Measure Information | 2024 Reporting Period |
---|---|
CMS eCQM ID | CMS986v2 |
Short Name |
GMCS |
NQF Number | 3592e |
Description |
This measure assesses the percentage of hospitalizations for adults aged 65 years and older at the start of the inpatient encounter during the measurement period with a length of stay equal to or greater than 24 hours who received optimal malnutrition care during the current inpatient hospitalization where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are screened for malnutrition risk, assessed to confirm findings of malnutrition risk or for a hospital dietitian referral order, and if identified with a "moderate" or "severe" malnutrition status in the current performed malnutrition assessment, receive a current "moderate" or "severe" malnutrition diagnosis and have a current nutrition care plan performed. |
Definition |
Malnutrition Risk Screening - the process of identifying and referring those individuals and populations who are at risk for nutrition-related problems, are appropriate for nutrition care services, and would benefit from the nutrition interventions. For the inpatient or acute care setting, the Malnutrition Risk Screening is performed by a nursing professional, Registered Dietitian (RD), or Registered Dietitian Nutritionist (RDN). Nutrition Assessment - a systematic approach for collecting, classifying, and synthesizing important and relevant data to describe nutritional status related nutritional problems, and their causes. This assessment includes review of the "whole" patient and evaluates the anthropometrics (i.e., body measurements and proportions), biochemical data (i.e., laboratory findings), clinical observations, and diet history (also known as 'ABCD'). For the inpatient or acute care setting, the Nutrition Assessment is performed by a RD or RDN. Malnutrition Diagnosis - a documented diagnosis that identifies and describes a specific nutrition problem(s) that can be resolved or improved through nutrition intervention(s). For the inpatient or acute care setting, the Malnutrition Diagnosis is identified by the physician/eligible clinician based on the scope of practice regulations within the respective state, commonwealth, or territory of care delivery. Nutrition Care Plan - a documented plan based on information collected during the Nutrition Assessment of individualized nutrition recommendations and interventions that are directed toward resolving the Malnutrition Diagnosis by altering or eliminating the nutrition etiology. The Nutrition Care Plan may encompass the interventions of Food and Nutrient Delivery, Nutrition Education, Nutrition Counseling, Coordination of Nutrition Care, and Population Based Nutrition Action, and is documented by the RD or RDN. |
Initial Population |
Valid Encounter: Inpatient hospitalizations during the measurement period with length of stay of 24 hours or more among individuals 65 years of age and older at the start of the inpatient encounter |
Population Exclusion |
None |
Steward | Academy of Nutrition and Dietetics |
Measure Scoring | Continuous Variable measure |
Measure Type | Intermediate Clinical Outcome measure |
Improvement Notation |
Higher score indicates better quality of care |
Guidance |
This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible hospitalizations and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. The initial population are hospitalizations during the measurement period for patients aged 65 years and greater with a length of stay of 24 hours and greater. Component Measure 1: Inpatient hospitalizations for patients with a current "Malnutrition Risk Screening" performed. Component Measure 2: Inpatient hospitalizations for patients with a current "Nutrition Assessment" performed from a "Malnutrition Screening At Risk Result" during the current hospitalization or a "Hospital Dietitian Referral" order from a physician or eligible clinician during the current hospitalization. For Component Measure 1 and Component Measure 2, only report LOINC code '84291-4 Nutrition and dietetics Risk assessment and screening note' when the RD or RDN performs both the "Malnutrition Risk Screening" and "Nutrition Assessment". Component Measure 3: Inpatient hospitalizations for patients with a current documented "Malnutrition Diagnosis" as a result of a current "Nutrition Assessment Status Moderately Malnourished" OR current "Nutrition Assessment Status Severely Malnourished". Component Measure 4: Inpatient hospitalizations for patients with a current "Nutrition Care Plan" performed as a result of a current "Nutrition Assessment Status Moderately Malnourished" OR current “Nutrition Assessment Status Severely Malnourished”. "Population 5 Measure Observation TotalMalnutritionComponentsScore" Calculations -For each hospitalization, Population Criteria 5 represents the subtotal of Measure Observations performed for Population Criteria 1, 2, 3, and 4. -For the reporting facility, the Population Criteria 5 Aggregate Operator 'Count' counts the number of eligible hospitalizations during the measurement period.
