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Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

Compare Versions of: "Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented"

The Compare function compares two years of the measure specifications found in the header of the measure's HTML. It does not include a comparison of any information in the body of the HTML, e.g., population criteria, Clinical Quality Language, or value sets.

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Measure Information 2022 Performance Period 2023 Performance Period 2024 Performance Period
Title Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
CMS eCQM ID CMS22v10 CMS22v11 CMS22v12
CBE ID Not Applicable Not Applicable Not Applicable
MIPS Quality ID 317 317 317
Description

Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive

Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive

Percentage of patient visits for patients aged 18 years and older seen during the measurement period who were screened for high blood pressure AND a recommended follow-up plan is documented, as indicated, if blood pressure is elevated or hypertensive

Definition *See CMS22v10.html *See CMS22v11.html

Blood Pressure (BP) Classification:

BP is defined by four (4) BP reading classifications: Normal, Elevated, First Hypertensive, and Second Hypertensive Readings

-Normal BP: Systolic BP (SBP) < 120 mmHg AND Diastolic BP (DBP) < 80 mmHg

-Elevated BP: SBP of 120-129 mmHg AND DBP < 80 mmHg

-First Hypertensive Reading: SBP of >= 130 mmHg OR DBP of >= 80 mmHg without a previous SBP of >= 130 mmHg OR DBP of >= 80 mmHg during the 12 months prior to the encounter

-Second Hypertensive Reading: Requires a SBP >= 130 mmHg OR DBP >= 80 mmHg during the current encounter AND a most recent BP reading within the last 12 months SBP >= 130 mmHg OR DBP >= 80 mmHg

Recommended BP Follow-Up:

The 2017 Guideline for the Prevention, Detection, Evaluation and Management of High Blood Pressure in Adults from the American College of Cardiology and American Heart Association recommends BP screening thresholds as defined under Blood Pressure Classifications and recommends interventions based on the current BP reading as listed in the "Recommended Blood Pressure Follow-Up Interventions" below (Whelton et al., 2018).

The types of Recommended Nonpharmacologic Interventions, such as lifestyle modifications, are listed following the section on Recommended Follow-Up Interventions based on BP Classification.

Recommended Blood Pressure Follow-Up Interventions:

-Normal BP: No follow-up required for SBP < 120 mmHg AND DBP < 80 mmHg

-Elevated BP: Patients with SBP of 120-129 mmHg AND DBP < 80 mmHg:

-Referral to Alternate/Primary Care Health Care Professional

OR

-Follow-up with rescreen in 2 to 6 months AND recommend nonpharmacologic interventions

-First Hypertensive BP Reading: Patients with one elevated reading of SBP >= 130 mmHg

OR DBP >= 80 mmHg:

-Referral to Alternate/Primary Care Health Care Professional

OR

-Follow-up with rescreen > 1 day and < 4 weeks AND recommend nonpharmacologic interventions

-Second Hypertensive BP Reading:

-Second Hypertensive BP Reading: Patients with second elevated reading of

SBP of 130-139 mmHg OR DBP of 80-89 mmHg (and not SBP >=140 OR DBP >=90):

-Referral to Alternate/Primary Care Healthcare Professional

OR

-Nonpharmacologic intervention AND reassessment in 2-6 months

AND an order for a laboratory test or ECG for hypertension

-Second Hypertensive BP Reading: SBP>=140 or DBP>=90:

-Referral to Alternate/Primary Care Healthcare Professional

OR

-Nonpharmacologic intervention AND BP-lowering medication

AND reassessment within 4 weeks AND an order for a laboratory test or ECG for hypertension

The 2017 Guideline outlines nonpharmacologic interventions (lifestyle modifications) which must include one or more of the following as indicated:

-Weight Reduction

-Dietary Approaches to Stop Hypertension (DASH) Eating Plan

-Dietary Sodium Restriction

-Increased Physical Activity

-Moderation in alcohol (ethanol alcohol (ETOH))

Initial Population

All patient visits for patients aged 18 years and older at the beginning of the measurement period

