eCQM: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan (CMS 69v5)


eCQM:

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan

CMS ID:

CMS 69v5

Measure Type:

Process

MIPS High Priority Measure:

No

Quality ID:

128

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)

Performance Benchmark for MIPS:

68.19%

Description:

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the previous six months AND with a BMI outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months of the current encounter.


Normal Parameters: Age 18 years and older BMI =>18.5 and <25 kg/m2

  • Numerator: Patients with a documented BMI during the encounter or during the previous six months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous six months before the current encounter.
  • Denominator: All patients 18 and older on the date of the encounter with at least one eligible encounter (defined as a signed chart note with an encounter type of Office Visit) during the measurement period.
    • Denominator Exclusions: Patients who are pregnant, patients receiving palliative care, or patients who refuse measurement of height and/or weight or refuse follow-up.

    • Denominator Exceptions: Patients with a documented Medical Reason:

      • Elderly Patients (65 or older) for whom weight reduction/weight gain would complicate other underlying health conditions such as the following examples: illness or physical disability, mental illness, dementia, confusion, nutritional deficiency, such as Vitamin/mineral deficiency.

      • Patients in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status.

eCQM Patient Reports

eCQM Patient Reports can help you identify patient care gaps and improve the performance of your quality measures. Click on the blue result numbers in the eCQM Dashboard to see the patient report for this measure.

The eCQM Patient Reports list the individual patients included in the measure’s population, which measure cohorts the patient is in, and contact information for the patient to streamline any downstream communication that may be needed to fulfill the measure requirements. You can choose to print the patient list for a measure or export it as a CSV.

The measure cohorts included in the eCQM Patient Report for CMS 69v5 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan are:

  • Initial patient population
  • Denominator
  • Numerator
  • Exclusion
  • Exception

Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you are able to meet the requirements of this measure within the Practice Fusion EHR.

  1. For all visits with patients over the age of 18 years, ensure the patient has a documented BMI from the current encounter or from during the previous six months.
  2. If the patient does not have a BMI from the previous six months, enter the patient’s height and weight in the vitals flowsheet to automatically calculate the BMI value.
  3. Review the recorded BMI value and determine whether it falls within the normal range, as defined by the measure (=> 18.5 and < 25 kg/m2).
  4. If the patient’s BMI falls outside of normal parameters, review the appropriate follow-up activities (listed in Table 1) and record them in the patient’s chart using the Practice Fusion EHR suggested workflows listed in Table 2, ensuring that the appropriate Reason is selected (Overweight or Underweight) depending on the patient’s BMI value.

Table 1: BMI Parameters and Required Follow-Up Activities

BMI Parameters

Required Follow-Up

Normal
=>18.5 and <25 kg/m2

None

Below Normal
<18.5 kg/m2

Referral to alternative provider/care setting that is ordered during the encounter

OR

Diet or lifestyle education given during the encounter

OR

Order for weight management medication completed during the encounter.

Above Normal
>25 kg/m2

Referral to alternative provider/care setting that is ordered during the encounter

OR

Diet or lifestyle education given during the encounter

OR

Order for weight management medication completed during the encounter.

Table 2: Practice Fusion Suggested Workflows for Follow-up Activities

Follow-up Activities

Practice Fusion Suggested Workflow

Referral to alternative provider/care setting
Below Normal

  • In the Screenings/Interventions/Assessments section of the encounter, search for the applicable referral being sent. Examples include:

    • Patient referral to dietitian (procedure) (SNOMED CT 103699006)

    • Refer to weight management program (procedure) (SNOMED CT 408289007)

  • Record and save the following information in the modal window that opens:

    • Status: Ordered

    • Reason: Underweight

    • Start Date: If the referral was made on the same date of service as the encounter in which it is recorded in the Screenings/Interventions/Assessments section, a start or end date should not be entered for the referral. (See Graphic 1 for example.)

Referral to alternative provider/care setting
Above Normal

  • In the Screenings/Interventions/Assessments section of the encounter, search for the applicable referral being sent. Examples include:

    • Patient referral to dietitian (procedure) (SNOMED CT 103699006)

    • Refer to weight management program (procedure) (SNOMED CT 408289007)

  • Record and save the following information in the modal window that opens:

    • Status: Ordered

    • Reason: Overweight

    • Start Date: If the referral was made on the same date of service as the encounter in which it is recorded in the Screenings/Interventions/Assessments section, a start or end date should not be entered for the referral. (See Graphic 1 for example.)

Diet or lifestyle education
Below Normal

  • In the Screenings/Interventions/Assessments section of the encounter, search for the appropriate diet or lifestyle education. Examples include:

    • Prescribed diet education (procedure) (SNOMED CT 386464006)

    • Feeding regime (regime/therapy) (SNOMED CT 418995006)

  • Record and save the following information about the diet or lifestyle recommendation in the modal window that opens:

    • Status: Ordered

    • Reason: Underweight

    • Start Date: If the procedure was ordered on the same date of service as the encounter in which it is recorded in the Screenings/Interventions/Assessments section, a start or end date should not be entered for the procedure. (See Graphic 1 for example.)

Diet or lifestyle education
Above Normal

  • In the Screenings/Interventions/Assessments section of the encounter, search for the appropriate diet or lifestyle education. Examples include:

    • Giving encouragement to exercise (procedure) (SNOMED CT 304549008)

    • Special diet education (procedure) (SNOMED CT 410177006)

  • Record and save the following information about the diet or lifestyle recommendation in the modal window that opens:

    • Status: Ordered

    • Reason: Overweight

    • Start Date: If the procedure was ordered on the same date of service as the encounter in which it is recorded in the Screenings/Interventions/Assessments section, a start or end date should not be entered for the procedure. (See Graphic 1 for example.)