"Population 6 Measure Observation TotalMalnutritionCompositeScore as Percentage" Calculations: -For each hospitalization, Population Criteria 6 represents the sum of performed Measure Observations 1, 2, 3, and 4 divided by the number of clinically eligible denominators. -For the reporting facility, the Population Criteria 6 Aggregate Operator 'Average' averages the performance of each "TotalMalnutritionCompositeScore as Percentage" across all eligible hospitalizations during the measurement period. "TotalMalnutritionCompositeScore Eligible Denominators" is always 4 except in the following two instances: -If a "Malnutrition Risk Screening" was performed and a "Malnutrition Screening Not At Risk Result" was identified AND "Hospital Dietitian Referral" was not ordered, then the "TotalMalnutritionCompositeScore Eligible Denominators" is 1. -If a "Nutrition Assessment" was performed and a "Nutrition Status Not or Mildly Malnourished" was identified, then the "TotalMalnutritionCompositeScore Eligible Denominators" are 2. The "TotalMalnutritionCompositeScore Eligible Denominators" equals 4: -If a "Malnutrition Risk Screening" was performed AND a "Malnutrition Screening At Risk Result" was identified AND a "Nutrition Assessment" was not performed. -If a "Malnutrition Risk Screening" was not performed AND a "Nutrition Assessment" was not performed. -If a "Hospital Dietitian Referral" was ordered AND a "Nutrition Assessment" was not performed. -If a "Nutrition Assessment Status Moderately Malnourished" OR "Nutrition Assessment Status Severely Malnourished" was identified. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter with a length of stay of greater than or equal to 24 hours during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
Rationale |
The components of this measure are supported by clinical guidance that recommends the following: (1) malnutrition screening for patients admitted into the acute inpatient care setting; (2) nutrition assessment for patients identified at-risk of malnutrition or with a hospital dietitian referral order to form the basis for appropriate nutrition interventions; (3) appropriate recognition, diagnosis, and documentation of the nutrition status of a patient in order to (4) address their condition with an appropriate plan of care and communicate patient needs to other care providers. The process for risk identification, assessment, diagnosis, and treatment of malnutrition necessitates a multi-disciplinary care team that begins with the identification of an initial risk population for a more thorough physical assessment by registered dietitian nutritionists (RDN). The RDN in turn provides the necessary treatment recommendations to address nutritional status and the clinical indicators that inform a medical diagnosis of malnutrition completed by a physician. The four component measures individually will only provide a fraction of the necessary information on quality of care for patients at-risk of malnutrition. For example, knowing which patients have been assessed out of those who were initially identified as at-risk, but not knowing if the appropriate proportion of patients were screened upon admission, would be an insufficient assessment of quality of care. Implementation of this measure supports timely nursing malnutrition risk screening and hand off to RDNs for appropriate nutritional assessment for patients at-risk of malnutrition during the current hospitalization. For patients identified with a moderate or severe malnutrition status from the nutrition assessment, best practice also recommends a medical diagnosis by a physician or other qualified healthcare professionals and the execution of the nutrition care plan by an RDN. Evidence demonstrates that implementing a standardized protocol for screening, assessment, diagnosis and care planning results in better identification of malnourished patients and subsequent improvements in rates of nutrition intervention for the malnourished. Outcomes modeling, and those reported in other studies, also demonstrate the benefits to patient outcomes, including reduced risk of 30-day readmissions, length of hospital stay, and complications, as well as improved quality of life after hospitalization. |
Stratification |
None |
Risk Adjustment |
None |
Clinical Recommendation |
