2017 CMS Web Interface

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1 CMS Web Interface PREV-9 (NQF 0421): Preventive Care and Screening: Bdy Mass Index (BMI) Screening and Fllw- Measure Steward: CMS Web Interface V1.0 Page 1 f 23 11/15/2016

2 Cntents INTRODUCTION... 3 WEB INTERFACE SAMPLING INFORMATION... 4 BENEFICIARY SAMPLING... 4 NARRATIVE MEASURE SPECIFICATION... 5 DESCRIPTION:... 5 IMPROVEMENT NOTATION: INITIAL POPULATION:... 5 DENOMINATOR:... 5 DENOMINATOR EXCLUSIONS:... 5 DENOMINATOR EXCEPTIONS:... 5 NUMERATOR:... 5 NUMERATOR EXCLUSIONS:... 5 DEFINITIONS:... 6 GUIDANCE:... 6 SUBMISSION GUIDANCE... 8 PATIENT CONFIRMATION... 8 SUBMISSION GUIDANCE... 9 DENOMINATOR CONFIRMATION... 9 SUBMISSION GUIDANCE NUMERATOR REPORTING SUBMISSION GUIDANCE NUMERATOR REPORTING DOCUMENTATION REQUIREMENTS APPENDIX I: PERFORMANCE CALCULATION FLOW: APPENDIX II: DOWNLOADABLE RESOURCE MAPPING TABLE APPENDIX III: MEASURE RATIONALE AND CLINICAL RECOMMENDATION STATEMENTS RATIONALE: CLINICAL RECOMMENDATION STATEMENTS: APPENDIX IV: USE NOTICES, COPYRIGHTS, AND DISCLAIMERS COPYRIGHT Web Interface V1.0 Page 2 f 23 11/15/2016

3 INTRODUCTION There are a ttal f 15 individual measures (including ne cmpsite cnsisting f tw measures) included in the CMS Web Interface targeting high-cst chrnic cnditins, preventive care, and patient safety. The measures dcuments are represented individually and cntain measure specific infrmatin. The crrespnding cding dcuments are psted separately in an Excel frmat. The Measure Dcuments are being prvided t allw grup practices and Accuntable Care Organizatins (ACOs) an pprtunity t better understand each f the 15 individual measures included in the CMS Web Interface data submissin methd. Each Measure Dcument cntains infrmatin necessary t submit data thrugh the CMS Web Interface. Narrative specificatins, supprting submissin dcumentatin, and calculatin flws are prvided within each dcument. Please review all f the measure dcumentatin in its entirety t ensure cmplete understanding f these measures. Web Interface V1.0 Page 3 f 23 11/15/2016

4 WEB INTERFACE SAMPLING INFORMATION BENEFICIARY SAMPLING Fr mre infrmatin n the sampling prcess and methdlgy please refer t the Web Interface Sampling Dcument, available at CMS.gv. Web Interface V1.0 Page 4 f 23 11/15/2016

5 NARRATIVE MEASURE SPECIFICATION DESCRIPTION: Percentage f patients aged 18 years and lder with a BMI dcumented during the current encunter r during the previus six mnths AND with a BMI utside f nrmal parameters, a fllw-up plan is dcumented during the encunter r during the previus six mnths f the current encunter Nrmal Parameters: Age 18 years and lder BMI => 18.5 and < 25 kg/m2 IMPROVEMENT NOTATION: Higher scre indicates better quality INITIAL POPULATION: All patients 18 years and lder n the date f the encunter with at least ne eligible encunter during the measurement perid DENOMINATOR: Equals Initial Ppulatin DENOMINATOR EXCLUSIONS: Patients wh are pregnant Patients receiving palliative care Patients wh refuse measurement f height and/r weight r refuse fllw-up DENOMINATOR EXCEPTIONS: Patients with a dcumented Medical Reasn: Elderly Patients (65 r lder) fr whm weight reductin/weight gain wuld cmplicate ther underlying health cnditins such as the fllwing examples: Illness r physical disability Mental illness, dementia, cnfusin Nutritinal deficiency, such as Vitamin/mineral deficiency Patients in an urgent r emergent medical situatin where time is f the essence and t delay treatment wuld jepardize the patient's health status NUMERATOR: Patients with a dcumented BMI during the encunter r during the previus six mnths, AND when the BMI is utside f nrmal parameters, a fllw-up plan is dcumented during the encunter r during the previus six mnths f the current encunter. NUMERATOR EXCLUSIONS: Nt Applicable Web Interface V1.0 Page 5 f 23 11/15/2016

