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ACP does not support “Emergency Department Visits for Hypoglycemia in Older Adults with Diabetes” at the health plan level because there is no testing data. While it is important to treat hypoglycemia, the measure is targeting a small percentage of the population with diabetes that go to the emergency department (ED). There appears to be a low overall event rate, which indicates the performance measure does not necessarily impact clinical outcomes. Many times, hypoglycemia is related to patient clinical characteristics and not treatment, such as patients with higher risk of cardiovascular events. In practice, there may be consequences of stopping treatment for patients with higher risk factors for hypoglycemia. There is strong evidence for caution in treatment and more vigilance in follow-up for older patients with diabetes, but there is no publicly available testing data available that demonstrates the performance measure’s reliability and validity. This performance measure is appropriate for use at the health plan level, but it is unclear whether this performance measure is only applied to hospital EDs. Finally, some patients may pay for medications out-of-pocket or use secondary insurance for pharmacy coverage, and those pharmacy claims may not be available to the health plan for this performance measure.