[CMS69v12] Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

Contents

• Measure Details
• Measure Parameters
• Elation Workflows
• Measure Information

   

Measure Details

Percentage of patients aged 18 years and older with a BMI documented during the current encounter or during the measurement period AND who had a follow-up plan documented if most recent BMI was outside of normal parameters.

 

Measure Parameters

Numerator: Patients with a documented BMI during the encounter or during the measurement period, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the measurement period.
 

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

Exclusions/Exceptions:

• Patients who are pregnant (with a diagnosis of pregnancy documented in their chart using ICD-10 codes)
• Patients receiving palliative or hospice care
• Patients with a documented medical reason for not documenting BMI or for not documenting a follow-up plan for a BMI outside normal parameters (e.g., elderly patients (65 or older) for whom weight reduction/weight gain would complicate other underlying health conditions such as illness or physical disability, mental illness, dementia, confusion, or 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.
• Patients who refuse measurement of height and/or weight.

These are the exclusion and exception document tags for this measure (Reference: Tag Reports and Notes with Document Tags):

• CQM EXCL: BMI MEAS REFUSED
• CQM EXC: BMI ABOVE NORM FOLL REJ
• CQM EXC: BMI ABOVE NORM MEDS REJ
• CQM EXC: BMI BELOW NORM FOLL REJ
• CQM EXC: BMI BELOW NORM MEDS REJ
• CQM EXC: BMI REF WT ASSESSMT REJ

 

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), a second Clinical Reminder will appear within a few seconds. Click "Address" next to the clinical reminder and select any of the pop up dialog boxes.

3. Documenting one of the following document tags in a visit note or report (Reference: Tag Reports and Notes with Document Tags):
   • Ref to Diet Svc
   • Ref to Dietitian
   • Ref to Wt Mgt Program
   • Diet Cnsl
   • Exc Cnsl
   • Nutrition Cnsl

 

Measure Information

BMI Above Normal Parameters:

Obesity is a chronic, multifactorial disease with complex psychological, environmental (social and cultural), genetic, physiologic, metabolic and behavioral causes and consequences. The prevalence of obesity in adults increased to 42.4 percent in 2018, with the highest percentage among adults in the 40-59 age bracket compared with other age group. Obesity is associated with several comorbid health problems including increased risk for coronary artery disease, type 2 diabetes, obstructive sleep apnea, 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 is critical and will help in reaching the 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 their best clinical judgment 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.

Reference: Measure Information from CMS

 

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• Clinical Reminders for Clinical Quality Measures
• Tag Reports and Notes with Document Tags
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