6 DEFINITIONS: BMI Bdy mass index (BMI) is a number calculated using the Quetelet index: weight divided by height squared (W/H2) and is cmmnly used t classify weight categries. BMI can be calculated using: Metric Units: BMI = Weight (kg) / (Height (m) x Height (m)) OR English Units: BMI = Weight (lbs.) / (Height (in) x Height (in)) x 703 Fllw- Prpsed utline f treatment t be cnducted as a result f a BMI ut f nrmal parameters. A fllw-up plan may include, but is nt limited t: dcumentatin f educatin, referral (fr example a registered dietician, nutritinist, ccupatinal therapist, physical therapist, primary care prvider, exercise physilgist, mental health prfessinal r surgen), pharmaclgical interventins, dietary supplements, exercise cunseling r nutritin cunseling. GUIDANCE: There is n diagnsis assciated with this measure. This measure is t be reprted a minimum f nce per perfrmance perid fr patients seen during the perfrmance perid. This measure may be reprted by eligible clinicians wh perfrm the quality actins described in the measure based n the services prvided at the time f the qualifying visit and the measure-specific denminatr cding. BMI Measurement Guidance: Height and Weight - An eligible clinician r their staff is required t measure bth height and weight. Bth height and weight must be measured within six mnths f the current encunter and may be btained frm separate encunters. Self-reprted values cannt be used. The BMI may be dcumented in the medical recrd f the prvider r in utside medical recrds btained by the prvider. If the mst recent dcumented BMI is utside f nrmal parameters, then a fllw-up plan is dcumented during the encunter r during the previus six mnths f the current encunter. If mre than ne BMI is reprted during the measurement perid, the mst recent BMI will be used t determine if the perfrmance has been met. Review the exclusins criteria t determine thse patients that BMI measurement may nt be apprpriate r necessary. Fllw- Guidance: The dcumented fllw-up plan must be based n the mst recent dcumented BMI, utside f nrmal parameters, example: "Patient referred t nutritin cunseling fr BMI abve r belw nrmal parameters." (See Definitins fr examples f fllw-up plan treatments). Variatin has been nted in studies explring ptimal BMI ranges fr the elderly (see Dnini et al., (2012); Hlme and Tnstad (2015); and Diehr et al. (2008). Ntably hwever, all these studies have arrived at ranges that differ frm the standard range fr ages 18 and lder, which is >=18.5 and < 25 kg/m2. Fr instance, bth Dnini et al. (2012) and Hlme and Tnstad (2015) reprted findings that suggest that higher BMI (higher than the upper end f 25kg/m2) in the elderly may be beneficial. Similarly, wrse utcmes have been assciated with being underweight (at a threshld higher than 18.5 kg/m2) at age 65 (Diehr et al. 2008). Because f ptimal BMI range variatin recmmendatins frm these studies, n specific ptimal BMI range fr the elderly is used. Hwever, It may be Web Interface V1.0 Page 6 f 23 11/15/2016

7 apprpriate t exempt certain patients frm a fllw-up plan by applying the exceptin criteria. Review the fllwing t apply the Medical Reasn exceptin criteria: The Medical Reasn exceptin culd include, but is nt limited t, the fllwing patients as deemed apprpriate by the health care prvider: Elderly Patients (65 r lder) fr whm weight reductin/weight gain wuld cmplicate ther underlying health cnditins such as the fllwing examples: Illness r physical disability Mental illness, dementia, cnfusin Nutritinal deficiency such as Vitamin/mineral deficiency Patients in an urgent r emergent medical situatin where time is f the essence and t delay treatment wuld jepardize the patient's health status Web Interface V1.0 Page 7 f 23 11/15/2016

