DECEMBER 1, 2021
By: Dr. Jordan Messler
The focus on glycemic management as a key indicator of patient safety was announced as part of CMS’s annual adjustment to inpatient payment policies, which are accompanied by updated rules for its Inpatient Quality Reporting (IQR) program.
This year, Centers for Medicare & Medicaid Services (CMS) has signaled a strong commitment to improving an often-overlooked area of inpatient care – glycemic management. For health system executives that haven’t noticed yet, there are many reasons why they need to start paying attention to glycemic quality metrics.
The focus on glycemic management as a key indicator of patient safety was announced as part of CMS’s annual adjustment to inpatient payment policies, which are accompanied by updated rules for its Inpatient Quality Reporting (IQR) program. The quality reporting program serves two purposes: to “drive quality improvement through measurement and transparency” and to “encourage hospitals and clinicians to improve the quality and cost of inpatient care provided to all patients.”
As CMS pushes the industry towards more value-based arrangements and shared risk, these rules are part of a diligent effort to identify areas for quality improvement that can have substantial impact on safety and costs across inpatient care. That’s exactly why glycemic management came into focus this year.
In fact, two of the three new electronic clinical quality metrics (eCQMs) CMS introduced this year involve glycemic management. One outlines measurement of prolonged, untreated hyperglycemia rates in hospitals while the other is intended to measure preventable severe hypoglycemia due to adverse drug effects.
The new eCQMs are heavily-focused on glycemic metrics because they are key indicators of patient safety in the hospital. The negative effects that high or low blood sugar can have on a person in the short-term and long-term are well documented. And for hospitals, there’s a growing mountain of evidence showing how abnormality in blood sugar stability impacts the quality and costs of care.
While there may be a conventional belief that monitoring and treating blood sugar is only important for people living with diabetes, it’s simply not true.
The truth is that around 2 in 5 patients admitted to the hospital have hyperglycemia, and a third of those have no history of diabetes. In addition to the number of people who have ongoing but undiagnosed blood glucose management issues, people who are critically ill experience transient, stress-induced hyperglycemia after surgery. Plus, there are hundreds of medications a person might be prescribed during a hospital stay that are known to impact insulin resistance, which in turn affects blood glucose levels.
The need for proper glucose management isn’t just isolated to a single disease state and specialty, or even a single unit in the hospital. But even though blood glucose is an underlying factor that could impact the outcomes of many of the conditions a person is being treated for in a hospital, it is often not treated as urgently or as effectively as it could be. Since providers tend to focus on a patient’s primary reason for admission and specialists only focus on their area of clinical expertise, glycemic management has historically been lower on the list of priorities.
On top of all that, many nurses and doctors don’t have the knowledge or skills needed to treat dysglycemia properly. So to assist in calculating insulin doses, they rely on outdated methods that require manual calculations and do not personalize treatment or address the workflow challenges of properly timing blood sugar checks and dose adjustments. These common approaches go against recommendations the American Diabetes Association (ADA) and other organizations have made to use personalized written or computerized dosing protocols as the standard of care.
The ADA and others recommend personalized treatment that is regularly adjusted as a patient’s need changes because currently, insulin is involved in 16.3% of medication error reports for high-alert medications in acute care settings, more than any other medication type. But on the flip side, when insulin is used effectively to help patients maintain their target blood glucose, it can be life-saving and improve their morbidity and mortality.
Research has also shown that keeping patients in target range, using clinically-validated protocols that allow for personalized care with safety guardrails, can reduce 30-day readmissions by up to 68% and cut length of stay by up to 3.2 days. Naturally, being able to improve patient outcomes more quickly – and keep them from returning to the hospital for the same condition – has a positive impact on total cost of care too. In fact, one hospital that studied the financial impact of improving glycemic management among patients documented cost savings as high as $9 million in their first year.
An exciting benefit of the new CMS reporting measures is that while they don’t actually set a standard or benchmark for good glycemic management, having a consistent, industry-wide measure will allow hospitals to see how they compare to other similar hospitals.
While every hospital should want to reduce their rates of hyperglycemia and hypoglycemia – for the many reasons discussed above – most hospitals do not have established glycemic KPIs that are benchmarked to give them an understanding of how well they’re doing or how far they have to go to improve. The first step is tracking consistent metrics, and CMS is creating incentives to encourage hospitals to follow through. Hospitals that do not adhere to reporting requirements stand to lose a portion of their payments for Medicare patients – and no one wants to see revenue dwindle from their largest payer.
Evidence about the impact of glycemic management on the cost and quality of inpatient care has been growing for decades and has become too hard to ignore. This recognition from CMS is a tipping point that has been a long time coming and hospitals that aren’t paying attention to glycemic management yet will start now.
– This article originally appeared on MedCityNews.
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