CMS69v11 – Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

All patients aged 18 and older on the date of the encounter with at least one eligible encounter during the measurement period

– DENOMINATOR EXCEPTIONS

• Patients with a documented medical reason
• Patients in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient’s health status.
• Patients who refuse measurement of height and/or weight.

– DENOMINATOR EXCLUSIONS

• Patients who are pregnant at any time during the measurement period.
• Patients receiving palliative or hospice care at any time during the measurement period.

– NUMERATOR

Patients with a documented BMI during the encounter or during the measurement period, AND when the BMI is outside of normal parameters, a follow-up plan is documented during the encounter or during the measurement period.

For Denominator:

All patients aged 18 years and older on the date of the encounter with at least one eligible encounter during the measurement period are included. To record an encounter performed, navigate to Patient > Provider Note > eSuperbill. 

Numerator:

Patients with a documented BMI are included in the numerator.

1. Has normal BMI not documented during the measurement period. To record vitals, navigate to Patient > Provider Note > Clinical > Vitals. Then, click on the ‘Add’ button. Enter Weight and Height of the patient and the system automatically calculates the BMI. Once done click ‘Accept’.

Note: Normal BMI range is 18.5-24.9 kg/m2 

2. Has High BMI with follow-up plan documented during the measurement period. Patients should have a diagnosis of ‘Overweight or Obese’ before or during the measurement period.
   • To record BMI, navigate to Patient > Provider Note > Clinical > Vitals.
   • To add an “Above Normal Follow up” intervention, navigate to Patient > Clinical > Evaluations. User can set the intervention status to Ordered or Performed.

2. • User can order intervention “Referrals where weight assessment may occur” using the workflow Patient > Clinical > Evaluations. The ‘Reason’ for ordering must be set to “Overweight or Obese”.

2. • To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses, and click ‘Add’. Search for the diagnosis, add the diagnosis details, and click ‘Save’. Then click ‘Accept’ and the diagnosis is added to the provider note.

2. • Patient is prescribed a medication for above normal BMI. To document medication order, use the workflow Patient> > Clinical > Prescription 

Note: High BMI range is 25 kg/m2 and above

3. Low BMI with follow-up plan documented during the measurement period. Patients should have a diagnosis of ‘Underweight’ before or during the measurement period.
   • To record BMI, navigate to Patient > Provider Note > Clinical > Vitals.
   • To document the diagnosis, use the workflow Patient > Provider Note > Diagnoses.
   • To add intervention “Below normal Follow up”, navigate to Patient > Clinical > Evaluations. User can set the intervention status to Ordered or Performed.

3. • User can order intervention “Referrals where weight assessment may occur” using the workflow Patient > Clinical > Evaluations. Reason for ordering can be set to “Overweight or Obese”

3. • To prescribe medication for below normal BMI, use the workflow Patient> Clinical > Prescription. 

Note: Low BMI range is below 18.5 kg/m2

 DENOMINATOR EXCEPTIONS

Patients fulfilling any of the following criteria are included in the Denominator Exception:

1. Patients who refused the measurement of height and/or weight. To record this, navigate to Patient > Clinical > Vitals. Click on the ‘Save’ button without recording Height and Weight. A pop up ‘Vitals not recorded’ appears. From the Height/Weight dropdown, select the reason of Patient Refusal.

Note: To document reasons for not recording vitals, users must set preferences from the Personal Module. Navigate to Personal > My Preferences > Patient. Mark the ‘Blood Pressure’ and ‘Height/Weight’ checkboxes. Then click ‘Save’.

2. No Medication Ordered for high BMI due to Medical Reason. To record this, navigate to Patient > Clinical > Medication. Mark the checkbox ‘Patient refused to provide current medication details’
3. No Follow Up for high BMI due to Medical Reason. To record this, navigate to Patient > Clinical > Evaluations. Search for “Above normal Follow up” and set the status to ‘Not Performed’ or ‘Not Ordered’. From the ‘Reason’ dropdown, add the “Medical or Other reason not done”
4. No BMI Referral due to Medical Reason. To record this, navigate to Patient > Clinical > Evaluations. Search for “Referrals where weight assessment may occur” and set the status to ‘Not Ordered’. From the ‘Reason’ dropdown, add the “Medical or Other reason not done”
5. No Medication Ordered for low BMI due to Medical Reason. To record this, navigate to Patient > Clinical > Medication.  Mark the checkbox ‘Patient refused to provide current medication details’ 

6. No Follow Up for low BMI due to Medical Reason. To record this, navigate to Patient > Clinical > Evaluations. Search for “Below normal Follow up” and set the status to ‘Not Performed’ or ‘Not Ordered’. From the ‘Reason’ dropdown, add the “Medical or Other reason not done”

DENOMINATOR EXCLUSIONS

Patients with any of the following condition are excluded from the denominator.

1. Pregnancy during the measurement period with a qualifying encounter during the measurement period. To record patient pregnancy, navigate to the workflow Patient > Provider Note > Diagnosis.

• • To record an encounter performed, navigate to Patient > Provider Note > eSuperbill. 

2. Patients receiving palliative care during the measurement period.
   • To record the ‘Palliative Care Encounter’ performed, use the workflow Patient > Provider Note > eSuperbill.
   • To record the ‘Palliative Care Intervention’ performed, use the workflow Patient > Clinical > Evaluations.
   • To record the ‘Functional Assessment of Chronic Illness Therapy’ assessment performed, navigate to Patient > Clinical > Evaluations.
   • To record the “Encounter for palliative care” diagnosis, use the workflow Patient > Provider Note > Diagnoses.
3. Patients who received hospice care during the measurement year. To document that patient is receiving hospice care outside of a hospital or long-term care facility, navigate to Patient > Clinical > Evaluations. Use the below mentioned codes to order or perform an intervention:
   • 385763009: Hospice Care (Regime/Therapy)
   • 385765002: Hospice Care Management (Procedure)

• To document an encounter inpatient, navigate to Patient > Clinical > Evaluations.

• Patients with hospice care assessment performed during the measurement period. To document the assessment, follow the workflow Patient > Clinical > Evaluations. Click ‘+ Add’ and search for an evaluation. Then select ‘Performed’ from the ‘Status’ dropdown and enter ‘Yes’ in the ‘Result’ field.
• Patients with hospice encounter during the measurement period. To document the hospice encounter, follow the workflow Patient > Clinical > Evaluations.