New Response to Issue (Posted 7/23/2021): Thank you for your inquiry about CMS69v9: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. Changes to the timing anchors in CMS69v9 (2021), specific to the clinical actions included in the numerator, require a follow-up intervention 12 months on or after the most recent high/low BMI. To meet the numerator requirements for the 2020 version of the measure specification (CMS69v8), a follow-up/intervention needed to be documented on or before the most recent high/low BMI (12 months or less on or before the qualifying encounter). To meet the numerator requirements for the current 2021 specification (CMS69v9), the most recent high/low BMI has to be documented during the qualifying encounter or during the previous twelve months and the follow-up plan/intervention for the most recent high/low BMI must be on or after the most recent high/low BMI. High BMI and Order for Follow Up "Most Recent Documented BMI" MostRecentBMI   with ( ( ( ["Intervention, Order": "Follow Up for Above Normal BMI"]       union ["Intervention, Order": "Referrals Where Weight Assessment May Occur"] ) ReferralHighBMI       where ReferralHighBMI.reason in "Overweight or Obese"    )     union ["Medication, Order": "Medications for Above Normal BMI"] ) HighBMIIntervention     such that MostRecentBMI.relevantDatetime 12 months or less on or before day of HighBMIIntervention.authorDatetime   where MostRecentBMI.result >= 25 'kg/m2' In response to the scenario you provided, in which a provider has 5 encounters with a patient, and a high/low BMI is documented each visit, since a follow-up plan/intervention was documented for the first 3 visits, but not for the last 2 visits, the patient will not meet the measure numerator criteria. This is due to the numerator requiring that a follow-up plan/intervention for the most recent high/low BMI be 12 months on or after the most recent high/low BMI. Thank you for your feedback. We will take it into consideration during the next eCQM Annual Update. Previous Response to Issue (Posted 6/23/2021): Thank you for your inquiry about CMS69v9: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. Since this measure is a patient-based measure, this means that the measure is meant to be reported "a minimum of once per reporting period for patients seen during the reporting period," not at every encounter. In the scenario you outlined when a patient is seen five (5) times during the reporting period and their BMI is documented during each encounter, the measure guidance states, "the most recent BMI will be used to determine if the performance has been met," and "if the most recent documented BMI is outside of normal parameters, then a follow-up plan must be documented during the encounter or during the previous twelve months of the current encounter." Therefore, with the example of the provider documenting follow-up for the first three (3) visits but none for the last two (2) visits, the BMI from the last encounter will be used determine if the performance has been met, and since a follow-up plan was documented during the previous twelve months of the current encounter (from the first three visits), the provider will have met the measure. The logic captures this as follows: Low BMI and Follow Up Provided "Most Recent Documented BMI" MostRecentBMI   with ["Intervention, Performed": "Follow Up for Below Normal BMI"] BelowNormalFollowUp     such that MostRecentBMI.relevantDatetime 12 months or less on or before day of start of BelowNormalFollowUp.relevantPeriod       and BelowNormalFollowUp.reason ~ "Underweight (finding)"   where MostRecentBMI.result < 18.5 'kg/m2' High BMI and Follow Up Provided "Most Recent Documented BMI" MostRecentBMI   with ["Intervention, Performed": "Follow Up for Above Normal BMI"] AboveNormalFollowUp     such that MostRecentBMI.relevantDatetime 12 months or less on or before day of start of AboveNormalFollowUp.relevantPeriod       and AboveNormalFollowUp.reason in "Overweight or Obese"   where MostRecentBMI.result >= 25 'kg/m2'

Is the intent of the metric to have a BMI follow-up plan with the patient at every visit if BMI is not within the measurement year? Meaning a provider has 5 visits with the patient, each visit a BMI is documented so at every visit a follow-up plan is required? Or is that a BMI follow-up is required within the measurement year? So, with the 5 visit example, the provider counseled or had some kind of follow-up plan for the first 3 visits but didn't have anything for the last 2 visits. Is the provider still meeting the metric or are they now failing because the last 2 visits they did not have a bmi follow-up plan? This piece here, simply part of the denominator? Most Recent Documented BMI o Last(["Physical Exam, Performed": "Body mass index (BMI) [Ratio]"] BMI o with "Qualifying Encounter During Measurement Period" QualifyingEncounter o such that BMI.relevantDatetime 12 months or less on or before day of o end of QualifyingEncounter.relevantPeriod o and BMI.result >= 0 'kg/m2' o sort by relevantDatetime This is the numerator: Numerator o "Normal BMI" is not null o or "High BMI and Order for Follow Up" is not null o or "High BMI and Follow Up Provided" is not null o or "Low BMI and Order for Follow Up" is not null o or "Low BMI and Follow Up Provided" is not null The description states: Percentage of patients aged 18 years and older with a BMI documented during the current encounter or within the previous twelve months AND who had a follow-up plan documented if most recent BMI was outside of normal parameters. Does this mean that the follow-up plan has to be done at every time the patient has a BMI documented?