NQF 0421(Core) Adult Weight Screening and Follow-up

The quality measure is defined as the percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented.

This measure was needed as it has been recorded that of the medicare population, 37 percent are overweight, and 18 percent are obese. Moreover, as per the American Obesity Association, between 1991 and 1998, the prevalence of obesity among persons age 60-69 increased by 45 percent.

To generate adult weight screening and follow-up report:

1.      From the horizontal menu, click REPORTS.

Fig 1: Reports menu

2.      The REPORTS page is displayed. In the REPORTS page, from the sub-menu, click Generate Report.

The Generate Report page is displayed.

Fig 2: Generate Report window

3.      From the Select drop-down list, select Clinical Quality Measures (CQM).

4.      Click the Calendar controls to select a From and To dates. For example, let us select January 1, 2013 as the From date and December 31, 2013 as the To date.

5.      Select a Provider from the drop-down list.

6.      From the CQM drop-down list, select Adult Weight Screening and Followup.

7.      Click the Generate Report button.

The following report is generated.

Fig 3: Adult Weight Screening and Follow-up Report

Provider name, NPI (National Provider Identification) number, and Report duration are displayed as a header (in yellow color) of the report.

The report displays the following information in the respective columns:

• Clinical Quality Measures (CQM): Describes the CQM.

Criteria 1

• Total Patient: Total Patient data includes patients who meet all of the following criteria:

• Were at least 65 years on the first day of the reporting period.

• Eligible Instance: Eligible Instance data includes patients who meet all of the following criteria:

• All the patients who met the Total Patient criteria.

• Had at least one or more encounter as an outpatient during the reporting period.

Note:

• Encounter outpatient is captured in the application under Clinical > Diagnosis> Add/Edit through the Diagnosis field.

The CPT codes that determine qualifying encounters are:

• Meets Performance: Meets Performance data includes patients who meet the following criteria:

• Met the Eligible Instance criteria.

• Who satisfy one of the following criteria:

• Had BMI measurement with the encounter or max. 6 months prior to encounter and BMI is equal to or greater than 22 kg/m2 and less than 30 kg/m2.

• Had BMI measurement along with the encounter or max. 6 months prior to encounter and BMI is equals to or greater than 30 kg/m2. In addition to this one of the following is documented:

• BMI follow-up Plan

• Dietary consultation order

• Had BMI measurement with the encounter or max. 6 months prior to encounter and BMI is less than 22 kg/m2. In addition to this, one of the following is documented:

• BMI follow-up Plan

• Dietary consultation order

Note:

• BMI is captured in the application under Clinical > Nursing Station> Vitals.

• BMI Management and Dietary consultation are captured in the application under Clinical > Lab Procedures & Radiology > Add/Edit.

The CPT Lab Procedure codes for follow-up plan BMI management are:

The follow-up plan BMI Management ICD-9 Codes are:

The Dietary Consultation Order SNOMED-CT codes are:

• Exclusion Instances: Exclusions data includes patients who meet one of the following criteria:

• If patient is suffering from a terminal illness during the current encounter or in the past six months from the date of the current encounter.

• If the patient has been diagnosed as ' active: Pregnancy'.

• If the patient has not undergone a physical exam for the 'patient reason'.

• If the patient has not undergone a physical exam for the 'medical reason'.

• If the patient has not undergone a physical exam for the 'system reason'.

Note:

• Pneumococcal vaccination is captured in the application under Clinical History> Immunization & Shots> Add/Edit.

Criteria 2

• Total Patient: Total Patient data includes patients who meet all of the following criteria:

• Were at least 18 years or at least 64 years on the first day of the reporting period.

• Eligible Instance: Eligible Instance data includes patients who meet all of the following criteria:

• All the patients who met the Total Patient criteria.

• Had at least one or more encounter as an outpatient during the reporting period.

The CPT codes that determine qualifying encounters are:

• Meets Performance: Meets Performance data includes patients who meet the following criteria:

• Met the Eligible Instance criteria.

• Who satisfy one of the following criteria:

• Had BMI measurement with the encounter or max. 6 months prior to encounter and BMI is equal to or greater than 22 kg/m2 and less than 30 kg/m2.

• Had BMI measurement along with the encounter or max. 6 months prior to encounter and BMI is equal to or greater than 30 kg/m2. In addition to this, one of the following is documented:

• BMI follow-up Plan

• Dietary consultation order

• Had BMI measurement with the encounter or max. 6 months prior to encounter and BMI is less than 22 kg/m2. In addition to this, one of the following is documented:

• BMI follow-up Plan

• Dietary consultation order

Note:

• BMI is captured in the application under Clinical > Nursing Station> Vitals.

• BMI Management and Dietary consultation are captured in the application under Clinical > Lab Procedures & Radiology > Add/Edit.

The CPT Lab Procedure codes for follow-up plan BMI management are:

The follow-up plan BMI Management ICD-9 Codes are:

The Dietary Consultation Order SNOMED-CT codes are:

• Exclusion Instances: Exclusions data includes patients who meet one of the following criteria:

• If patient is suffering from a terminal illness during the current encounter or in the past six months from the date of the current encounter.

• If the patient has been diagnosed as ' active: Pregnancy'.

• If the patient has not undergone a physical exam for the 'patient reason'.

• If the patient has not undergone a physical exam for the 'medical reason'.

• If the patient has not undergone a physical exam for the 'system reason'.

The following image depicts the workflow for achieving the performance rate of this measure for Criteria 2.

Fig 4: Adult Weight Screening and Followup Report Workflow

Note:

• The above image satisfies one of the condition(s) mentioned as a part of each parameter (Total Patient, Eligible Instance, and Meets Performance) for achieving the overall Performance rate. You may generate the details using other conditions mentioned as part of each parameter.

• Performance Rate: Percentage of patients aged 18 years and older with a calculated BMI in the past six months or during the current visit documented in the medical record AND if the most recent BMI is outside parameters, a follow-up plan is documented.

• For example, in the image you see:

• Total Patients: 24

• Eligible Instance: 11

• Meets Performance (Adult Weight Screening and Followup): 2

• Exclusion Instances: 0

• Performance Rate: (Meet Performance ÷ (Eligible Instance – Exclusion Instance) )*100 = (2÷(11-0)) *100 = 18.2%

Tip:

To see the variations in Performance rate, parameters to be affected are:

• Eligible Instance: For satisfying its conditions, see Diagnosis as this is the section where patient encounter is recorded.

• Meets Performance: For satisfying its conditions, see Vitals and Lab Procedures & Radiology as this is the section where vaccination is recorded.