American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) clinical guidelines on nutrition screening, assessment, and intervention in adults, Screening for nutrition risk is suggested for hospitalized patients. (A.S.P.E.N., 2011). This guideline places nutrition assessment and screening in the context of intervention as part of nutrition care. Screening those individuals at risk of malnutrition is the first step in nutrition care as nutrition risk, identified by nutrition screening, is associated with longer length of hospital stay, complications, and mortality. Malnutrition screening is also a predictor of mortality risk. Nutrition assessment is suggested for all patients who are identified to be at malnutrition risk by nutrition screening. Malnourished patients, identified by nutrition assessment tools, have more complications and longer hospitalizations than do patients with optimal nutrition status. Such patients, identified by nutrition assessment tools, have more infectious and noninfectious complications, longer hospital length of stay, and greater mortality. Nutrition support intervention is recommended for patients identified by assessment as at risk for malnutrition or malnourished. Nutrition support intervention in patients identified assessment as at risk for malnutrition or malnourished improves clinical outcomes. Nutrition interventions in malnourished patients are associated with improved nutrition status, nutrient intake, physical function, and quality of life. Hospital readmissions, inpatient length of stay, and complications were reduced with increased nutrition support interventions. |
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Measure Information | 2023 Reporting Period | 2024 Reporting Period |
---|---|---|
Title | Global Malnutrition Composite Score | Global Malnutrition Composite Score |
CMS eCQM ID | CMS986v1 | CMS986v2 |
Short Name |
GMCS |
GMCS |
NQF Number | 3592e | 3592e |
Description |
This measure assesses the percentage of hospitalizations for adults aged 65 years and older prior to the start of the measurement period with a length of stay equal to or greater than 24 hours who received optimal malnutrition care during the current inpatient hospitalizations where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are screened for malnutrition risk, assessed to confirm findings of malnutrition risk, and if identified with a "moderate" or "severe" malnutrition status in the current performed malnutrition assessment, receive a current "moderate" or "severe" malnutrition diagnosis and have a current nutrition care plan performed. |
This measure assesses the percentage of hospitalizations for adults aged 65 years and older at the start of the inpatient encounter during the measurement period with a length of stay equal to or greater than 24 hours who received optimal malnutrition care during the current inpatient hospitalization where care performed was appropriate to the patient's level of malnutrition risk and severity. Malnutrition care best practices recommend that for each hospitalization, adult inpatients are screened for malnutrition risk, assessed to confirm findings of malnutrition risk or for a hospital dietitian referral order, and if identified with a "moderate" or "severe" malnutrition status in the current performed malnutrition assessment, receive a current "moderate" or "severe" malnutrition diagnosis and have a current nutrition care plan performed. |
Initial Population |
Valid Encounter: Inpatient hospitalizations during the measurement period with length of stay of 24 hours or more among individuals 65 years of age and older at the start of the measurement period. |
Valid Encounter: Inpatient hospitalizations during the measurement period with length of stay of 24 hours or more among individuals 65 years of age and older at the start of the inpatient encounter |
Measure Steward | Academy of Nutrition and Dietetics | Academy of Nutrition and Dietetics |
Measure Scoring | Continuous Variable measure | Continuous Variable measure |
Measure Type | Intermediate Clinical Outcome measure | Intermediate Clinical Outcome measure |
Improvement Notation |
Higher score indicates better quality of care. |
Higher score indicates better quality of care |
Guidance |
The measure is constructed as an arithmetic average of four equally weighted component measures expressed as a percentage. The four measure populations used to calculate the Total Components Measure Score may differ. Component Measure 1: Inpatient hospitalizations for patients with a current screening for malnutrition risk performed at the time of admission. Component Measure 2: Inpatient hospitalizations for patients with a current assessment for malnutrition performed from an "at risk" finding in a current malnutrition screening. Component Measure 3: Inpatient hospitalizations for patients with a current malnutrition diagnosed as a result of a "moderate" or "severe" malnutrition status from a current malnutrition assessment. Component Measure 4: Inpatient hospitalizations for patients with a current nutrition care plan performed as a result of a "moderate" or "severe" malnutrition status from a current malnutrition assessment. The activities of the four component numerators do not need to be performed sequentially. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter with a length of stay of greater than or equal to 24 hours during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