8 PATIENT CONFIRMATION SUBMISSION GUIDANCE Establishing patient eligibility fr reprting requires the fllwing: Determine if the patient s medical recrd can be fund OR OR Guidance If yu can lcate the medical recrd select Yes If yu cannt lcate the medical recrd select N - Medical Recrd Nt Fund Determine if the patient is qualified fr the sample If the patient is deceased, in hspice, mved ut f the cuntry r was enrlled in HMO select Nt Qualified fr Sample, select the applicable reasn frm the prvided drp-dwn menu, and enter the date the patient became ineligible Patient Cnfirmatin If N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected, the patient is cmpleted but nt cnfirmed. The patient will be skipped and anther patient must be reprted in their place, if available. The Web Interface will autmatically skip any patient fr whm N Medical Recrd Nt Fund r Nt Qualified fr Sample is selected in all ther measures int which they have sampled. If Nt Qualified fr Sample is selected and the date is unknwn, yu may enter the last date f the measurement perid (i.e., 12/31/). The Measurement Perid is defined as January 1 December 31,. NOTE: - In Hspice: Select this ptin if the patient is nt qualified fr sample due t being in hspice care at any time during the measurement perid (this includes nn-hspice patients receiving palliative gals r cmfrt care) - Mved ut f Cuntry: Select this ptin if the patient is nt qualified fr sample because they mved ut f the cuntry any time during the measurement perid - Deceased: Select this ptin if the patient died during the measurement perid - HMO Enrllment: Select this ptin if the patient was enrlled in an HMO at any time during the measurement perid (i.e., Medicare Advantage, nn-medicare HMOs, etc.) Web Interface V1.0 Page 8 f 23 11/15/2016

9 DENOMINATOR CONFIRMATION SUBMISSION GUIDANCE Determine if the patient is qualified fr the measure OR OR If the patient is qualified fr the measure select Yes If there is a denminatr exclusin fr patient disqualificatin frm the measure select Denminatr Exclusin If there is an "ther" CMS apprved reasn fr patient disqualificatin frm the measure select N- Other CMS Apprved Reasn Denminatr Exclusin cdes can be fund in the Web Interface PREV Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance Denminatr If Denminatr Exclusin r N Other CMS Apprved Reasn is selected, the patient will be skipped and anther patient must be reprted in their place, if available. The patient will nly be remved frm the measure fr which ne f these ptins was selected, nt all Web Interface measures. CMS Apprved Reasn may nly be selected when apprved by CMS. T request a CMS Apprved Reasn, yu wuld need t prvide the patient rank, measure, and reasn fr request in a Quality Payment Prgram Service Desk inquiry. A CMS decisin will be prvided in the reslutin f the inquiry. Patients fr whm a CMS Apprved Reasn is selected will be skipped and anther patient must be reprted in their place, if available. Web Interface V1.0 Page 9 f 23 11/15/2016

10 NUMERATOR REPORTING SUBMISSION GUIDANCE Determine if the patient had a BMI dcumented during the mst recent visit r in the last 6 mnths prir t the mst recent visit OR If the patient has nt had a BMI dcumented select N If the patient has had a BMI calculated select Yes Numeratr cdes can be fund in the PREV Web Interface Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance NOTE: Numeratr - The six mnth lk-back can be calculated as a lk-back f <7 mnths frm the mst recent encunter Web Interface V1.0 Page 10 f 23 11/15/2016

