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Two New HEDIS® Measures Target Obesity
The Healthcare Effectiveness Data and Information Set (HEDIS®)
reviews completed this spring included two new measures designed
to assess obesity screening in adults and children. The results
for Humana members showed that less than half of the reviewed medical
records had a body mass index (BMI) documented in the medical record.
A closer look at the new measures:
- Adult BMI Assessment (ABA) — The
ABA measure looks at the percentage of commercial, Medicaid
and Medicare members between 18 and 74 years of age who had
an outpatient office visit and who had BMI documented in the
measurement year or in the prior year.
- Weight Assessment and Counseling
for Nutrition and Physical Activity for Children/Adolescents
(WCC) — The
WCC measure assesses the percentage of commercial and Medicaid
members 3 through 17 years old who had an outpatient office
visit with a primary care physician (PCP) or OB/GYN and who
had evidence of BMI percentile assessment, counseling for nutrition
and counseling for physical activity during the measurement
year.
To assess compliance with these measures, HEDIS review nurses
looked for specific documentation in the medical record, as required
by the National Committee for Quality Assurance (NCQA). Here is
a summary of documentation points required for this measure:
Adult BMI Assessment:
- The documentation must indicate the date of the
BMI and the BMI value.
- For members younger than 19, the BMI may be documented
as a percentile or plotted on an age-growth chart.
- Notation of height and weight only is not sufficient;
BMI must be calculated.
- Documentation must show that BMI was assessed and calculated
during the measurement year.
Weight Assessment and Counseling for Nutrition and Physical Activity
for Children/Adolescents (WCC):
- Documentation must include a note indicating the
date on which the BMI percentile was documented and evidence
of either of the following:
- BMI percentile, or
- BMI percentile plotted on age-growth
chart
Notation of height and weight only is
not sufficient.
- For adolescents 16 through 17 years old,
documentation of a BMI value expressed as kg/m2 is acceptable.
- Documentation must include a note indicating the date and
at least one of the following during the measurement year:
- Engagement in discussion of current nutrition behaviors (e.g.,
eating habits, dieting behaviors)
- Checklist indicating nutrition was addressed
- Counseling or referral for nutrition education
- Educational materials on nutrition were provided
- Anticipatory guidance for nutrition (information
that helps families prepare for expected physical and behavioral
changes during a child or teen's current and approaching
stage of development)
- Documentation must include a note indicating the date
and at least one of the following during the measurement
year:
- Engagement in discussion of current physical activity
behaviors (e.g. exercise routine, participation in sports
activities, 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 (information that helps families prepare for
expected physical and behavioral changes during a child
or teen's current and approaching
stage of development)
To simplify calculations, physicians can use the BMI calculator
available on the National Heart, Lung, and Blood Institute Obesity
Education Web site at http://www.nhlbi.nih.gov/guidelines/obesity/ob_home.htm.
The site also provides a BMI calculator that can be uploaded to
hand-held devices.
For more information about HEDIS reviews, contact Karen Wooldridge
in Humana's Corporate Quality Management department at kwooldridge@humana.com or 502-580-8835.
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