[CQM-4647] CMS 69 BMI question Created: 06/09/21  Updated: 09/07/21  Resolved: 06/24/21

Status: Closed
Project: eCQM Issue Tracker
Component/s: None

Type: EC eCQMs - Eligible Clinicians Priority: Moderate
Reporter: Christine Bailey (Inactive) Assignee: Mathematica EC eCQM Team
Resolution: Answered Votes: 0
Labels: None

Contact Name: Christine
Contact Email: baileyck@multicare.org
Contact Phone: 206-779-7020
Institution/Name: MultiCare Health Systems
Solution: 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'
Solution Posted On:
2022 Performance Period EC eCQMs:
CMS0069v10
2021 Performance Period EC eCQMs:
CMS69v9/NQFna
Impact: 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?
Last Commented Date:

 Description   

Adding some additional thoughts: Our EHR vendor is interpreting the rule as counseling must happen anytime AFTER BMI is logged.
Some of our providers get a BMI at every visit which provides a graph for our patients to see their weight over time. Counseling at every visit causes burden and could irritate our patients, we don't want a negative impact on our patients by bringing it up so often which could make the patient not want to return for the care they need.  BMI doesn't go down or up over night.

 Comments   
Comment by Mathematica EC eCQM Team [ 09/07/21 ]

Thank you for your follow-up comment about CMS69v9: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. CMS does not provide guidance or recommendations on clinical or EHR workflow. While the measure logic does not require an intervention be documented with every BMI measurement, if the BMI is outside of normal limits, it does require that an intervention be documented on the same day as the BMI or within the 12 months following the BMI. How your providers document that may be dependent upon local workflow, EHR workflow, and to what degree communication of a repeat intervention needs to be shared with the patient based on the specific situation you describe. As long as the documented intervention is consistent with the concepts captured in following value sets it will meet the numerator requirements.

Follow Up for Above Normal BMI (2.16.840.1.113883.3.600.1.1525)
Follow Up for Below Normal BMI (2.16.840.1.113883.3.600.1.1528)

Comment by Christine Bailey (Inactive) [ 08/04/21 ]

Thank you for the follow-up comments, that is extremely helpful.  

I was told by my EHR vendor that they won't make a change from statements/answers provided through this forum.  Is there someone that I can escalate this to someone within CMS that can convince my EHR vendor to update the logic?

Comment by Mathematica EC eCQM Team [ 07/30/21 ]

​Thank you for your follow-up inquiry about CMS69v9: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan. We are aware that a discrepancy exists between the numerator statement provided in the header and the CQL. Since the header is only meant to provide a written narrative of the measure logic, please refer to the measure logic itself as the source of truth. The timeframe indicated for "AboveNormalFollowUp.relevantPeriod" is the start and end time of the period during which the follow-up is documented by the clinician. This relevant period begins when the most recent BMI is documented and ends when the follow up intervention is documented within 12 months from the documented BMI. To meet the measure, the most recent BMI has to be documented during the qualifying encounter or within the 12 months before the qualifying encounter. However, the follow-up plan/intervention for an abnormal BMI must be documented during or within 12 months after the most recent documented BMI. We will work to align the measure header and logic during the upcoming update cycle for the measure.

Comment by Christine Bailey (Inactive) [ 07/23/21 ]

Thank you - this was the first time I had submitted a question and never saw the solution piece.  Looking forward to the follow-up answer as well. 

Comment by Mathematica EC eCQM Team [ 07/23/21 ]

Hello, thank you for reaching out. You may find our response to the inquiry under the "Solution" field above, in the ticket information. Additionally, we are working to address the follow-up question in the comments.

Comment by Christine Bailey (Inactive) [ 07/22/21 ]

My tickets states closed and resolution is "answered".  I don't see the an answer. 

Comment by Christine Bailey (Inactive) [ 07/16/21 ]

Hello - just checking to see if you have any update.  My providers are getting anxious to hear. 

Comment by Mathematica EC eCQM Team [ 07/08/21 ]

Thank you for the follow-up question. We will review your ticket and provide a response as soon as possible.

Comment by Kimberly (Inactive) [ 07/06/21 ]

There are multiple cases with conflicting solutions around the 2021 changes to BMI Screening and follow-up - CMS 69v9 (CQM-3996, CQM-4656, CQM-4647). Our concern is also that the measure narrative indicates " If the most recent documented BMI is outside of normal parameters, then a follow-up plan is documented during the encounter or during the previous twelve months of the current encounter". In addition, we would appreciate clear guidance on what timeframe is indicated for "AboveNormalFollowUp.relevantPeriod". Does a follow-up plan for abnormal BMI documented within 12 months prior to most recent BMI met the measure? 

  • 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' 

 

Comment by Mathematica EC eCQM Team [ 06/24/21 ]

We apologize for the delay in providing a response for your question. We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your continued patience.

Comment by Gail Henson-Swaney [ 06/17/21 ]

Our Quality Reporting Team shares this same concern, which was also reported under CQM-4656, where I added our comments to the ticket opened by Sanford Health. We'll be watching both for a response.

Comment by Christine Bailey (Inactive) [ 06/17/21 ]

Thank you. 

Comment by Mathematica EC eCQM Team [ 06/17/21 ]

We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your patience.

Comment by Christine Bailey (Inactive) [ 06/16/21 ]

Just checking in to see if there is going to be an answer soon. 

Comment by Mathematica EC eCQM Team [ 06/10/21 ]

Thank you for submitting your question. We will review your ticket and provide a response as soon as possible.

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