Measure: CMS122
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%)
Measure Versions
| eMeasure Code |
Measure Year |
Full Version Number |
Title |
| CMS122v11 |
2023 |
11 |
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) |
| CMS122v10 |
2022 |
10.0.000 |
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) |
| CMS122v9 |
2021 |
9.3.000 |
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) |
| CMS122v8 |
2020 |
8.4.000 |
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) |
| CMS122v7 |
2019 |
7.4.000 |
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) |
| CMS122v6 |
2018 |
6.1.000 |
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) |
| CMS122v5 |
2017 |
5.0.000 |
Diabetes: Hemoglobin A1c (HbA1c) Poor Control (> 9%) |
Description
Percentage of patients 18-75 years of age with diabetes who had hemoglobin A1c > 9.0% during the measurement period
Guidance
If the HbA1c test result is in the medical record, the test can be used to determine numerator compliance.
Only patients with a diagnosis of Type 1 or Type 2 diabetes should be included in the denominator of this measure; patients with a diagnosis of secondary diabetes due to another condition should not be included.
This eCQM is a patient-based measure.
This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Patient Group Definitions
| Group |
Description |
Instructions Links |
| Initial Population | Patients 18-75 years of age with diabetes with a visit during the measurement period | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Exclude patients who are in hospice care for any part of the measurement period.
Exclude patients 66 and older who are living long term in an institution for more than 90 consecutive days during the measurement period.
Exclude patients 66 and older with an indication of frailty for any part of the measurement period who meet any of the following criteria:
- Advanced illness with two outpatient encounters during the measurement period or the year prior
- OR advanced illness with one inpatient encounter during the measurement period or the year prior
- OR taking dementia medications during the measurement period or the year prior
Exclude patients receiving palliative care during the measurement period. | Webchart Instructions |
| Numerator | Patients whose most recent HbA1c level (performed during the measurement period) is >9.0% or is missing, or was not performed during the measurement period. | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| Denominator Exceptions | None | |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS122v10 |
|
2022 |
10.0.000 |
Not Applicable |
f2986519-5a4e-4149-a8f2-af0a1dc7f6bc |
| Steward |
Developer |
Endorsed By |
| National Committee for Quality Assurance |
National Committee for Quality Assurance |
|
| Scoring Method |
Measure Type |
Stratification |
Risk Adjustment |
| Proportion |
INTERMEDIATE OUTCOME |
None |
None |
Rate Aggregation
None
Improvement Notation
Lower score indicates better quality
Rationale
Diabetes is the seventh leading cause of death in the United States. In 2017, diabetes affected approximately 34 million Americans (10.5 percent of the U.S. population) and killed approximately 84,000 people (Centers for Disease Control and Prevention [CDC], 2020a). Diabetes is a long-lasting disease marked by high blood glucose levels, resulting from the body's inability to produce or use insulin properly (CDC, 2020a). People with diabetes are at increased risk of serious health complications including vision loss, heart disease, stroke, kidney damage, and amputation of feet or legs (CDC, 2018).
In 2017, diabetes cost the U.S. an estimated $327 billion: $237 billion in direct medical costs and $90 billion in reduced productivity. This is a 34 percent increase from the estimated $245 billion spent on diabetes in 2012 (American Diabetes Association [ADA], 2018).
Controlling A1c blood levels helps reduce the risk of microvascular complications (eye, kidney and nerve diseases) (ADA, 2020).
