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[CMS69v6] NQF 0421 Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up

Last Updated: May 20, 2019 07:41PM PDT

1. Measure Details
2. Measure Parameters
3. Meeting the Measure in Elation
4. Measure Information

1. Measure Details
Report on the 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. Normal parameters: 
BMI between 18.5 and 25.

2. Measure Parameters:
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 of the current encounter

Denominator: All patients 18 and older on the date of the encounter with at least one eligible encounter during the measurement period

Exclusions/Exceptions: Patients who are pregnant, patients receiving palliative care, and patients who refuse measurement of height and/or weight or refuse follow-up.

OR 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

3. Elation Workflows

1/ Document the patient's BMI by recording height and weight in the visit note. If the patient's BMI is within normal parameters (between 18.5 and 25), no further action is needed. 

2/ If the patient's BMI is outside normal parameters (either BMI: Overweight or BMI: Underweight),  click "Address" next to the clinical reminder and select any of the pop up dialog boxes.


4. Measure Information
BMI Above Normal Parameters
Obesity continues to be a costly public health concern in the United States. This is because obesity is associated with several comorbid health problems including increased risk for coronary artery disease, type 2 diabetes, various types of cancer, gallstones and disability. These comorbid conditions are associated with higher medical care utilization and costs among obese patients. 

Screening for BMI and follow-up therefore is critical to closing this gap and contributes to quality goals of population health and cost reduction. However, due to concerns for other underlying conditions (such as bone health) or nutrition related deficiencies providers are cautioned to use clinical judgment and take these into account when considering weight management programs for overweight patients, especially the elderly.

BMI below Normal Parameters 
On the other end of the body weight spectrum is underweight (BMI <18.5 kg/m2), which is equally detrimental to population health. When compared to normal weight individuals(BMI 18.5-25 kg/m2), underweight individuals have significantly higher death rates with a Hazard Ratio of 2.27 and  95% confidence intervals (CI) = 1.78, 2.90.

Poor nutrition or underlying health conditions can result in underweight. Therefore patients should be equally screened for underweight and followed up with nutritional counseling to reduce mortality and morbidity associated with underweight.
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