Time to Prepare: Quality Measures are Coming for Inpatient Glycemic Control

Historically, diabetes care in the hospital setting has been hard to measure for many organizations. When it comes to glucose metrics, many keep track of their hypoglycemia as “never events,” but measurement of hyperglycemia has not been as much of a priority. This, however, may be changing for hospitals across the country. Reporting glucose metrics, as part of improved medication safety, are the next quality measures that are expected to be adopted.

Last year, the Centers for Medicare & Medicaid Services (CMS) began a Medication Measures Special Innovation Project to develop new quality measures for medications that affect patient safety for Medicare patients. The project has since resulted in the recommendation of 8 National Quality Forum (NQF)-endorsed measures for the ambulatory care setting, including two electronic clinical quality measures for the inpatient setting. These two electronic clinical quality measures, NQF 2362 and NQF 2363, are for hyperglycemia and severe hypoglycemia.

• NQF 2362: Glycemic Control – Hyperglycemia
  Average percentage of hyperglycemic hospital days for individuals with a diagnosis of diabetes mellitus, anti-diabetic drugs (except metformin) administered, or at least one elevated glucose level (>200 mg/dL) during the hospital stay.
• NQF 2363: Glycemic Control –  Severe Hypoglycemia
  The rate of severe hypoglycemic events (<40 mg/dL) within 12 hours of administration of rapid/short-acting insulin or within 24 hours of administration of an anti-diabetic agent other than rapid/short-acting insulin, and no subsequent glucose value greater than 80 mg/dL within five minutes of the low glucose event.

The next step in the review process for the measures is CMS endorsement. Once this occurs, the measures will be included in the Hospital Inpatient Quality Reporting Program, meaning CMS will use the quality measures in its quality improvement, public reporting on the Hospital Compare website, and potentially in pay-for-reporting programs, such as the Hospital Value-Based Purchasing Program.

While the timing of CMS’s endorsement is still uncertain, the measures are expected to move forward within the next year. We’ve also heard of Group Purchasing Organizations who will be tracking their member hospitals’ hypoglycemia rates, and health systems who are incentivizing their pharmacists based on good hypoglycemia and hyperglycemia measures.

Similar to other measures currently captured under the Hospital Inpatient Quality Reporting Program, preparing in advance of CMS implementation has significant benefits. As an example, consider the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) survey requirements.  Following the HCAHPS survey introduction, multiple survey vendors reported that those who begin measuring ahead of CMS’ national implementation, outperformed and stayed ahead over time.

If you don’t know how you are performing on glucose metrics or see opportunity for improvement, now is the time to act. An eGlycemic Management System such as EndoTool will help manage hyperglycemia, prevent hypoglycemia, standardize care practices at your organization, and provide some of the reporting you need to track progress and drive improvement.

By preparing in advance of CMS requirements and optimizing your glycemic management, you are not only setting yourself up for potentially more reimbursement under the value-based purchasing model, your setting your organization up for enhanced patient safety, improved patient outcomes and significant cost savings.

To learn more about the upcoming measures, please contact our team.