All patient visits for patients aged 18 years and older at the beginning of the measurement period

All patient visits for patients aged 18 years and older at the beginning of the measurement period

Numerator

Patient visits where patients were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is elevated or hypertensive

Patient visits where patients were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is elevated or hypertensive

Patient visits where patients were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is elevated or hypertensive

Numerator Exclusions

Not Applicable

Not Applicable

Not Applicable

Denominator

Equals Initial Population

Equals Initial Population

Equals Initial Population

Denominator Exclusions

Patient has an active diagnosis of hypertension

Patient has an active diagnosis of hypertension

Patient has an active diagnosis of hypertension

Denominator Exceptions

Documentation of medical reason(s) for not screening for high blood pressure (e.g., patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status).

Documentation of patient reason(s) for not screening for blood pressure measurements or for not ordering an appropriate follow-up intervention if patient BP is elevated or hypertensive (e.g., patient refuses).

Documentation of medical reason(s) for not screening for high blood pressure (e.g., patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status).

Documentation of patient reason(s) for not screening for blood pressure measurements or for not ordering an appropriate follow-up intervention if patient BP is elevated or hypertensive (e.g., patient refuses).

Documentation of medical reason(s) for not screening for high blood pressure (e.g., patient is in an urgent or emergent medical situation where time is of the essence and to delay treatment would jeopardize the patient's health status).

Documentation of patient reason(s) for not screening for blood pressure measurements or for not ordering an appropriate follow-up intervention if patient BP is elevated or hypertensive (e.g., patient refuses).

Measure Steward Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS) Centers for Medicare & Medicaid Services (CMS)
Measure Scoring Proportion measure Proportion measure Proportion measure
Measure Type Process measure Process measure Process measure
Improvement Notation

Higher score indicates better quality

Higher score indicates better quality

Higher score indicates better quality

Guidance

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older during the measurement period. This measure should be reported for every visit. The measure requires that blood pressure measurements (i.e., diastolic and systolic) be obtained during each visit in order to determine the blood pressure reading used to evaluate if an intervention is needed.

Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures obtained during a patient visit, only the last, or most recent, pressure measurement will be used to evaluate the measure requirements.

The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. The documented follow-up plan must be related to the current blood pressure reading as indicated, example: "Patient referred to primary care provider for BP management."

Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.

This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center for more information on the QDM.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older during the measurement period. This measure should be reported for every visit. The measure requires that blood pressure measurements (i.e., diastolic and systolic) be obtained during each visit in order to determine the blood pressure reading used to evaluate if an intervention is needed.

Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures obtained during a patient visit, only the last, or most recent, pressure measurement will be used to evaluate the measure requirements.

The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. The documented follow-up plan must be related to the current blood pressure reading as indicated, example: "Patient referred to primary care provider for BP management."

Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

This eCQM is an episode-based measure. An episode is defined as each eligible encounter for patients aged 18 years and older during the measurement period. This measure should be reported for every visit. The measure requires that blood pressure measurements (i.e., diastolic and systolic) be obtained during each visit in order to determine the blood pressure reading used to evaluate if an intervention is needed.

Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures obtained during a patient visit, only the last, or most recent, pressure measurement will be used to evaluate the measure requirements.

The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated. The documented follow-up plan must be related to the current blood pressure reading as indicated, example: "Patient referred to primary care provider for BP management."

Telehealth encounters are not eligible for this measure because the measure requires a clinical action that cannot be conducted via telehealth.

This version of the eCQM uses QDM version 5.6. Please refer to the QDM page for more information on the QDM.

