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  1. eCQM Issue Tracker
  2. CQM-4742

CMS 69v9 &v10 - BMI screening and follow up plan - Follow up plan timing change PY21 spec year will flip a previously met outcome to an unmet with a new BMI

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    • Resolution: Answered
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    • Hugo Andrade
    • Sanford Health
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      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'

      Please review the responses to your specific questions:

      For CMS69v9, the numerator logic requires documentation of a follow-up intervention 12 months on or after the most recent high/low BMI. Therefore, a follow-up plan/intervention from a high/low BMI measurement prior to the most recent BMI will not satisfy the measures numerator criteria.
      Once eCQM measure specifications are published, they are final. This includes the 2022 version of the CMS69v10 specifications.
      In response to the conflicting solutions posted to CQM-4647 and CQM-4656, we acknowledge that the former solution posted to CQM-4647 was incorrect. It has been updated to align with the solution posted in CQM-4656.
      Thank you for your feedback. We will take it into consideration during the next eCQM Annual Update.
      Show
      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' Please review the responses to your specific questions: For CMS69v9, the numerator logic requires documentation of a follow-up intervention 12 months on or after the most recent high/low BMI. Therefore, a follow-up plan/intervention from a high/low BMI measurement prior to the most recent BMI will not satisfy the measures numerator criteria. Once eCQM measure specifications are published, they are final. This includes the 2022 version of the CMS69v10 specifications. In response to the conflicting solutions posted to CQM-4647 and CQM-4656 , we acknowledge that the former solution posted to CQM-4647 was incorrect. It has been updated to align with the solution posted in CQM-4656 . Thank you for your feedback. We will take it into consideration during the next eCQM Annual Update.
    • CMS0069v10
    • CMS69v8/NQF0421e
    • logic as is will cause deprioritization of measure.

      this is in follow-up to your solution to my original post – CQM - 4656

       

      Thank you for your response. 

       

      The response describes that your intent is to require documentation of a follow-up plan for every newly captured weight, being the most recent high/low BMI, no matter the timing of the previous plan documented to meet the measure (could be days before). Is that correct? the intent described is to document another plan although there is no changes from the previous plan captured during the current measurement period. If this is correct, health systems with the same EMR instance cannot reasonably ask clinicians to redocument the same plan for our patients seeking care more than once a measurement period. please advise, this will cause frustration and deprioritization of work on this measure. 

       

      If not able to correct logic to capture numerator action and stop this measurement period, can you confirm that this will be corrected for 2022 or CMS 69v10?

       

      Additionally, can you clarify your solution comments on CQM - 4656 vs CQM - 4676. They are in conflict per interpretation. Which is it? you say that intent will satisfy measure with first three visits follow up plan even though there is a more recent BMI (visit 5) and the other that it is not met with a new BMI captured on 4/1/21.

      CQM-4647 solution response:

      "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."

      CQM-4656 solution response:

      "As a result, in the scenario that you outlined, this patient will not meet the measure numerator criteria because the follow-up plan documented on 03/1/2021 is prior to the most recent high BMI on 04/1/2021."

            edave Mathematica EC eCQM Team
            hugo.andrade@sanfordhealth.org Hugo Andrade (Inactive)
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