Expanding the reach of the Global Malnutrition Composite Score

In the summer of 2024, the Centers for Medicare and Medicaid Services (CMS) issued a final rule that stated the Global Malnutrition Composite Score (GMCS) would be expanded to include all adults aged 18 and older. This change is slated to be implemented on January 1, 2026. This expansion will have significant impacts for hospitals who choose to report on the quality of their malnutrition care. 

Recap: What is the Global Malnutrition Composite Score?

The GMCS is a CMS electronic clinical quality measure or eCQM. Acute care hospitals who receive reimbursement from CMS are required to track and report on certain quality measures – the eCQMs. Some eCQMs are mandatory for all hospitals to report, while others are optional.  

The GMCS is a new, optional eCQM, having only been introduced in January 2024. It is the first nutrition-related CMS quality measure ever. The GMCS reflects the quality of malnutrition care given to patients who are Medicare beneficiaries, so the current version only tracks patients aged 65 and older.

To read the full explanation of the GMCS, catch up on our introductory blog here. 

What’s changing with the Global Malnutrition Composite Score?

In the summer of 2024, CMS announced it would be expanding the age range for the GMCS from only patients aged 65 and older to all adults starting at age 18. This means all adult patients will be tracked, included, and reported for the GMCS quality measure beginning in 2026. The same four components of the GMCS – malnutrition screening, dietitian assessment, physician diagnosis, and nutrition plan of care – will remain the same. 

Why the change?

In their final rule, CMS highlights the detrimental impact that malnutrition has on clinical outcomes. They acknowledge that these impacts aren’t limited to older adults, and neither is malnutrition. Importantly, the ruling spotlights the influence of proper nutrition care and interventions, stating that “by identifying instances of malnutrition among younger populations, the benefits of proper nutrition could be felt over a lifetime.”  

The change also aligns with CMS’ priorities for health equity and patient-centered care. By tailoring nutrition care and intervention to each patient’s needs, we are improving the quality of healthcare and can have a real, positive impact on clinical outcomes and quality of life.  

What can dietitians do?

As always, dietitians are the malnutrition champions. So many times, a malnutrition diagnosis and treatment plan are set in motion by the RD. With that said, to provide the best malnutrition care, it takes an interdisciplinary team effort.  

Nursing typically completes the malnutrition screening, so meet with nursing leadership to ensure nurses understand how to ask and interpret questions on your facility’s malnutrition screen. Reiterate the importance of the malnutrition screen so questions aren’t skipped or rushed.  

Physicians also need to be involved to make the official medical diagnosis of malnutrition. Educate on the proper diagnoses to use and show them where to find the dietitian’s recommendations and plan of care. Share the malnutrition diagnostic criteria with your physicians to make sure they know what to look for to make a diagnosis.  

And most importantly, help your team understand that malnutrition can affect patients of all ages, all backgrounds, and all sizes. It’s not just for the elderly or the terminally ill. Equitable healthcare gives all patients fair and equal treatment according to his/her needs. 

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Reference

Department of Health and Human Services, Centers for Medicare & Medicaid Services. Final Rule – Medicare and Medicaid Programs and the Children’s Health Insurance Program; Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Policy Changes and Fiscal Year 2025 Rates; Quality Programs Requirements; and Other Policy Changes. Published August 28, 2024. Available from https://public-inspection.federalregister.gov/2024-17021.pdf. GMCS ruling begins on page 1551.