11 NUMERATOR REPORTING SUBMISSION GUIDANCE If the patient had a BMI calculated, determine if the mst recent BMI is within nrmal parameters If the mst recent BMI is utside f nrmal parameters select N IF NO OR If the patient s mst recent BMI was nt within nrmal limits, determine if a fllw-up plan was dcumented If there was n fllw-up plan dcumented select N OR If there was a fllw-up plan dcumented select Yes When a recmmended fllw-up fr an abnrmal BMI is nt dcumented fr medical reasns select N - Denminatr Exceptin - Medical Reasns OR If the mst recent BMI is within nrmal parameters select Yes Numeratr and Denminatr Exceptin cdes can be fund in the PREV Cding Dcument. The Dwnladable Resurce Mapping Table can be lcated in Appendix II f this dcument. Guidance NOTE: Numeratr - Amputees are nt cnsidered denminatr exceptins - BMI calculatin and recmmended fllw-up plan cannt be cmpleted during a telehealth encunter Web Interface V1.0 Page 11 f 23 11/15/2016

12 DOCUMENTATION REQUIREMENTS When submitting data thrugh the CMS Web Interface, the expectatin is that medical recrd dcumentatin is available that supprts the actin reprted in the Web Interface i.e., medical recrd dcumentatin is necessary t supprt the infrmatin that has been submitted. Web Interface V1.0 Page 12 f 23 11/15/2016

13 Appendix I: Perfrmance Calculatin Flw: Web Interface V1.0 Page 13 f 23 11/15/2016

14 Web Interface V1.0 Page 14 f 23 11/15/2016

15 Web Interface V1.0 Page 15 f 23 11/15/2016

16 Patient Cnfirmatin Flw Fr, cnfirmatin f the Medical Recrd Fund, r indicating the patient is Nt Qualified fr Sample with a reasn f In Hspice, Mved ut f Cuntry, Deceased, r HMO Enrllment, will nly need t be dne nce per patient. Refer t the Measure Reprting Dcument fr further instructins. 1. Start Patient Cnfirmatin Flw. 2. Check t determine if Medical Recrd can be fund. a. If n, Medical Recrd nt fund, mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, Medical Recrd fund, cntinue prcessing. 3. Check t determine if Patient Qualified fr the sample. a. If n, the patient des nt qualify fr the sample, select the reasn why and enter the date (if date is unknwn, enter 12/31/) the patient became ineligible fr sample. Fr example; In Hspice, Mved ut f Cuntry, Deceased, HMO Enrllment. Mark apprpriately fr cmpletin and stp abstractin. This remves the patient frm the beneficiary sample fr all measures. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the sample; cntinue t the Measure Cnfirmatin Flw fr PREV-9. Web Interface V1.0 Page 16 f 23 11/15/2016

17 Measure Cnfirmatin Flw fr PREV-9 Fr, measure specific reasns a patient is Nt Cnfirmed r excluded fr Denminatr Exclusin r Other CMS Apprved Reasn will need t be dne fr each measure where the patient appears. Refer t the Measure Reprting Dcument fr further instructins. 1. Start Measure Cnfirmatin Flw fr PREV-9. Cmplete fr cnsecutively ranked patients aged 18 years and lder at the beginning f the measurement perid. Further infrmatin regarding patient selectin fr specific disease and patient care measures can be fund in the Web Interface Sampling Methdlgy Dcument. Fr patients wh have the incrrect date f birth listed, a change f the patient date f birth by the abstractr may result in the patient n lnger qualifying fr the PREV-9 measure. If this is the case, the system will autmatically remve the patient frm the measure requirements. 2. Check t determine if the patient qualifies fr the measure (Denminatr Exclusin). a. If n, the patient des nt qualify fr the measure select: Denminatr Exclusin fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue prcessing. 3. Check t determine if the patient qualifies fr the measure (Other CMS Apprved Reasn). a. If n, the patient des nt qualify fr the measure select: N Other CMS Apprved Reasn fr patient disqualificatin. Mark apprpriately fr cmpletin and stp abstractin. Patient is remved frm the perfrmance calculatins fr this measure. The patient will be skipped and replaced. Other CMS Apprved Reasn may nly be selected if yu have received an apprval frm CMS in the reslutin f a requested Quality Payment Prgram Service Desk Inquiry at QPP Service Desk. Stp prcessing. b. If yes, the patient des qualify fr the measure, cntinue t the PREV-9 measure flw. Web Interface V1.0 Page 17 f 23 11/15/2016