Weight management medication
Below Normal

  • In the Medications or Plan section of the encounter, order an applicable weight management medication, ensuring the start date is assigned. Examples include:

    • Megestrol Acetate 20 MG Oral Tablet (RXNORM 860215)

    • Megestrol Acetate 160 MG Oral Tablet (RXNORM 860231)

Weight management medication
Above Normal

  • In the Medications or Plan section of the encounter, order an applicable weight management medication, ensuring the start date is assigned. Examples include:

    • Orlistat 120 MG Oral Capsule (RXNORM 314153)

    • Orlistat 60 MG Oral Capsule (RXNORM 692876)

Graphic 1: Example of data elements recorded in Screenings/Interventions/Assessments


To access a complete list of appropriate follow-up activities and medications for the purposes of this measure, visit the
United States Health Information Knowledgebase (USHIK). This site is produced by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS and the National Library of Medicine (NLM). A free Unified Medical Language System® (UMLS) license, available from NLM, is required to access USHIK. Additional Measure Information
  • This 2016 measure version has been updated from the previous 2015 version specifications, incorporating the following change:

    • Added exceptions to the measure specifications, including medical reasons for not performing indicated follow-up plan.

    • Updated to reflect the change in measure specifications to one initial population. Removed medical reason for exclusion.

    • Updated measure description to align with clinical guidelines by removing separate population criteria for patients age 65 and older.

    • Updated guidance to address elderly population.

    • Updated initial population to align with clinical guidelines by removing separate population criteria for patients age 65 and older.

  • This measure is to be reported a minimum of once per reporting period for patients seen during the reporting period.
  • BMI Measurement Guidance: An eligible professional or their staff is required to measure both height and weight. Both height and weight must be measured within six months of the current encounter and may be obtained from separate encounters. Patient self-reported values cannot be used.
  • If more than one BMI is reported during the measurement period, the most recent BMI will be used to determine if the performance has been met.
  • For a patient to be recognized for the denominator exceptions, you may use the suggested workflow detailed in Table 3.

Table 3: Practice Fusion Suggested Workflow for CMS 69v5 Denominator Exceptions

Denominator Exception Criteria

Practice Fusion Suggested Workflow

Above Normal Follow-up
Reason Not Done

  • In the Screenings/Interventions/Assessments section of the encounter, search for one of the data elements associated with an Above Normal Follow-Up as listed in Table 2 and select the item. Examples include:

    • Patient referral to dietitian (procedure) (SNOMED CT 103699006)

    • Refer to weight management program (procedure) (SNOMED CT 408289007)

  • Once selected, record the following in the modal window that opens:

    • Status: Not Ordered

    • Reason: Refusal of treatment by patient, Medical contraindication, Procedure contraindicated, OR Treatment not tolerated

    • Start Date: If the action was performed on the same date of service as the encounter in which it is recorded in the Screenings/Interventions/Assessments section, a start or end date should not be entered for the refusal.

Below Normal Follow-up
Reason Not Done

  • In the Screenings/Interventions/Assessments section of the encounter, search for one of the data elements associated with an Below Normal Follow-Up as listed in Table 2 and select the item. Examples:

    • Prescribed diet education (procedure) (SNOMED CT 386464006)

    • Feeding regime (regime/therapy) (SNOMED CT 418995006)

  • Once selected, record the following in the modal window that opens:

    • Status: Not Ordered

    • Reason: Refusal of treatment by patient, Medical contraindication, Procedure contraindicated, OR Treatment not tolerated

    • Start Date: If the action was performed on the same date of service as the encounter in which it is recorded in the Screenings/Interventions/Assessments section, a start or end date should not be entered for the refusal.

Referral to alternate provider/care setting
Reason Not Done

  • In the Screenings/Interventions/Assessments section of the encounter, search for the appropriate referral (see Table 2) and select the item.

  • Once selected, record the following in the modal window that opens:

    • Status: Not Ordered

    • Reason: Refusal of treatment by patient, Medical contraindication, Procedure contraindicated, OR Treatment not tolerated

    • Start Date: If the action was performed on the same date of service as the encounter in which it is recorded in the Screenings/Interventions/Assessments section, a start or end date should not be entered for the refusal.

For a patient to be recognized for the denominator exclusion, you may use the suggested workflow in Table 4.

Table 4: Practice Fusion Suggested Workflow for CMS 69v5 Denominator Exclusions

Denominator Exclusion Criteria

Practice Fusion Suggested Workflow

Diagnosis of Pregnancy

  • In the Diagnoses section of the patient Summary or encounter, ensure that an active diagnosis of pregnancy has been recorded. The complete list of diagnosis codes for pregnancy that will qualify a patient for the denominator exclusion are listed here.

Diagnosis of Palliative Care

  • To record that a patient is currently under palliative care, search for the term “Encounter for Palliative Care” (ICD10 Z51.5) in the Diagnoses section of the patient chart.

Refusal of Height and/or Weight Measurement or Follow-up

  • In the Screenings/Interventions/Assessments section of the encounter, search for “Body mass index (BMI) [Ratio]” (LOINC 39156-5).

  • Once selected, record the following in the modal window that opens:

    • Status: Not Ordered

    • Reason: Refusal of treatment by patient

    • Start Date: If the action was performed on the same date of service as the encounter in which it is recorded in the Screenings/Interventions/Assessments section, a start or end date should not be entered for the refusal.

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