Brief Description of Measure:

​CMS69: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan:
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

Description of Issue:

Based on the 2021 specifications (v9), the measure logic related to the interventions ordered or performed as part of a follow up plan to attribute the follow up plan to a reason of an above normal or below normal BMI assessment.

Stakeholders have asked about the possibility of using a relevant BMI diagnosis code to attribute the follow up plan to the above or below normal BMI assessment, rather than the reason attribute.

The measure developer would like to receive feedback on the proposed addition to the logic that would include the use of a diagnosis to attribute the follow up plan to the above or below normal BMI assessment.

Proposed Solution:

​CURRENT LOGIC:
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 Global."NormalizeInterval" ( MostRecentBMI.relevantDatetime, MostRecentBMI.relevantPeriod ) ends 12 months or less on or before day of HighBMIIntervention.authorDatetime
  where MostRecentBMI.result >= 25 'kg/m2'

Low BMI and Order for Follow up
"Most Recent Documented BMI" MostRecentBMI
  with ( ( ( ["Intervention, Order": "Follow Up for Below Normal BMI"]
      union ["Intervention, Order": "Referrals Where Weight Assessment May Occur"] ) ReferralLowBMI
      where ReferralLowBMI.reason ~ "Underweight (finding)"
  )
    union ["Medication, Order": "Medications for Below Normal BMI"] ) LowBMIIntervention
    such that Global."NormalizeInterval" ( MostRecentBMI.relevantDatetime, MostRecentBMI.relevantPeriod ) 12 months or less on or before day of LowBMIIntervention.authorDatetime
  where MostRecentBMI.result < 18.5 'kg/m2'

PROPOSED ADDITIONS TO LOGIC:
High BMI Interventions Performed with Overweight or Obese Diagnosis
["Intervention, Performed": "Follow Up for Above Normal BMI"] HighInterventionsPerformed
  with ["Diagnosis": "Overweight or Obese"] OverweightObese
    such that OverweightObese.prevalencePeriod overlaps Global."NormalizeInterval" ( HighInterventionsPerformed.relevantDatetime, HighInterventionsPerformed.relevantPeriod )

Low BMI Interventions Performed with Underweight Diagnosis
["Intervention, Performed": "Follow Up for Below Normal BMI"] LowInterventionsPerformed
  with ["Diagnosis": "Underweight (finding)"] Underweight
    such that Underweight.prevalencePeriod overlaps Global."NormalizeInterval" ( LowInterventionsPerformed.relevantDatetime, LowInterventionsPerformed.relevantPeriod )

Rationale for Change:

Adding the diagnosis option to the logic so underweight, overweight, or obese BMIs are captured as diagnoses will provide an alternate way to capture the intent and applicability of the intervention.