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By Jordan Messler, MD, SFHM, FACP
Glycemic management is an often-overlooked or under-prioritized area of inpatient care. Despite a mountain of evidence that shows how high and low blood glucose can negatively impact the quality and costs of care, there’s a conventional belief that monitoring and treating blood sugar is only important for people living with diabetes or not as important during a short hospital stay. This mentality has made it challenging for glycemic management committees to enact change in hospitals and health systems across the country. However, as the Centers for Medicare & Medicaid Services (CMS) continues to drive the industry towards value-based arrangements, new policies are giving hospital glycemic management committees the necessary leverage to prioritize change.
CMS Puts its Muscle Behind Glycemic Management
When CMS announced its annual adjustment to inpatient payment policies for FY22, it included updated rules for its Inpatient Quality Reporting (IQR) program. The IQR program is designed to drive quality improvement through measurement and transparency. It requires healthcare facilities to capture and report electronic clinical quality measures (eCQMs) data, which is then publicly displayed to help consumers make the best decisions on their healthcare journey as well as celebrate hospitals through their rating system. After decades of research about the impact of glycemic management on the cost and quality of inpatient care, CMS brought it to the forefront by introducing two new eCQMs that center on glycemic metrics. The first rule measures prolonged, untreated rates of hyperglycemia in the hospital. The second rule focuses on hospitals capturing data on patients with preventable severe hypoglycemia.
The new eCQMs are significant steps that encourage hospitals and clinicians to improve the quality of their glycemic management – and it’s long overdue. Blood sugar challenges cuts across disease states and reasons for admission and impacts every hospital department. While just 10% of Americans live with diabetes, nearly 40% of all hospitalized patients require insulin therapy to regulate high blood sugar during their stay. Hyperglycemia often occurs in patients after surgery due to complex pathophysiology and the body’s response to stress. This is exacerbated by the fact hundreds of medications – including steroids like dexamethasone – impact blood glucose and can even cause insulin resistance.
Greater Visibility Enables Large-Scale Change
These new CMS measures illuminate the importance of optimal glycemic management and these eCQMS continue to incentivize hospitals and health systems to support improvement initiatives. Unfortunately, most hospitals have limited visibility into their rates of hypoglycemia or hyperglycemia, which hampers their ability to augment their approach. In fact, 59% of all hospitals in the U.S. have no automated way to pull this data and nearly one third have no metric at all.
These new measures spotlight data shortcomings and provide glycemic management committees with the necessary buy-in to create long-lasting change and implement solutions. Glycemic management committees and diabetes educators have known and spoken of the dangers of inadequate inpatient glycemic management for decades, but until now, it has been low on the list of hospital priorities. CMS is indicating the impact of dysglycemia is too significant to ignore, which gives these multidisciplinary steering committees the backing they need to drive large-scale practice change. Glycemic management committees are responsible for improvement efforts that touch every unit in the hospital and foster collaboration among clinicians and staff members across multiple departments. By making glycemic management an area of focus and prioritizing their input, these groups can work alongside hospital leadership to improve patient outcomes and lower the cost of care.
Accelerating Change Management
While change management can be difficult, the reality is time is running out for hospitals and health systems to prepare for these new reporting requirements. The new CMS measures have elevated glycemic management to the executive and board levels, as they will review their quality dashboards and determine which of the nine eCQMs they wish to report on. Hospitals need to begin collecting new eCQM data on January 1, 2023, and they should be working with their EHR vendors to implement electronic data collection processes and reports. Based on previous measures, the industry expectation is that those metrics will be due at the end of February 2024. Hospitals that fail to meet the reporting requirements for eCQMs stand to lose a portion of their payments for Medicare patients.
Hospital and health system leaders should turn to their glycemic management committee to help shepherd them through this process. This group can take a closer look at their current glycemic management data, identify opportunities for enhanced patient safety and quality improvements, and implement new technology and workflows that enable optimal glycemic management best practices. Inpatient glycemic management will be under public scrutiny for the first time ever, and it’s time that hospitals prioritize optimal treatment and management by finally listening to their glycemic management committee.