18 Measure Flw fr PREV-9 The measure diagrams were develped by CMS as a supplemental resurce t be used in cnjunctin with the measure specificatins. They shuld nt be used as a substitutin fr the measure specificatins. Fr Dwnladable Resurce Mapping Table, g t Appendix II and use the Variable Names lcated in the appendix alng with the applicable tabs within the PREV Cding Dcument. 1. Start prcessing PREV-9 (NQF 0421) Flw fr the patients that qualified fr sample in the Patient Cnfirmatin Flw and the Measure Cnfirmatin Flw fr PREV-9. Nte: Include remainder f patients listed in Web Interface that were cnsecutively cnfirmed and cmpleted fr this measure in the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the d categry (eligible denminatr, i.e. 222 patients). 2. Check t determine if the patient had a BMI calculated during the mst recent visit r within the last six mnths prir t the mst recent visit. a. If n, the patient did nt have a BMI calculated during the mst recent visit r within the last six mnths prir t the mst recent visit, perfrmance is nt met and shuld nt be included in the numeratr. Stp prcessing. b. If yes, the patient had a BMI calculated during the mst recent visit r within the last six mnths prir t the mst recent visit, cntinue prcessing. 3. Check t determine if the patient s mst recent BMI is within nrmal parameters. a. If n, the patient s mst recent BMI is nt within nrmal parameters, cntinue prcessing. b. If yes, the patient s mst recent BMI is within nrmal parameters, perfrmance is met and the patient will be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a¹ categry (numeratr, i.e. 85 patients). Stp prcessing. 4. Check t determine if the patient s fllw-up plan was dcumented. a. If n, the patient s fllw-up plan was nt dcumented, cntinue prcessing. b. If yes, the patient s fllw-up plan was dcumented, perfrmance is met and the patient will be included in the numeratr. Fr the sample calculatin in the flw these patients wuld fall int the a² categry (numeratr, i.e. 90 patients). Stp prcessing. 5. Check t determine if the patient s fllw-up plan was Nt dcumented fr a denminatr exceptin, medical reasn(s). a. If n, the patient s fllw-up plan was Nt dcumented fr a denminatr exceptin, medical reasn(s), perfrmance is nt met and the patient shuld nt be included in the numeratr. Stp prcessing. b. If yes, the patient s fllw-up plan was Nt dcumented fr a denminatr exceptin, medical reasn(s), this is a denminatr exceptin and the case shuld be subtracted frm the denminatr. Fr the sample calculatin in the flw these patients wuld fall int the b categry (denminatr exceptin, i.e. 25 patients). Stp prcessing. Sample Calculatin Perfrmance Rate Equals Perfrmance Met is categry a¹ plus a² in the measure flw (175 patients) Denminatr is categry d in the measure flw (222 patients) Denminatr Exceptin is categry b in the measure flw (25 patients) Web Interface V1.0 Page 18 f 23 11/15/2016

19 175 (Perfrmance Met) divided by 197 (Denminatr minus Denminatr Exceptin) equals a perfrmance rate f percent Calculatin May Change Pending Perfrmance Met Web Interface V1.0 Page 19 f 23 11/15/2016

20 Appendix II: Dwnladable Resurce Mapping Table Each data element within this measure s denminatr r numeratr is defined as a pre-determined set f clinical cdes. These cdes can be fund in the Web Interface PREV Cding Dcument. *PREV-9: Preventive Care and Screening: Screening fr Bdy Mass Index (BMI) Screening and Fllw- Measure Cmpnent/Excel Tab Data Element Variable Name Cding System(s) Denminatr Exclusin/ Denminatr Exclusin Cdes Exclusin PREGNANCY_CODE I9 I10 SNM EX_CODE I9 I10 SNM PATIENT_REASON_REFUSED SNM Numeratr/Numeratr BMI Dcumented BMI_CODE LN Cdes/Numeratr Drug Cdes BMI_ABNORMAL_CODE HCPCS BMI Abnrmal BMI_ABNORMAL_CODE HCPCS OVERWEIGHT_CODE SNM UNDERWEIGHT_CODE SNM Fllw-up Plan BMI_ABNORMAL_CODE HCPCS BMI_FOLLOW_UP_CODE I9 I10 C4 HCPCS SNM REFERRAL_CODE SNM BMI_DRUG_CODE RxNrm (Drug EX=N) Denminatr Exceptin/ Denminatr Exceptin Cdes Medical Reasn MEDICAL_OTHER_REASON SNM * Fr EHR mapping, the cding within PREV-9 is cnsidered t be all inclusive Web Interface V1.0 Page 20 f 23 11/15/2016

