1. Behavioral Health Clinic Quality Measures (BHCQMs)
0421 Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow up (BMI-SF)
0024 Weight Assessment for Children/Adolescents: Body Mass Index Assessment for Children/Adolescents (WCC-BH)
February 2, 2017

2. Objectives of this webinar
The participants will be able to -
Describe what needs to be collected in these measures
Plan how to gather and record data for the measures
Identify process changes which will need to occur at their Center

3. BHCQM Summary
Measure
Specifics
Omit
Where Documented
Who Documents
Numerator
Denominator
Frequency
Comments
0421 Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow up (BMI-SF)
Percentage of individuals aged 18 years and older with a BMI documented; if the BMI is outside of normal parameters, a follow up plan is documented. Height and weight must be measured by the provider; self report cannot be used. Follow up plan may include but is not limited to one of the following: Documentation of education; referral, pharmacological interventions, dietary supplements, exercise counseling, nutrition counseling
Omit clients if one of the following reasons is documented: Client is receiving palliative care, client is pregnant, client refuses to have height and weight taken, any other reason documented by the provider why BMI is not appropriate, client is in a crisis situation.
Medical record. Means to extract data and aggregate needed.
Must take place during a prescriber encounter, but does not have to be done by the prescriber.
The number of clients with a documented BMI during the encounter or previous 6 month AND, when the BMI is outside of normal parameters, a documented follow up plan.
The number of adult individuals served.
Use BMI for current encounter or during previous 6 month period; once per year
Normal parameters: ≥65: >23 and < : >18.5 and <25
0024 Weight Assessment for Children/Adolescents: Body Mass index Assessment for Children/Adolescents (WCC-BH)
Percentage of individuals ages 3 to 17 with primary care practitioner (PCP) or obstetrical/gynecological (OB/GYN) practitioner outpatient visit who had evidence of body mass index (BMI) percentile documentation during the measurement year.
Individuals with diagnosis of pregnancy during the reporting period or individuals who opted out of being weighed.
May use both administrative data and paper or electronic health records data. Means to extract and aggregate data needed.
Documented by Care Coordinator, Direct Care Staff, LVN, MA, Prescribers, RN.
The number of individuals with a BMI percentile recorded during the measurement period or year prior to measurement period.
The number of child/adolescent individuals served.
Once per year. 2 year reporting period.
BMI percentile may be BMI percentile OR BMI percentile plotted on an age-growth chart. Height, weight and BMI must be from same data source
Hybrid allows BHC to use their own BMI measures

4. 0421 Preventive Care and Screening: Adult Body Mass Index (BMI) Screening and Follow up (BMI-SF)
Percentage of clients aged 18 years and older with a BMI documented AND if the BMI is outside of normal parameters, a follow-up plan is documented.
Body mass index (BMI) is a measure of body fat that is based on height, weight, age and gender.
Normal Parameters: • Age 65 years and older BMI > 23 and < 30
• Age years BMI > 18.5 and < 25
(0421 BMI-SF)

5. Purpose and Benefits
Underweight (BMI below parameters) could be indicative of
depression
eating disorder
malnutrition
Obesity (BMI above parameters) is associated with
increased risk for coronary artery disease
type 2 diabetes
various types of cancer
other serious health risks
These comorbid medical conditions are associated with higher use of health care services and costs among obese clients. Obesity is also associated with an increased risk of death, particularly in adults younger than age 65 years and has been shown to reduce life expectancy by 6 to 20 years depending on age and race .
Less than 50% of obese adults in 2010 received advice to exercise or perform physical activity.
(0421 BMI-SF)

6. Denominator
All clients 18 years and older at the time of the encounter
Eligible encounters during the reporting period (CPT or HCPCS):
90791, 90792, 90832, 90834, 90837, 90839, 96150, 96151, 96152, 97001, 97003, 97802, 97803, 98960, 99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, D7140, D7210, G0101, G0108, G0270, G0271, G0402, G0438, G0439, G0447
The measurement period for the denominator is the measurement year (9/1/17 - 8/31/18).
Reference for eligible encounters:
(0421 BMI-SF)

7. Exclusions
A client is not eligible if one or more of the following reasons are documented:
client is receiving palliative care
client is pregnant
client refuses height and/or weight measurement
any other reason documented in the medical record by the provider why BMI measurement was not appropriate
client is in an urgent or emergent medical situation
(0421 BMI-SF)

8. Numerator
The number of clients in the eligible population with a documented BMI during the encounter or during the previous six months AND, when the BMI is outside of normal parameters, a follow-up plan is documented.
(0421 BMI-SF)

9. What counts as follow up?
A follow-up plan may include, but is not limited to:
Documentation of education
Referral (for example a registered dietician, nutritionist, occupational therapist, physical therapist, primary care provider, exercise physiologist, mental health professions, or surgeon)
Pharmacological interventions
Dietary supplements
Exercise counseling
Nutrition counseling
(0421 BMI-SF)

10. Details, details………
Staff must measure both height and weight self-reported values
cannot be used.
There is no diagnosis associated with this measure.
The BMI and follow up (if needed), or documentation why it was not collected, must be captured on the same day as a prescriber or therapist visit (see eligible encounter codes), but does not have to be done by the prescriber or therapist.
SAMHSA presentation on this measure:
(0421 BMI-SF)

11. Documentation
The BMI may be documented in the medical record or it may be obtained in outside medical records. If the most recent documented BMI is outside of normal parameters, then a follow-up plan must be documented during the encounter.
The documented follow-up plan must be based on the most recent documented BMI outside of normal parameters.
If more than one BMI is reported during the measure period, the most recent BMI will be used to determine if the performance has been met.
(0421 BMI-SF)

