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

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Measure Information	2023 Performance Period	2024 Performance Period	2025 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	CMS22v11	CMS22v12	CMS22v13
CBE ID*	Not Applicable	Not Applicable	Not Applicable
MIPS Quality ID	317	317	317
Measure Steward	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)	Centers for Medicare & Medicaid Services (CMS)
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
Measure Scoring	Proportion measure	Proportion measure	Proportion measure
Measure Type	Process	Process	Process
Stratification	*See CMS22v11.html	None	None
Risk Adjustment	*See CMS22v11.html	None	None
Rationale	*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). Show more > 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). Show less	Hypertension is a prevalent condition that affects approximately 66.9 million people in the United States. It is estimated that about 20-40 percent 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 percent. 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 percent (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 percent 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). Show more > Hypertension is a prevalent condition that affects approximately 66.9 million people in the United States. It is estimated that about 20-40 percent 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 percent. 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 percent (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 percent 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). Show less
Clinical Recommendation Statement	*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.	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.
Improvement Notation	Higher score indicates better quality	Higher score indicates better quality	Higher score indicates better quality
Definition	*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 -Firs... t 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)) Show more > 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)) Show less	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 -Firs... t 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 time periods for follow-up actions specified for the elevated and the second hypertensive (130-139 DBP OR 80-89 SBP) BP classifications slightly differ from time periods given in the 2017 Guideline. This allows for clinician discretion due to patient condition and stability of the measure specification over time. 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 within 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 within 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 within 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 -A “heart-healthy diet,” such as Dietary Approaches to Stop Hypertension (DASH) Eating Plan -Dietary Sodium Restriction -Increased Physical Activity -Moderation in alcohol consumption Show more > 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 time periods for follow-up actions specified for the elevated and the second hypertensive (130-139 DBP OR 80-89 SBP) BP classifications slightly differ from time periods given in the 2017 Guideline. This allows for clinician discretion due to patient condition and stability of the measure specification over time. 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 within 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 within 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 within 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 -A “heart-healthy diet,” such as Dietary Approaches to Stop Hypertension (DASH) Eating Plan -Dietary Sodium Restriction -Increased Physical Activity -Moderation in alcohol consumption Show less
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 5.6. Please refer to the QDM page for more information on the QDM. Show more > 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. Show less	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. Show more > 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. Show less	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. Show more > 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. Show less
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
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
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 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). Show more > 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). Show less	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). Show more > 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). Show less	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). Show more > 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). Show less
Telehealth Eligible	No	No	No
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Previous Version	No Version Available	CMS22v11	CMS22v12

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Specifications

Additional Resources for CMS22v12

CMS22v12-TRN.xlsx

Header

Updated copyright.
Measure Section: Copyright
Source of Change: Annual Update
Added a statement addressing the American College of Cardiology/American Heart Association (ACC/AHA) 2017 Guidelines for High Blood Pressure in Adults.
Measure Section: Rationale
Source of Change: Expert Work Group Review
Updated references.
Measure Section: Reference
Source of Change: Measure Lead
Updated grammar, wording, and/or formatting to improve readability and consistency.
Measure Section: Multiple Sections
Source of Change: Annual Update

Logic

Added 'day of 'Measurement Period'' for day precision when comparing datetime to interval as days.
Measure Section: Denominator
Source of Change: Test Case Review
Updated the names of CQL definitions, functions, and/or aliases for clarification and to align with the CQL Style Guide.
Measure Section: Definitions
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 Encounter to Screen for Blood Pressure (2.16.840.1.113883.3.600.1920): Added 9 CPT codes (92625, 92537, 92538, 92540, 92541, 92542, 92544, 92545, 92546) based on review by technical experts, SMEs, and/or public feedback. Added 2 CPT codes (99424, 99491) based on terminology update. Deleted 13 CPT codes based on terminology update.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Patient Declined (2.16.840.1.113883.3.526.3.1582): Added 1 SNOMED CT code (895451009) based on terminology update. Deleted 3 SNOMED CT codes (183944003, 413310006, 413312003) based on terminology update.
Measure Section: Terminology
Source of Change: Annual Update
Value set Payer (2.16.840.1.114222.4.11.3591): Added 5 SOP codes (1111, 1112, 142, 344, 141) based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead
Value set Pharmacologic Therapy for Hypertension (2.16.840.1.113883.3.526.1577): Added 23 RxNorm codes based on review by technical experts, SMEs, and/or public feedback. Added 5 RxNorm codes (2598343, 2589881, 2589885, 2599173, 2621022) based on terminology update. Deleted 12 RxNorm codes based on review by technical experts, SMEs, and/or public feedback.
Measure Section: Terminology
Source of Change: Measure Lead