Telehealth Eligible No No No
Rationale *See CMS22v10.html *See CMS22v11.html

Hypertension is a prevalent condition that affects approximately 66.9 million people in the United States. It is estimated that about 20-40% of the adult population has hypertension; the majority of people over age 65 have a hypertension diagnosis (Appleton et al., 2013 and Luehr et al., 2012). Winter (2013) noted that 1 in 3 American adults have hypertension and the lifetime risk of developing hypertension is 90%. The African American population or non-Hispanic Blacks, the elderly, diabetics and those with chronic kidney disease are at increased risk of stroke, myocardial infarction and renal disease. Non-Hispanic Blacks have the highest prevalence at 38.6% (Winter et al., 2013). Hypertension is a major risk factor for ischemic heart disease, left ventricular hypertrophy, renal failure, stroke and dementia (Luehr et al., 2012). Prevention of hypertension and the treatment of established hypertension are complementary approaches to reducing cardiovascular disease risk in the population, but prevention of hypertension provides the optimal means of reducing risk and avoiding harmful consequences. Periodic blood pressure (BP) screening can identify individuals who develop elevated BP over time. More frequent BP screening may be particularly important for individuals with elevated atherosclerotic cardiovascular disease (ASCVD) risk (Whelton et al., 2018).

Hypertension is the most common reason for adult office visits other than pregnancy. Garrison (2013) stated that in 2007, 42 million ambulatory visits were attributed to hypertension (Garrison & Oberhelman, 2013). It also has the highest utilization of prescription drugs. Numerous resources and treatment options are available, yet only about 40-50% of the hypertensive patients have their blood pressure under control (<140/90) (Appleton et al., 2013 and Luehr et al., 2012). In addition to medication non-compliance, poor outcomes are also attributed to poor adherence to lifestyle changes such as a low-sodium diet, weight loss, increased exercise and limiting alcohol intake. Many adults find it difficult to continue medications and lifestyle changes when they are asymptomatic. Symptoms of elevated blood pressure usually do not occur until secondary problems arise such as with vascular diseases (myocardial infarction, stroke, heart failure and renal insufficiency) (Luehr et al., 2012).

Appropriate follow-up after blood pressure measurement is a pivotal component in preventing the progression of hypertension and the development of heart disease. Detection of marginally or fully elevated blood pressure by a specialty clinician warrants referral to a provider familiar with the management of hypertension and prehypertension.

The American College of Cardiology/American Heart Association (ACC/AHA) 2017 Guidelines provide updated recommendations for ASCVD risk. For additional information please refer to the 2017 ACC/AHA guidelines: https://www.acc.org/latest-in-cardiology/ten-points-to-remember/2017/11/09/11/41/2017-guideline-for-high-blood-pressure-in-adults.

Lifestyle modifications have demonstrated effectiveness in lowering blood pressure (U.S. Department of Health and Human Services, 2003). The synergistic effect of several lifestyle modifications results in greater benefits than a single modification alone. Baseline diagnostic/laboratory testing establishes if a co-existing underlying condition is the etiology of hypertension and evaluates if end organ damage from hypertension has already occurred. Landmark trials such as the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial (ALLHAT) have repeatedly proven the efficacy of pharmacologic therapy to control blood pressure and reduce the complications of hypertension. A review of 35 studies found that the pharmacist-led interventions involved medication counseling and patient education. Twenty-nine of the 35 studies showed statistically significant improvement in BP levels of the intervention groups at follow-up (Reeves et al., 2020). Follow-up intervals based on blood pressure control have been established by the 2017 ACC/AHA guideline and the United States Preventive Services Task Force (Whelton et al., 2018; USPSTF, 2021).

Stratification *See CMS22v10.html *See CMS22v11.html

None

Risk Adjustment *See CMS22v10.html *See CMS22v11.html

None

Clinical Recommendation Statement *See CMS22v10.html *See CMS22v11.html

The U.S. Preventive Services Task Force (USPSTF, 2021) recommends screening for high blood pressure in adults aged 18 years and older. This is a grade A recommendation.

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CMS22v11.html 112.36 KB
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CMS22v11-TRN.xlsx 21.6 KB
eCQM Jira Issue Tracker
*Note there may be more tickets in the eCQM Tracker - ONC Project Tracking System (Jira) for this measure. Only tickets tagged with their associated CMS measure ID appear.

Header

  • Updated copyright.

    Measure Section: Copyright

    Source of Change: Annual Update

  • Updated disclaimer.

