Preparing for CMS Glycemic Reporting: A Quality Leader’s Perspective

As hospitals enter 2026, inpatient glycemic management is taking on new significance. With fiscal year 2026 reporting underway and financial impact ahead, severe hypoglycemia and hyperglycemia are now recognized not only as clinical safety events, but also as indicators of quality and performance.

From a quality and medication safety perspective, this shift feels overdue. Glycemic events are rarely isolated. When they occur, they often reflect broader system challenges, including variation in insulin management, complex workflows, and inconsistent decision making as patients move across care settings.

The increased focus from the Centers for Medicare & Medicaid Services reinforces the need to approach glycemic management as an enterprise responsibility rather than a unit-specific issue.

Common challenges hospitals face

Even with this awareness, many hospitals face similar challenges. Reactive insulin approaches remain common and can drive unnecessary glucose variability. In teaching hospitals, rotating learners and unit-level differences make standardization especially difficult.

Visibility is another major challenge. Too often, glycemic risk becomes clear only after a severe event occurs. At the bedside, complex insulin protocols add cognitive burden for nurses caring for increasingly complex patients. Even when data exists, turning it into meaningful action or benchmarking performance against similar organizations can be harder than expected.

Five actions we have taken to prepare for CMS glycemic reporting

At VCU Health, preparing for CMS glycemic reporting has meant moving beyond awareness and into action. Rather than treating reporting as a compliance exercise, we have used it as an opportunity to strengthen the systems that support safer, more consistent inpatient care.

These tactics have been central to our approach:

1. Standardizing insulin management beyond critical care
   One of our early priorities was extending standardized, patient-specific insulin management beyond the ICU and across inpatient care settings at our three hospitals. We reviewed insulin infusion protocols for consistency, reduced unnecessary variability, and made sure protocols and educational materials were easy for teams to access. We are also expanding our use of EndoTool beyond the Cardiac Surgery ICU so that standardization is embedded directly into clinical workflows.
2. Simplifying and aligning frontline workflows
   We have built reminders and tasks within our electronic health record to support glucose monitoring and hypoglycemia treatment. At the same time, we are working with clinical teams to standardize workflows outside of the EHR. This alignment is helping reduce complexity today while also simplifying transitions as our standardization efforts continue to expand.
3. Improving visibility into glycemic trends
   Partnering with our data team, we developed reporting that tracks hypoglycemia and hyperglycemia rates over time. These data are now available in provider dashboards and shared with nursing unit leaders. We continue to focus on helping teams understand the data to see how their daily actions contribute to safer glycemic control.
4. Creating shared ownership across disciplines
   Three years ago, we brought together nurses, pharmacists, IT leaders, hospitalists, and endocrinologists to take a hard look at our glycemic management processes. Through a Failure Modes and Effects Analysis, we identified vulnerabilities across insulin ordering, preparation, administration, and even meal delivery. That work informed a multi-year roadmap that continues to guide improvement.
5. Establishing governance to sustain progress
   What began as a small workgroup has evolved into a standing Glycemic Management Committee that reports to our Medication Safety Committee. This group oversees regulatory response, safety concerns, performance data, and policies related to glycemic management. Having clear ownership has been critical to sustaining momentum.

By focusing on these system-level actions, we are not only preparing for CMS reporting, but also strengthening the foundation for safer inpatient glycemic care.

Why this moment matters

CMS glycemic reporting not only represents an opportunity to reduce variation, improve safety, and support clinicians with more reliable systems of care–it is a patient safety imperative. Hospitals that invest early in standardization, visibility, and governance will be better positioned to meet reporting expectations and deliver higher-quality inpatient care, while improving outcomes.