Measure: CMS165
Controlling High Blood Pressure
Measure Versions
eMeasure Code |
Measure Year |
Full Version Number |
Title |
CMS165v12 |
2024 |
12.0.000 |
Controlling High Blood Pressure |
CMS165v11 |
2023 |
11 |
Controlling High Blood Pressure |
CMS165v10 |
2022 |
10.0.000 |
Controlling High Blood Pressure |
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 Population | Patients 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 period | Webchart Instructions |
Denominator | Equals Initial Population | Webchart Instructions |
Denominator Exclusions | Patients 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.
Exclude patients whose hospice care overlaps the measurement period. | Webchart Instructions |
Numerator | Patients 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 period | Webchart Instructions |
Numerator Exclusions | Not Applicable | Webchart Instructions |
Denominator Exceptions | None | |
Details
Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
CMS165v7 |
165 |
2019 |
7.3.000 |
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 |
INTERMEDIATE |
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 |
Essential Hypertension |
2.16.840.1.113883.3.464.1003.104.12.1011 |
Diagnosis |
Kidney Transplant Recipient |
2.16.840.1.113883.3.464.1003.109.12.1029 |
Diagnosis |
Pregnancy |
2.16.840.1.113883.3.526.3.378 |
Encounter, Performed |
Adult Outpatient Visit |
2.16.840.1.113883.3.464.1003.101.12.1065 |
Encounter, Performed |
Annual Wellness Visit |
2.16.840.1.113883.3.526.3.1240 |
Encounter, Performed |
Encounter Inpatient |
2.16.840.1.113883.3.666.5.307 |
Encounter, Performed |
ESRD Monthly Outpatient Services |
2.16.840.1.113883.3.464.1003.109.12.1014 |
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, Order |
Hospice care ambulatory |
2.16.840.1.113762.1.4.1108.15 |
Intervention, Performed |
Hospice care ambulatory |
2.16.840.1.113762.1.4.1108.15 |
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 |
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
The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.
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Copyright
This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved.
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CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.
Source:
https://ecqi.healthit.gov/ecqm/measures/cms165v7