    Measure Section: Disclaimer

    Source of Change: Standards/Technical Update

  • Updated references.

    Measure Section: Reference

    Source of Change: Measure Lead

  • Clarified definition for second hypertensive blood pressure reading (Systolic Blood Pressure [SBP] 130-139 or Diastolic Blood Pressure [DBP] 80-89) to align with intent of measure.

    Measure Section: Definition

    Source of Change: ONC Project Tracking System (JIRA): CQM-5102

  • Updated version number of the Quality Data Model (QDM) used in the measure specification to v5.6.

    Measure Section: Guidance

    Source of Change: Standards/Technical Update

  • Updated grammar, wording, and formatting to improve readability and consistency.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

Logic

  • Updated logic for second hypertensive blood pressure reading (SBP 130-139 or DBP 80-89) to align with intent of measure.

    Measure Section: Definitions

    Source of Change: ONC Project Tracking System (JIRA): CQM-5102

  • Revised logic of First Hypertensive (SBP >=130 OR DBP >= 80); Second Hypertensive (SBP >= 140 OR DBP >= 90); and Encounter with Elevated Blood Pressure Reading (SBP 120 to 129) and (DBP less than 80) to ensure values are captured for both diastolic and systolic blood pressure when evaluating criteria.

    Measure Section: Definitions

    Source of Change: Measure Lead

  • Updated the version of the Quality Data Model (QDM) to 5.6 and Clinical Quality Language (CQL) to 1.5.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the version number of the Measure Authoring Tool (MAT) Global Common Functions Library to v7.0.000.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

  • Replaced the Global.CalendarAgeInYearsAt function with the native CQL function AgeInYearsAt to take advantage of existing CQL features and increase human readability. As a result of this change, the LOINC code 21112-8 is no longer required and has been removed from the Terminology section of the human readable specification.

    Measure Section: Multiple Sections

    Source of Change: Measure Lead

  • Updated logic using the new QDM 5.6 'Encounter, Performed' class attribute to exclude telehealth (or virtual) encounters using the logical representation (class !~ virtual), for measures containing telehealth-eligible codes, where telehealth is not appropriate. For more information, please refer to the 2023 Telehealth Guidance document.

    Measure Section: Multiple Sections

    Source of Change: Standards/Technical Update

Value set

The VSAC is the source of truth for the value set content, please visit the VSAC for downloads of current value sets.

  • Value set Dietary Recommendations (2.16.840.1.113883.3.600.1515): Added 2 SNOMED CT codes (436691000124108, 436951000124105) based on terminology update. Deleted 5 SNOMED CT codes (182954008, 182955009, 182956005, 182960008, 361231003) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Encounter to Screen for Blood Pressure (2.16.840.1.113883.3.600.1920): Added 1 CDT code (D3921) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Pharmacologic Therapy for Hypertension (2.16.840.1.113883.3.526.1577): Added 4 RxNorm codes (2477889, 2047715, 2047716, 2047717) based on terminology update. Deleted 1 RxNorm code (1191185) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Value set Referral or Counseling for Alcohol Consumption (2.16.840.1.113883.3.526.3.1583): Added 16 SNOMED CT codes based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Weight Reduction Recommended (2.16.840.1.113883.3.600.1510): Added 8 SNOMED CT codes (307818003, 248114003, 289169006, 388962008, 388970003, 388976009, 410199003, 718361005) based on review by technical experts, SMEs, and/or public feedback. Added 7 HCPCS codes (S9452, S9470, S9451, G0270, G0271, G0447, G0473) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Value set Medical Reason (2.16.840.1.113883.3.526.3.1007): Deleted 1 SNOMED CT code (397745006) based on terminology update.

    Measure Section: Terminology

    Source of Change: Annual Update

  • Removed direct reference code LOINC code (21112-8) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

  • Added direct reference code ActCode code (VR) based on review by technical experts, SMEs, and/or public feedback.

    Measure Section: Terminology

    Source of Change: Measure Lead

Last Updated: Mar 04, 2024