Summary
Not meeting CMS122FHIR's poor-control numerator does not mean that a patient has achieved an appropriate individualized glycemic goal.
Detail
Reviewed on 2026-11-03. The pinned CQL counts an assessment above 9%, a selected assessment without a result, or no assessment in the numerator. It considers HbA1c and glucose management indicator. The existing missing-result note explains why absence of testing must not be dropped.
The ADA Standards of Care 2026, section 6 recommends an A1C goal below 7% for many nonpregnant adults, while individualizing goals for treatment risks, frailty, function, and comorbidity. It also addresses CGM time in range and hypoglycemia. Thus, a qualifying A1C of 8% can be outside the measure's elevated-result branch while above an individual's treatment goal. Conversely, intensification solely to achieve a uniform low A1C can be unsuitable for someone at substantial hypoglycemia risk.
The same ADA section summarizes foundational trial evidence and its limitations; this note relies on that guideline synthesis rather than independently reviewing each underlying trial. The measure does not by itself assess comprehensive cardiovascular or kidney risk management.
Resolution
Open for clinical review. Keep poor-control reporting, missing assessments, and individualized goal attainment distinct in explanations. Proposed tests should include a value exactly at 9%, above 9%, missing results, and HbA1c/GMI selection. These are test proposals; no CQL execution or new clinical target is established by this note.