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Measure: CMS165

Controlling High Blood Pressure

Measure Versions

eMeasure Code Measure Year Full Version Number Title
CMS165v9 2021 9.2.000 Controlling High Blood Pressure
CMS165v8 2020 8.5.000 Controlling High Blood Pressure
CMS165v7 2019 7.3.000 Controlling High Blood Pressure
CMS165v6 2018 6.2.000 Controlling High Blood Pressure
CMS165v5 2017 5.0.000 Controlling High Blood Pressure

Description

Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period

Guidance

In reference to the numerator element, only blood pressure readings performed by a clinician in the provider office are acceptable for numerator compliance with this measure. Blood pressure readings from the patient's home (including readings directly from monitoring devices) are not acceptable. If no blood pressure is recorded during the measurement period, the patient's blood pressure is assumed "not controlled." If there are multiple blood pressure readings on the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading.

Patient Group Definitions

Group Description Instructions Links
Initial PopulationPatients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement periodWebchart Instructions
DenominatorEquals Initial PopulationWebchart Instructions
Denominator ExclusionsPatients with evidence of end stage renal disease (ESRD), dialysis or renal transplant before or during the measurement period. Also exclude patients with a diagnosis of pregnancy during the measurement period.Webchart Instructions
NumeratorPatients whose blood pressure at the most recent visit is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement periodWebchart Instructions
Numerator ExclusionsNot ApplicableWebchart Instructions
Denominator ExceptionsNone

Details

Full eMeasure Code eMeasure Identifier Measure Year Version NQF # GUID
CMS165v5 165 2017 5.0.000 0018 abdc37cc-bac6-4156-9b91-d1be2c8b7268
Steward Developer Endorsed By
National Committee for Quality Assurance National Committee for Quality Assurance National Quality Forum
Scoring Method Measure Type Stratification Risk Adjustment
Proportion PROCESS None None

Rate Aggregation

None

Improvement Notation

Higher score indicates better quality

Rationale

Hypertension, or high blood pressure, is a very common and dangerous condition that increases risk for heart disease and stroke, two of the leading causes of death for Americans (Farley et al., 2010). Compared with other dietary, lifestyle, and metabolic risk factors, high blood pressure is the leading cause of death in women and the second-leading cause of death in men, behind smoking (Danaei et al., 2011). Approximately 1 in 3 U.S. adults, or about 70 million people, have high blood pressure but only about half (52%) of these people have their high blood pressure under control. Additionally, data from NHANES 2011 to 2012 found that 17.2% of U.S. adults are not aware they have hypertension (Nwankwo et al., 2013). Projections show that by 2030, approximately 41.4% of US adults will have hypertension, an increase of 8.4% from 2012 estimates (Heidenreich et al., 2011). The estimated direct and indirect cost of high blood pressure for 2011 is $46.4 billion. This total includes direct costs such as the cost of physicians and other health professionals, hospital services, prescribed medications and home health care, as well as indirect costs due to loss of productivity from premature mortality (Mozaffarian et al., 2015). Projections show that by 2030, the total cost of high blood pressure could increase to an estimated $274 billion (Heidenreich et al., 2011). Better control of blood pressure has been shown to significantly reduce the probability that undesirable and costly outcomes will occur. In clinical trials, antihypertensive therapy has been associated with reductions in stroke incidence (35-40%), myocardial infarction (20-25%) and heart failure (>50%) (Chobanian et al., 2003). Thus, the relationship between the measure (control of hypertension) and the long-term clinical outcomes listed is well established.

Clinical Recommendation Statement

The United States Preventive Services Task Force (2007) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation. 

Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (2003): Treating systolic blood pressure and diastolic blood pressure to targets that are <140/90 mmHg is associated with a decrease in cardiovascular disease complications.

