool for hospitals to better understand the “state of malnutrition care” in their institution and identify critical areas for quality improvement. Further, empirical testing of the composite measure has shown that collection of malnutrition care indicators may be helpful in studying the influences of clinical malnutrition, including the effect of risk mitigation on adverse patient outcomes and healthcare costs.
Malnutrition quality measures have a history of proving their worth, as the individual component measures of the Global Malnutrition Composite Score have already been implemented by more than 250 hospitals as part of a national hospital learning collaborative of the Malnutrition Quality Improvement Initiative.
National surveillance data in U.S. hospitals indicates only about 8 percent of hospitalized adults have a diagnosis of malnutrition. However, the scientific evidence indicates as many as 20 percent to 50 percent of hospitalized patients may actually be malnourished or at risk of malnutrition and thus at greater risk for poor health outcomes and increased healthcare costs.
The time for CMS to act is now. CMS adoption of the Global Malnutrition Composite Score measure will help close the gap in identification and intervention of malnutrition and help healthcare institutions better measure up to support older adults’ nutrition care.
Angel F. Valladares, MPH, works with Avalere Health to provide strategic guidance and implementation support specific to digital health, real-world evidence generation, quality measure development and adoption and patient and provider engagement.