This measure is constructed of four clinically eligible components that are aggregated as an arithmetic average of eligible hospitalizations and expressed as a percentage. The four populations used to calculate the four components may differ and the measure observations for the four components do not need to be performed sequentially. The initial population are hospitalizations during the measurement period for patients aged 65 years and greater with a length of stay of 24 hours and greater. Component Measure 1: Inpatient hospitalizations for patients with a current "Malnutrition Risk Screening" performed. Component Measure 2: Inpatient hospitalizations for patients with a current "Nutrition Assessment" performed from a "Malnutrition Screening At Risk Result" during the current hospitalization or a "Hospital Dietitian Referral" order from a physician or eligible clinician during the current hospitalization. For Component Measure 1 and Component Measure 2, only report LOINC code '84291-4 Nutrition and dietetics Risk assessment and screening note' when the RD or RDN performs both the "Malnutrition Risk Screening" and "Nutrition Assessment". Component Measure 3: Inpatient hospitalizations for patients with a current documented "Malnutrition Diagnosis" as a result of a current "Nutrition Assessment Status Moderately Malnourished" OR current "Nutrition Assessment Status Severely Malnourished". Component Measure 4: Inpatient hospitalizations for patients with a current "Nutrition Care Plan" performed as a result of a current "Nutrition Assessment Status Moderately Malnourished" OR current “Nutrition Assessment Status Severely Malnourished”. "Population 5 Measure Observation TotalMalnutritionComponentsScore" Calculations -For each hospitalization, Population Criteria 5 represents the subtotal of Measure Observations performed for Population Criteria 1, 2, 3, and 4. -For the reporting facility, the Population Criteria 5 Aggregate Operator 'Count' counts the number of eligible hospitalizations during the measurement period.
"Population 6 Measure Observation TotalMalnutritionCompositeScore as Percentage" Calculations: -For each hospitalization, Population Criteria 6 represents the sum of performed Measure Observations 1, 2, 3, and 4 divided by the number of clinically eligible denominators. -For the reporting facility, the Population Criteria 6 Aggregate Operator 'Average' averages the performance of each "TotalMalnutritionCompositeScore as Percentage" across all eligible hospitalizations during the measurement period. "TotalMalnutritionCompositeScore Eligible Denominators" is always 4 except in the following two instances: -If a "Malnutrition Risk Screening" was performed and a "Malnutrition Screening Not At Risk Result" was identified AND "Hospital Dietitian Referral" was not ordered, then the "TotalMalnutritionCompositeScore Eligible Denominators" is 1. -If a "Nutrition Assessment" was performed and a "Nutrition Status Not or Mildly Malnourished" was identified, then the "TotalMalnutritionCompositeScore Eligible Denominators" are 2. The "TotalMalnutritionCompositeScore Eligible Denominators" equals 4: -If a "Malnutrition Risk Screening" was performed AND a "Malnutrition Screening At Risk Result" was identified AND a "Nutrition Assessment" was not performed. -If a "Malnutrition Risk Screening" was not performed AND a "Nutrition Assessment" was not performed. -If a "Hospital Dietitian Referral" was ordered AND a "Nutrition Assessment" was not performed. -If a "Nutrition Assessment Status Moderately Malnourished" OR "Nutrition Assessment Status Severely Malnourished" was identified. This eCQM is an episode-based measure. An episode is defined as each inpatient hospitalization or encounter with a length of stay of greater than or equal to 24 hours during the measurement period. This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM. |
Next Version | CMS986v2 | No Version Available |
Previous Version | No Version Available |
Header
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Revised the narrative of the Initial Population age parameter to start at the beginning of the encounter to align the measure with other eligible hospital measures.
Measure Section: Description
Source of Change: ONC Project Tracking System (JIRA): CQM-5829
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Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
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Updated references.
Measure Section: Reference
Source of Change: Measure Lead
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Added definitions for the four component measures (i.e., 'Malnutrition Risk Screening', 'Nutrition Assessment', 'Malnutrition Diagnosis', and 'Nutrition Care Plan') to clarify each component's activity and responsible discipline(s).
Measure Section: Definition
Source of Change: Measure Lead
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Revised the narrative of the Initial Population age parameter to start at the beginning of the encounter to align the measure with other eligible hospital measures.
Measure Section: Initial Population
Source of Change: ONC Project Tracking System (JIRA): CQM-5829
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Updated grammar, wording, and/or formatting to improve readability and consistency.