Definition

None

Transmission Format

TBD

Applicable Value Sets

Category Value Set OID
Diagnosis Chronic Kidney Disease, Stage 5 2.16.840.1.113883.3.526.3.1002
Diagnosis End Stage Renal Disease 2.16.840.1.113883.3.526.3.353
Diagnosis Pregnancy 2.16.840.1.113883.3.526.3.378
Encounter, Performed Annual Wellness Visit 2.16.840.1.113883.3.526.3.1240
Encounter, Performed ESRD Monthly Outpatient Services 2.16.840.1.113883.3.464.1003.109.12.1014
Encounter, Performed Face-to-Face Interaction 2.16.840.1.113883.3.464.1003.101.12.1048
Encounter, Performed Home Healthcare Services 2.16.840.1.113883.3.464.1003.101.12.1016
Encounter, Performed Office Visit 2.16.840.1.113883.3.464.1003.101.12.1001
Encounter, Performed Preventive Care Services - Established Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1025
Encounter, Performed Preventive Care Services-Initial Office Visit, 18 and Up 2.16.840.1.113883.3.464.1003.101.12.1023
Intervention, Performed Dialysis Education 2.16.840.1.113883.3.464.1003.109.12.1016
Intervention, Performed Other Services Related to Dialysis 2.16.840.1.113883.3.464.1003.109.12.1015
Patient Characteristic Ethnicity Ethnicity 2.16.840.1.114222.4.11.837
Patient Characteristic Payer Payer 2.16.840.1.114222.4.11.3591
Patient Characteristic Race Race 2.16.840.1.114222.4.11.836
Patient Characteristic Sex ONC Administrative Sex 2.16.840.1.113762.1.4.1
Physical Exam, Performed Diastolic Blood Pressure 2.16.840.1.113883.3.526.3.1033
Physical Exam, Performed Systolic Blood Pressure 2.16.840.1.113883.3.526.3.1032
Procedure, Performed Dialysis Services 2.16.840.1.113883.3.464.1003.109.12.1013
Procedure, Performed Kidney Transplant 2.16.840.1.113883.3.464.1003.109.12.1012
Procedure, Performed Vascular Access for Dialysis 2.16.840.1.113883.3.464.1003.109.12.1011

References

Centers for Disease Control and Prevention (CDC). Prevalence of self-reported cardiovascular disease among persons aged >=35 years with diabetes: United States, 1997-2005. MMWR Morb Mortal Wkly Rep. 2007;56:1129-1132.
Chobanian AV, Bakris GL, Black HR, et al; National Heart, Lung, and Blood Institute Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure; National High Blood Pressure Education Program Coordinating Committee. The seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure: the JNC 7 report. JAMA. 2003;289(19):2560-2572.
Danaei G, Ding EL, Mozaffarian D, Taylor B, Rehm J, Murray CJ, Ezzati M. The preventable causes of death in the United States: comparative risk assessment of dietary, lifestyle, and metabolic risk factors [published correction appears in PLoS Med. 2011;8. doi: 10.1371/annotation/0ef47acd-9dcc-4296-a897-872d182cde57]. PLoS Med. 2009;6:e1000058.
Farley TA, Dalal MA, Mostashari F, Frieden TR. Deaths preventable in the US by improvements in the use of clinical preventive services. Am J Prev Med. 2010;38:600-9.
Heidenreich, P.A., J.G. Trogdon, O.A. Khavjou, et al. 2011. "Forecasting the future of cardiovascular disease in the United States: a policy statement from the American Heart Association." Circulation.123:933-944.
Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. 2003. "Prevention, Detection, Evaluation, and Treatment of High Blood Pressure. The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure." NIH Publication No. 035233.
Mozaffarian, D., E.J. Benjamin, A.S. Go, et al. 2015. "Heart disease and stroke statistics-2015 update: a report from the American Heart Association." Circulation. 131:e29-e322. doi: 10.1161/CIR.0000000000000152
Nwankwo T, Yoon SS, Burt V, Gu Q. Hypertension among adults in the US: National Health and Nutrition Examination Survey, 2011-2012. NCHS Data Brief, No. 133. Hyattsville, MD: National Center for Health Statistics, Centers for Disease Control and Prevention, US Dept of Health and Human Services, 2013.
U.S. Preventive Services Task Force. 2007. "Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement." Ann Intern Med 147(11):783-6.

Disclaimer

These performance Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Copyright

Physician Performance Measure (Measures) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). 

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Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any CPT or other codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2015 American Medical Association. LOINC(R) copyright 2004-2015 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2015 International Health Terminology Standards Development Organisation. ICD-10 copyright 2015 World Health Organization. All Rights Reserved.

Source: https://ecqi.healthit.gov/ecqm/measures/cms165v5