21 Appendix III: Measure Ratinale and Clinical Recmmendatin Statements RATIONALE: BMI Abve Nrmal Parameters Obesity cntinues t be a cstly public health cncern in the United States. This is because besity is assciated with several cmrbid health prblems including increased risk fr crnary artery disease, type 2 diabetes, varius types f cancer, gallstnes and disability. These cmrbid cnditins are assciated with higher medical care utilizatin and csts amng bese patients (Myer, 2012, p. 373). Padula, Allen & Nair (2014) examined data frm a cmmercial claims and encunter database t estimate the cst fr besity and assciated cmrbidities between and fund that n the average, besity cntributed t $1907 mre in cst per patient per visit fr inpatient and utpatient claims, while the increase in cst fr cmrbidities ranged frm $527 fr besity with cngestive heart failure (CHF) t $15, 733 fr the cmbinatin f besity, diabetes mellitus, hypertensin and depressin. Similarly, data frm 2006 shw that per capita annual medical spending csts attributable t besity are higher by $1,429 (42 percent) when cmpared t per capita csts attributable t nrmal weight patients. The natinal aggregate cst fr besity related csts (acrss all payers) was estimated t be equivalent t $147 billin using 2008 dllars (Finkelstein, Trgdn, Chen & Dietz, 2009). Obesity is als assciated with an increased risk f death, particularly in adults yunger than age 65 years and has been shwn t reduce life expectancy by 6 t 20 years depending n age and race (LeBlanc et al., 2011; Masters et al., 2013) Against this backgrund f high besity related csts, CDC 2009 data shwed that all states were still lagging behind the Healthy Peple 2010 besity target f 15 percent and that the self-reprted verall prevalence f besity amng adults had increased 1.1 percentage pints in 2007 t 26.7 percent (2010). Mst recent data shws that the prevalence f BMI-defined besity in adults cntinues t exceed 30% (34.9 verall) and highest amng middle-aged adults (34.9). The findings als revealed the prevalence f besity being higher amng black adult wmen (56.6%) cmpared with 37.1% f black adult men (Ogden, Carrll, Kit and Flegel, 2013). Despite the high besity prevalence, and related csts, less than 50% f bese adults in 2010 received advice t exercise r perfrm physical activity (Barnes & Schenbrn, 2012) indicating a gap in care fr a high impact disease cnditin. Screening fr BMI and fllw-up therefre is critical t clsing this gap and cntributes t quality gals f ppulatin health and cst reductin. Hwever, due t cncerns fr ther underlying cnditins (such as bne health) r nutritin related deficiencies prviders are cautined t use clinical judgment and take these int accunt when cnsidering weight management prgrams fr verweight patients, especially the elderly (NHLBI Obesity Educatin Initiative, 1998, p. 91). BMI belw Nrmal Parameters On the ther end f the bdy weight spectrum is underweight (BMI <18.5 kg/m2), which is equally detrimental t ppulatin health. When cmpared t nrmal weight individuals(bmi kg/m2), underweight individuals have significantly higher death rates with a Hazard Rati f 2.27 and 95% cnfidence intervals (CI) = 1.78, 2.90 (Brrell & Lalitha (2014). Pr nutritin r underlying health cnditins can result in underweight (Fryer & Ogden, 2012). The Natinal Health and Nutritin Examinatin Survey (NHANES) results frm the indicate that wmen are mre likely t be underweight than men (2012). Therefre patients shuld be equally screened fr underweight and fllwed up with nutritinal cunselling t reduce mrtality and mrbidity assciated with underweight. CLINICAL RECOMMENDATION STATEMENTS: The US Preventive Health Services Task Frce (USPSTF) recmmends that clinicians screen all adults (aged 18 years and lder) fr besity. Clinicians shuld ffer r refer patients with a BMI f 30 r higher t intensive, multicmpnent behaviral interventins. This is a B recmmendatin (Myer, 2012). Web Interface V1.0 Page 21 f 23 11/15/2016