Clinical Recommendation Statement
American Diabetes Association (2020):
- An A1C goal for many nonpregnant adults of <7% (53 mmol/mol) is appropriate. (Level of evidence: A)
- On the basis of provider judgement and patient preference, achievement of lower A1C goals (such as <6.5%) may be acceptable if this can be achieved safely without significant hypoglycemia or other adverse effects of treatment. (Level of evidence: C)
- Less stringent A1C goals (such as <8% [64 mmol/mol]) may be appropriate for patients with a history of severe hypoglycemia, limited life expectancy, advanced microvascular or macrovascular complications, extensive comorbid conditions, or long-standing diabetes in whom the goal is difficult to achieve despite diabetes self-management education, appropriate glucose monitoring, and effective doses of multiple glucose-lowering agents including insulin. (Level of evidence: B)
Definition
None
Transmission Format
TBD
Applicable Value Sets
| Category |
Value Set |
OID |
| Diagnosis |
Diabetes |
2.16.840.1.113883.3.464.1003.103.12.1001 |
| Diagnosis |
Frailty Diagnosis |
2.16.840.1.113883.3.464.1003.113.12.1074 |
| Encounter, Performed |
Acute Inpatient |
2.16.840.1.113883.3.464.1003.101.12.1083 |
| Encounter, Performed |
Annual Wellness Visit |
2.16.840.1.113883.3.526.3.1240 |
| Encounter, Performed |
Care Services in Long-Term Residential Facility |
2.16.840.1.113883.3.464.1003.101.12.1014 |
| Encounter, Performed |
Emergency Department Visit |
2.16.840.1.113883.3.464.1003.101.12.1010 |
| Encounter, Performed |
Encounter Inpatient |
2.16.840.1.113883.3.666.5.307 |
| Encounter, Performed |
Frailty Encounter |
2.16.840.1.113883.3.464.1003.101.12.1088 |
| Encounter, Performed |
Home Healthcare Services |
2.16.840.1.113883.3.464.1003.101.12.1016 |
| Encounter, Performed |
Nonacute Inpatient |
2.16.840.1.113883.3.464.1003.101.12.1084 |
| Encounter, Performed |
Nursing Facility Visit |
2.16.840.1.113883.3.464.1003.101.12.1012 |
| Encounter, Performed |
Observation |
2.16.840.1.113883.3.464.1003.101.12.1086 |
| Encounter, Performed |
Office Visit |
2.16.840.1.113883.3.464.1003.101.12.1001 |
| Encounter, Performed |
Outpatient |
2.16.840.1.113883.3.464.1003.101.12.1087 |
| Encounter, Performed |
Palliative Care Encounter |
2.16.840.1.113883.3.464.1003.101.12.1090 |
| Encounter, Performed |
Preventive Care Services - Established Office Visit, 18 and Up |
2.16.840.1.113883.3.464.1003.101.12.1025 |
| Encounter, Performed |
Preventive Care Services-Initial Office Visit, 18 and Up |
2.16.840.1.113883.3.464.1003.101.12.1023 |
| Encounter, Performed |
Telephone Visits |
2.16.840.1.113883.3.464.1003.101.12.1080 |
| Intervention, Order |
Hospice care ambulatory |
2.16.840.1.113762.1.4.1108.15 |
| Intervention, Performed |
Hospice care ambulatory |
2.16.840.1.113762.1.4.1108.15 |
| Intervention, Performed |
Palliative Care Intervention |
2.16.840.1.113883.3.464.1003.198.12.1135 |
| Laboratory Test, Performed |
HbA1c Laboratory Test |
2.16.840.1.113883.3.464.1003.198.12.1013 |
| Medication, Active |
Dementia Medications |
2.16.840.1.113883.3.464.1003.196.12.1510 |
| Patient Characteristic Ethnicity |
Ethnicity |
2.16.840.1.114222.4.11.837 |
| Patient Characteristic Payer |
Payer |
2.16.840.1.114222.4.11.3591 |
| Patient Characteristic Race |
Race |
2.16.840.1.114222.4.11.836 |
| Patient Characteristic Sex |
ONC Administrative Sex |
2.16.840.1.113762.1.4.1 |
| Symptom |
Frailty Symptom |
2.16.840.1.113883.3.464.1003.113.12.1075 |
References
CITATIONAmerican Diabetes Association. (2018). Economic costs of diabetes in the U.S. in 2017. Diabetes Care, 41, 917-928. Retrieved from http://care.diabetesjournals.org/content/early/2018/03/20/dci18-0007
CITATIONAmerican Diabetes Association. (2020). 6. Glycemic targets: Standards of Medical Care in Diabetes–2020. Diabetes Care 2020; 43(Suppl. 1):S66–S76. https://doi.org/10.2337/dc20-S006
CITATIONCenters for Disease Control and Prevention. (2018). Diabetes Report Card 2017. Atlanta, GA: Centers for Disease Control and Prevention, US Dept of Health and Human Services. Retrieved from https://www.cdc.gov/diabetes/pdfs/library/diabetesreportcard2017-508.pdf
CITATIONCenters for Disease Control and Prevention. (2020a). National Diabetes Statistics Report, 2020. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Dept of Health and Human Services. Retrieved from https://www.cdc.gov/diabetes/data/statistics-report/index.html
CITATIONCenters for Disease Control and Prevention. (2020b). Diabetes Basics. Retrieved from https://www.cdc.gov/diabetes/basics/diabetes.html
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Source:
https://ecqi.healthit.gov/ecqm/measures/cmsv1