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  2. CQM-3636

CMS69v7 - Numerator Query

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      Thank you for your question. For the purposes of CMS 69, if provider 1 has an encounter with a patient on 1/31/2019, where their BMI was checked and was outside of normal parameters, and appropriate follow-up was provided, then provider 1 would receive credit for the measure. If provider 2 sees the same patient on 3/5/2019 and the BMI is not measured during this encounter, provider 2 could still receive credit for provider 1’s actions on 1/31/2019, on account of the shared EHR. This is because, while the BMI was not measured during the encounter with Provider 2 on 3/5/2019, the encounter on 1/31/2019, where the BMI was measured, was outside of normal limits, and appropriate follow-up was provided falls within the timing requirement of these clinical actions, occurring within the 12 months prior to the encounter, which meets numerator requirements.

      However, if provider 2 assessed BMI during the encounter on 3/5/2019, and found the BMI was outside the normal range, and provider 2 did not intervene, then both provider 1 and provider 2 would fail the measure, unless an exception was noted.
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      Thank you for your question. For the purposes of CMS 69, if provider 1 has an encounter with a patient on 1/31/2019, where their BMI was checked and was outside of normal parameters, and appropriate follow-up was provided, then provider 1 would receive credit for the measure. If provider 2 sees the same patient on 3/5/2019 and the BMI is not measured during this encounter, provider 2 could still receive credit for provider 1’s actions on 1/31/2019, on account of the shared EHR. This is because, while the BMI was not measured during the encounter with Provider 2 on 3/5/2019, the encounter on 1/31/2019, where the BMI was measured, was outside of normal limits, and appropriate follow-up was provided falls within the timing requirement of these clinical actions, occurring within the 12 months prior to the encounter, which meets numerator requirements. However, if provider 2 assessed BMI during the encounter on 3/5/2019, and found the BMI was outside the normal range, and provider 2 did not intervene, then both provider 1 and provider 2 would fail the measure, unless an exception was noted.
    • EP
    • CMS69v7/NQF421
    • CMS69v6/NQF0421

      Hi Team,

      We have a query related to provider attribution logic for CMS69v7:

      Consider a scenarios for our providers like this:
      • Patient = Joe
      • Has encounter with Provider 1 on 31 Jan 2019 and with Provider 2 on 5 Mar 2019
      • On 31 Jan 2019: BMI is measured & BMI counseling or intervention is provided
      • On 5 Mar 2019: BMI is not measured & BMI counseling or intervention is not provided

      If I were Provider 2, I would see on the chart that Provider 1 had measured the BMI and provided treatment just over a month ago.

      • If this were a medication that provider 1 prescribed, I would see the medication still active on the chart. It would be rather odd if provider 1 were to discontinue the medication and then re-prescribe it, yet provider 2 wants to receive credit for the BMI measure.

      • If they received BMI counseling, I would know that someone in my office who is qualified to do the counseling had already talked to the patient. I would think that I would not need to perform the intervention again so soon. – see answer on issue JIRA #2564.

      As this is not a “visit-based” measure, I would think that I would need to look at the patient and see if the patient is getting the treatment they should. If the treatment is already being performed, is there a reason why I, as a subsequent provider on the care team, would re-perform interventions that are already in the patient’s plan of care?

      Many of the scenarios we are seeing is where provider 1 is a mid-level provider (a Physician’s Assistant for example) and when the patient returns to the office the next time, it is provider 2 who is the actual physician in the office (though this is not always the case – occasionally, it is two physicians).

      It seems that issue JIRA #3344’s answer would not apply in cases like this, but issue JIRA #2564’s answer would. Can you please clarify this?

      Please confirm if provider 1 and provider 2 will get the credit OR only provider 1 will get the credit

            edave Mathematica EC eCQM Team
            vinaykumarp Vinay (Inactive)
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