22 As cited in Wilkinsn et al. (2013), the Institute fr Clinical Systems Imprvement (ICSI) Preventive Services fr Adults, Obesity Screening (Level II) Recmmendatin prvides the fllwing guidance: - Recrd height, weight and calculate bdy mass index at least annually Clinicians shuld cnsider waist circumference measurement t estimate disease risk fr patients wh have BMI scres indicative f verweight r besity class I. Fr adult patients with a BMI f 25 t 34.9 kg/m2, sex-specific waist circumference cutffs shuld be used in cnjunctin with BMI t identify increased disease risk. -A BMI greater r equal t 30 is defined as bese -A BMI f is defined as verweight -Intensive interventin fr bese individuals, based n BMI, is recmmended by the U.S. Preventive Services t help cntrl weight Similarly, the 2013 jint reprt/guideline frm the American Heart Assciatin, American Cllege f Cardilgy and the Obesity Sciety als recmmend measuring height and weight and calculating BMI at annual visits r mre frequently, using the current cutpints fr verweight (BMI > kg/m2) and besity (BMI >=30 kg/m2) t identify adults wh may be at elevated risk f mrtality frm all causes. They als recmmended cunseling verweight and bese individuals n their increased risk fr CVD, type 2 diabetes, and all-cause mrtality, and need fr lifestyle changes. Nutritinal safety fr the elderly shuld be cnsidered when recmmending weight reductin. "A clinical decisin t freg besity treatment in lder adults shuld be guided by an evaluatin f the ptential benefits f weight reductin fr day-t-day functining and reductin f the risk f future cardivascular events, as well as the patient's mtivatin fr weight reductin. Care must be taken t ensure that any weight reductin prgram minimizes the likelihd f adverse effects n bne health r ther aspects f nutritinal status" Evidence Categry D. (NHLBI Obesity Educatin Initiative, 1998, p. 91). In additin, weight reductin prescriptins in lder persns shuld be accmpanied by prper nutritinal cunseling and regular bdy weight mnitring. (NHLBI Obesity Educatin Initiative, 1998, p. 91). The pssibility that a standard apprach t weight lss will wrk differently in diverse patient ppulatins must be cnsidered when setting expectatins abut treatment utcmes. Evidence Categry B. (NHLBI Obesity Educatin Initiative, 1998). Web Interface V1.0 Page 22 f 23 11/15/2016

23 Appendix IV: Use Ntices, Cpyrights, and Disclaimers COPYRIGHT These measures were develped by Quality Insights f Pennsylvania as a special prject under the Quality Insights' Medicare Quality Imprvement Organizatin (QIO) cntract HHSM PA001C with the Centers fr Medicare & Medicaid Services. These measures are in the public dmain. Limited prprietary cding is cntained in the measure specificatins fr cnvenience. Users f the prprietary cde sets shuld btain all necessary licenses frm the wners f these cde sets. Quality Insights f Pennsylvania disclaims all liability fr use r accuracy f any Current Prcedural Terminlgy (CPT [R]) r ther cding cntained in the specificatins. CPT cntained in the Measures specificatins is cpyright American Medical Assciatin. All Rights Reserved. These perfrmance measures are nt clinical guidelines and d nt establish a standard f medical care, and have nt been tested fr all ptential applicatins. THE MEASURES AND SPECIFICATIONS ARE PROVIDED AS IS WITHOUT WARRANTY OF ANY KIND. Web Interface V1.0 Page 23 f 23 11/15/2016