12. Performance is met if:
Center staff documents a BMI and a follow-up plan at the eligible encounter OR
The client has a documented BMI within the previous six months of the current encounter, the clinic staff documents a follow-up plan at the current visit OR
The client has a documented BMI within the previous six months of the current encounter AND the client has a documented follow-up plan for a BMI outside normal parameters within the previous six months of the current visit OR
The client’s documented BMI is within normal parameters.
(0421 BMI-SF)

13. Data Collection
This measure is stratified by whether the client is a Medicaid beneficiary, eligible for both Medicare and Medicaid, and other (i.e. private insurance, GR, grant-funded etc..
Start planning how you will collect data. It may be extracted from your EHR if that is set up in your system. If your Center uses paper records, a separate database may facilitate data collection.
(0421 BMI-SF)

14. Report Template
(0421 BMI-SF)

15. What it will take to be successful
Build in BMI, follow up, and omission criteria into your medical record
Make ability to assess height and weight are readily available at all relevant sites
Designate and train staff responsible
Protocols and procedures establish and facilitate a consistent process
Determine the best way to make certain all individuals have their BMI assessed and addressed
Determine the way you will identify and extract the data for the measurement year, stratified by payor source
Test the system and reports frequently (quarterly review preferable)
(0421 BMI-SF)

16. 0024 Weight Assessment for Children/Adolescents:
Body Mass Index Assessment for Children/Adolescents (WCC-BH)
What outcome is being measured?
BMI: a statistical measure of the weight of a person scaled according to height
BMI percentile: A percentile ranking based on the CDCs BMI-for-age growth charts, which indicates the relative position of a person’s BMI number among others of the same gender and age.
BMI norms for youth vary with age and gender, this measure looks at whether BMI is assessed, rather than absolute BMI. At least one time per measurement year.
Purpose/Benefit?
Childhood obesity has more than doubled in children and quadrupled in adolescents in the past 30 years. Only if it is tracked can it be meaningfully addressed.
(0024 WCC-BH)

17. What needs to be collected?
Denominator: The number of children ages 3 to 17 who had an outpatient visit with a primary care practitioner (PCP), Obstetrical/gynecological (OB/GYN) practitioner during the measurement year or with the Behavioral Health Clinic site.
Denominator Measurement Period: The measurement year (MY)
Why? To assure assessment of BMI at least once a year
Numerator: The number of children in the eligible population who had evidence of body mass index (BMI) percentile documentation
Numerator MP: The MY
(0024 WCC-BH)

18. What needs to be collected – by Stratification:
Payor source
Medicaid
Dual Medicare and Medicaid
Other (i.e. private insurance, GR, etc.)
Age
3-11 years
12-17 years
Total - combined ages stratifications
(0024 WCC-BH)

19. What needs to be collected-
Because of difficulty accessing PCP or OB/Gyn records, the BHC may routinely obtain this information from our individuals and note in the data-reporting template that we use our own records rather than those of an outside PCP. (*SAMHSA Webinar 5 hybrid flow modification)
Height, weight and BMI must be from same source
Numerator documentation must include a BMI percentile
Exclude Pregnancy
(0024 WCC-BH)

20. Where to record the information? There are several ways to do this:
In the electronic health record (EHR).
If an EHR is used to gather data, indicate in the additional notes on the template.
Database
Paper
Excel
(0024 WCC-BH)

21. Each BHC will need to determine the following:
When will gathering the BMI take place?
When doing vital signs before a clinic visit
May require some changes – height must be measured
Who will collect and document the BMI?
Not specified; could include.
A medical assistant
Clinic flow/administrative staff
Nursing staff
If it is on paper – how will the data be then gathered electronically?
(0024 WCC-BH)

22. Process change: Workflow: Is BMI measured and documented?
Need to actually measure height, not just ask
2. Procedures/policies:
Think of all the steps in the process. Is there an actual procedure documenting this?
Will you need to amend the documentation process to capture this data
Allows consistency between staff and sites
3. Examples:
From MHMR Tarrant - test the system! See if what is planned works, or will there need to be changes
PDSA cycles!
(0024 WCC-BH)

23. (0024 WCC-BH)

24. (0024 WCC-BH)

25. (0024 WCC-BH)

26. (0024 WCC-BH)

27. Remember… Start planning assessment and collection methods now.
Measurement year begins 9/1/17
Data reporting for measurement year 9/1/18
Resources: Texas Council Intranet Website
Contact Jolene Rasmussen with any questions

28. Upcoming Webinars March 2 BHCQMs Webinar 3: April 6 BHCQMs Webinar 4:
0028 Preventive Care & Screening: Tobacco Use: Screening & Cessation Intervention (TSC)
April 6 BHCQMs Webinar 4:
1365 Child & Adolescent Major Depressive Disorder: Suicide Risk Assessment (SRA-BH-C)
0104 Adult Major Depressive Disorder: Suicide Risk Assessment (SRA-A)
May 4 BHCQMs Webinar 5:
2152 Preventive Care and Screening: Unhealthy Alcohol Use: Screening and Brief Counseling (ASC)
July 6 BHCQMs Webinar 6:
0418 Screening for Clinical Depression and Follow up Plan (CDF-BH)
0710 Depression Remission at 12 Months (DEP-REM-12)
August 3 BHCQM Webinar 7:
Time to Initial Evaluation (I-Eval)