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:

An intended change was made to the CQL measure logic in the 2021 version of the specification (v9), to support the workflow of having the BMI intervention occur AFTER the most recent BMI. The logic change removing the 12 month look back for the documentation of the BMI follow-up plan after the last BMI has increased burden among implementers. Additionally, the logic change was not fully reflected in the numerator description creating a misalignment between the measure header and the CQL logic.

The expert work group was convened to discuss timeliness of follow up plans that align with evidence and the measure intent. Based on expert work group feedback we propose a six month look back period so that the intervention is documented either during the encounter or in the 6 months prior to the encounter. This change should reduce burden on both clinicians and implementers.

A separate CRP issue related to timing of the BMI assessment or screening is available for clincial and technical review. 

Proposed Solution:

​CURRENT HEADER LANGUAGE:
Numerator: 
Patients with a documented BMI during the encounter or during the previous twelve months, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter

PROPOSED HEADER LANGUAGE:
Numerator:
Patients with a documented BMI during the measurement period, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter at the time of the most recent BMI or during the six months before the most recent BMI

CURRENT LOGIC:
High BMI and Follow up Provided
("Most Recent Documented BMI" MostRecentBMI
  with ["Intervention, Performed": "Follow Up for Above Normal BMI"] AboveNormalFollowUp
    such that Global."NormalizeInterval" ( MostRecentBMI.relevantDatetime, MostRecentBMI.relevantPeriod ) ends 12 months or less on or before day of start of Global."NormalizeInterval" ( AboveNormalFollowUp.relevantDatetime, AboveNormalFollowUp.relevantPeriod )
      and AboveNormalFollowUp.reason in "Overweight or Obese"
  where MostRecentBMI.result >= 25 'kg/m2')

Low BMI and Follow up Provided
"Most Recent Documented BMI" MostRecentBMI
  with ["Intervention, Performed": "Follow Up for Below Normal BMI"] BelowNormalFollowUp
    such that Global."NormalizeInterval" ( MostRecentBMI.relevantDatetime, MostRecentBMI.relevantPeriod ) ends 12 months or less on or before day of start of Global."NormalizeInterval" ( BelowNormalFollowUp.relevantDatetime, BelowNormalFollowUp.relevantPeriod )
      and BelowNormalFollowUp.reason ~ "Underweight (finding)"
  where MostRecentBMI.result < 18.5 'kg/m2')
 
PROPOSED LOGIC:
High BMI and Follow up Provided
(from
    "Most Recent Documented BMI" MostRecentBMI,
    ( "High BMI Interventions Performed with Overweight or Obese Diagnosis"
      union "High BMI Interventions Ordered with Overweight or Obese Diagnosis"
      union (["Intervention, Performed": "Follow Up for Above Normal BMI"] AboveNormalFollowUp
          where AboveNormalFollowUp.reason in "Overweight or Obese")
) Interventions
    where ( Coalesce(start of Global."NormalizeInterval"(Interventions.relevantDatetime, Interventions.relevantPeriod), Interventions.authorDatetime) 6 months or less on or before day of Global."NormalizeInterval" ( MostRecentBMI.relevantDatetime, MostRecentBMI.relevantPeriod )
        or Coalesce(start of Global."NormalizeInterval"(Interventions.relevantDatetime, Interventions.relevantPeriod), Interventions.authorDatetime)during Global."NormalizeInterval" ( MostRecentBMI.relevantDatetime, MostRecentBMI.relevantPeriod )
          and MostRecentBMI.result >= 25 'kg/m2'    ))

Low BMI and Follow up Provided
 from
    "Most Recent Documented BMI" MostRecentBMI,
    ( "Low BMI Interventions Performed with Underweight Diagnosis"
      union "Low BMI Interventions Ordered with Underweight Diagnosis"
      union (["Intervention, Performed": "Follow Up for Below Normal BMI"] BelowNormalFollowUp
       where BelowNormalFollowUp.reason ~ "Underweight (finding)") ) Interventions
    where ( Coalesce(start of Global."NormalizeInterval"(Interventions.relevantDatetime, Interventions.relevantPeriod), Interventions.authorDatetime) 6 months or less on or before day of Global."NormalizeInterval" ( MostRecentBMI.relevantDatetime, MostRecentBMI.relevantPeriod )
        or Coalesce(start of Global."NormalizeInterval"(Interventions.relevantDatetime, Interventions.relevantPeriod), Interventions.authorDatetime)during Global."NormalizeInterval" ( MostRecentBMI.relevantDatetime, MostRecentBMI.relevantPeriod )
          and MostRecentBMI.result < 18.5 'kg/m2'    ))

) 

Rationale for Change:

​Updating the logic will address implementer concerns while also ensuring the measure intent is met and supports a clinically appropriate workflow.