As the number of older adults in the US continues to grow, it is imperative to promote public health policies that help keep them healthy and active. Establishing quality measures to help evaluate malnutrition care can be an effective tool because healthy nutrition is vital for healthy aging.

The US Centers for Medicare & Medicaid Services (CMS) has proposed a rule that includes the Global Malnutrition Composite Score (GMCS) as an optional measure for the US Hospital Inpatient Prospective Payment System (IPPS) for fiscal year 2023. Use of the GMCS, a comprehensive tool for assessing the quality of hospital care for patients over 65, can help improve nutrition care and advance health equity. Stakeholders can comment until June 17, 2022, on the need for and importance of this malnutrition quality measure.

If included in the final rule, the GMCS would be the first nutrition-focused quality measure included in any CMS payment program. CMS explained in its proposed rule that “Research indicates that preventive screening and interventions may reduce risk of malnutrition in older adults and improve quality of life, particularly for individuals with chronic conditions.”

The proposal further noted, “Partly due to the substantial impacts on clinical outcomes, malnutrition imposes a serious burden on the healthcare system. Hospitalized patients with poor nutrition have been estimated to incur approximately 300 percent higher healthcare costs than those who are adequately nourished.”

CMS also commented, “Hospitals have an opportunity to identify malnutrition during the patient admission process and to address it efficiently and effectively with individualized interventions that could optimize outcomes including reduced readmissions and lengths of stay. Research demonstrates that there is significant room to improve identification, diagnosis, and treatment of malnutrition in hospitalized patients.” Specifically, the malnutrition measure will help address the under-diagnosis of malnutrition, as more than 30% of hospitalized adults are affected by malnutrition, although it is diagnosed in less than 9% of patients.

Measuring hospital malnutrition care has also been identified as a way to help advance health equity. In its proposed rule, CMS explained, “We believe adopting a malnutrition measure would address several priority areas identified in the CMS Equity Plan for Medicare, including evaluating impacts of disparities, integrating equity solutions across CMS programs, and increasing the ability of the healthcare workforce to meet the needs of underserved populations.”

Indeed, if adopted, the GMCS measure would be one of the few available IPPS quality measures that would help advance health equity.

The GMCS measure was developed by the Academy of Nutrition and Dietetics and Avalere Health to measure the quality of malnutrition care delivered to patients age 65 and older in the inpatient setting. It is calculated as an average of the performance scores for four component measures for patients 65 and older:

• Malnutrition screening of patients.
• Nutrition assessment of patients at risk for malnutrition.
• Appropriate malnutrition diagnosis documentation for patients identified as malnourished.
• Documented nutrition care plan in the medical record for patients identified as malnourished.

Over the past eight years, Registered Dietitian Nutritionists (RDNs) have championed the implementation of the individual component measures of the GMCS in more than 200 hospitals as part of a national hospital learning collaborative of the Malnutrition Quality Improvement Initiative (MQii).One quality improvement study of 27 MQii Learning Collaborative hospitals found implementing these practices led to a statistically significant reduction in risk of 30-day readmissions.

Medicare uses the Hospital IPPS in deciding how to reimburse most hospitals for acute care hospital inpatient stays using rates set under Medicare Part A. IPPS hospitals are required to report on a specific number of electronic clinical quality measures (eCQMs). For FY 2023, the proposal would allow hospitals to self-select the GMCS measure. Including the GMCS measure in the final FY 2023 IPPS rule, which is expected to be released in early fall 2022, would help hospitals improve malnutrition care and reap patient and health outcome benefits demonstrated by MQii learning collaborative hospitals.

In its proposed rule, CMS explained, “Nutrition screening is the first step in optimal malnutrition care and triggers a nutrition assessment for patients found to be at risk.” We encourage more hospitals to take this first step and support healthy aging by using the open comment period to urge CMS to adopt the GMCS measure in its FY 2023 final rule. 

More information about the GMCS measure will be shared in an upcoming ICAA webinar, Advocating for Older Adult Nutrition and Quality Measurement, on June 8, 2022, from 1:00–2:00 p.m. EDT. Please register here. 

Dana Buelsing Sowards, MS, CAPM, LSSGB, is manager of quality standards operations at the Academy of Nutrition and Dietetics.

Mujahed Khan, MBA, RDN, LDN, FAND, is senior manager of quality improvement at the Academy of Nutrition and Dietetics.