Measure Section: Multiple Sections
Source of Change: Annual Update
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Updated measure language to indicate referral to a hospital dietitian is applicable to meet the measure intent as care for patients who are malnourished.
Measure Section: Multiple Sections
Source of Change: Measure Lead
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Added narrative to clarify performance calculations for individual and aggregate scores based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Multiple Sections
Source of Change: ONC Project Tracking System (JIRA): CQM-5495
Logic
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Revised the age anchor from the start of the measurement period to the start of the encounter to align the measure with other eligible hospital measures.
Measure Section: Initial Population
Source of Change: ONC Project Tracking System (JIRA): CQM-5829
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Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Definitions
Source of Change: Standards/Technical Update
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Revised the timing attributes for the logic definitions to more accurately represent the timing for the performed measure observations.
Measure Section: Definitions
Source of Change: Measure Lead
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Updated measure definitions to allow all clinically eligible activities performed in pre-admission settings to be evaluated in the Measures Observations.
Measure Section: Definitions
Source of Change: Measure Lead
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Added logic to capture hospitalizations for patients 'not at risk' for malnutrition.
Measure Section: Definitions
Source of Change: Measure Lead
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Added logic to capture hospitalizations for patients 'not or mildly malnourished'.
Measure Section: Definitions
Source of Change: Measure Lead
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Added logic to capture hospitalizations for patients 'not at risk' for malnutrition.
Measure Section: Functions
Source of Change: Measure Lead
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Added logic to capture hospitalizations for patients 'not or mildly malnourished'.
Measure Section: Functions
Source of Change: Measure Lead
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Updated the sixth measure observation logic in hospitalizations for patients who were screened for malnutrition risk, identified as not at risk for malnutrition, and did not have an order for a hospital dietitian referral during that hospitalization.
Measure Section: Multiple Sections
Source of Change: Measure Lead
Value Set
The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.
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Added value set Emergency Department Visit (2.16.840.1.113883.3.117.1.7.1.292) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Added value set Hospital Dietitian Referral (2.16.840.1.113762.1.4.1095.91) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Value set Malnutrition Diagnosis (2.16.840.1.113762.1.4.1095.55): Added 3 ICD-10-CM codes (T73.0XXA, T73.0XXD, T73.0XXS) based on terminology update. Deleted 1 ICD-10-CM code (T73.0) based on terminology update. Deleted 2 SNOMED CT codes (190602008, 360549009) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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Replaced value set Malnutrition Risk Screening (2.16.840.1.113762.1.4.1095.40) with value set Malnutrition Risk Screening (2.16.840.1.113762.1.4.1095.92) based on applicability of value set and/or OID.
Measure Section: Terminology
Source of Change: Measure Lead
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Value set Malnutrition Screening At Risk Result (2.16.840.1.113762.1.4.1095.38): Added 3 SNOMED CT codes (129845004, 445421000124101, 704361005) based on review by technical experts, SMEs, and/or public feedback. Deleted 1 SNOMED CT code (284670008) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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Added value set Malnutrition Screening Not At Risk Result (2.16.840.1.113762.1.4.1095.34) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Replaced value set Malnutrition Assessment (2.16.840.1.113762.1.4.1095.29) with value set Nutrition Assessment (2.16.840.1.113762.1.4.1095.21) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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Replaced value set Nutritional Status Moderately Malnourished (2.16.840.1.113762.1.4.1095.47) with value set Nutrition Assessment Status Moderately Malnourished (2.16.840.1.113762.1.4.1095.44) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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Added value set Nutrition Assessment Status Not or Mildly Malnourished (2.16.840.1.113762.1.4.1095.48) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Replaced value set Nutrition Care Plan (2.16.840.1.113762.1.4.1095.88) with value set Nutrition Care Plan (2.16.840.1.113762.1.4.1095.93) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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Replaced value set Nutritional Status Severely Malnourished (2.16.840.1.113762.1.4.1095.43) with value set Nutrition Assessment Status Severely Malnourished (2.16.840.1.113762.1.4.1095.42) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
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Added value set Observation Services (2.16.840.1.113762.1.4.1111.143) based on change in measure requirements/measure specification.
Measure Section: Terminology
Source of Change: Measure Lead
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Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead