Presented by: Healthcare Outcomes and Analysis LA Care Health Plan Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents September 30, 2010 Presented by: Healthcare Outcomes and Analysis LA Care Health Plan

Presentation Purpose: Best Practices for documenting record for the new measure “Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC)” Proper documentation of WCC visit(s) reflect a better quality of care for patients and a positive feedback for providers’ participation to encourage children and adolescent wellness.

WCC - Background: Obesity In Children and Teens The problem of childhood obesity in the United States has grown considerably in recent years. Statistics/Facts: Between 16 and 33 percent of children and adolescents are obese. Obesity is among the easiest medical conditions to recognize but most difficult to treat. Unhealthy weight gain due to poor diet and lack of exercise is responsible for over 30,000 deaths each year. The annual cost to society is estimated at nearly $100 billion. Overweight children are much more likely to become overweight adults unless they adopt and maintain healthier patterns of eating and exercise.

WCC – Background (contin.): According to a study conducted by CDC in 2004, 16% of children (over 9 million) 6-19 years of age are overweight or “obese.” This number is three times the population in 1980. 1 In addition to the three-fold increase, obesity has “more than doubled” in both children and adolescents from ages 2-5 and also ages 12-19. Similarly, the population more than tripled in children between 6-11 years old in the past three decades (according to this same study). 2 References: 1. Obesity In Children and Teens, American Academy of Child and Adolescent Psychiatry, May 2008 2. Prevalence of overweight and obesity among children and adolescents: United States, CDC, 2004

WCC – Background (contin.): Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (WCC): Is one of the newest HEDIS measures developed by the National Committee for Quality Assurance (NCQA) The measure consists of three (3) indicators: Body mass index (BMI) Counseling for Nutrition Counseling for Physical Activity

WCC - Body Mass Index (BMI) Indicator Documentation: Body Mass Index – documentation in the medical record should include date and BMI percentile &/or value depending upon the child’s age BMI norms vary for children between the ages 3 to 15 years, so the BMI percentile should be recorded, not just the value. For 16-17 years of age, BMI value is acceptable.

WCC - BMI Indicator Calculation: The formula used to calculate BMI is as follows: Weight in Pounds BMI = ( (Height in inches) x (Height in inches) )x703 The pediatric height and weight charts can be found on the CDC website at: http://www.cdc.gov/growthcharts/data/set1clinical/set1color.pdf

WCC - Counseling for Nutrition Indicator Documentation: Documentation must include a note indicating the date and at least one of the following: Discussion of current nutrition behaviors (e.g., eating and dieting behaviors) Checklist indicating nutrition was assessed Counseling or referral for nutrition education Member received educational materials on nutrition Anticipatory guidance for nutrition

WCC - Physical Activity Indicator Documentation: Counseling for Physical Activity Documentation must include a note indicating the date and at least one of the following: Discussion of current physical activity behaviors (e.g., exercise routine, participation in sports activities and exam for sports participation) Checklist indicating physical activity was addressed Counseling or referral for physical activity Member received educational materials on physical activity Anticipatory guidance for physical activity

WCC – Best Practices for Documentation: BMI Don’ts No BMI or BMI percentile documented in the medical record or plotted on age-growth chart Notation of height and weight only BMI or BMI percentile noted before or after the measurement year Entries on the BMI growth charts without an affiliated date Nutrition and Diet Don’ts No counseling/education on nutrition and diet Counseling/education before or after the measurement year Notation of “health education” or “anticipatory guidance” without any specific mention of nutrition

WCC – Best Practices for Documentation (contin.): Physical Activity Don’ts No counseling/education on physical activity Notation of “cleared for gym class” alone without any documentation of a discussion Counseling/education before or after the measurement year Notation of “health education” or “anticipatory guidance” without any specific mention of physical activity

WCC – Best Practices for Documentation (contin.): Take advantage of any type of member visit, whether it’s for a well-child visit or sick visit to assess and counsel your patient on their BMI, nutrition, and physical activity.

For questions, please contact: Carina Yapyuco, RN cyapyuco@lacare For questions, please contact: Carina Yapyuco, RN cyapyuco@lacare.org Theresa Colom, LVN tcolom@lacare.org