Measure: CMS22
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented
Measure Versions
| eMeasure Code |
Measure Year |
Full Version Number |
Title |
| CMS22v12 |
2024 |
12.1.000 |
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented |
| CMS22v11 |
2023 |
11 |
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented |
| CMS22v10 |
2022 |
10.0.000 |
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented |
| CMS22v9 |
2021 |
9.3.000 |
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented |
| CMS22v8 |
2020 |
8.2.000 |
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented |
| CMS22v7 |
2019 |
7.1.000 |
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented |
| CMS22v6 |
2018 |
6.0.000 |
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented |
| CMS22v5 |
2017 |
5.1.000 |
Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented |
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
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 (https://ecqi.healthit.gov/qdm) for more information on the QDM.
Patient Group Definitions
| Group |
Description |
Instructions Links |
| Initial Population | All patient visits for patients aged 18 years and older at the beginning of the measurement period | Webchart Instructions |
| Denominator | Equals Initial Population | Webchart Instructions |
| Denominator Exclusions | Patient has an active diagnosis of hypertension | Webchart Instructions |
| 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 | Webchart Instructions |
| Numerator Exclusions | Not Applicable | Webchart Instructions |
| 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). | Webchart Instructions |
Details
| Full eMeasure Code |
eMeasure Identifier |
Measure Year |
Version |
NQF # |
GUID |
| CMS22v10 |
|
2022 |
10.0.000 |
Not Applicable |
9a033a94-3d9b-11e1-8634-00237d5bf174 |
| Steward |
Developer |
Endorsed By |
| Mathematica |
Centers for Medicare & Medicaid Services (CMS) |
|
| Scoring Method |
Measure Type |
Stratification |
Risk Adjustment |
| Proportion |
PROCESS |
None |
None |
Rate Aggregation
None
Improvement Notation
Higher score indicates better quality
Rationale
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 SL, et al., 2012 and Luehr D, et al., 2012). Winter (2013) noted that 1 in 3 American adults have hypertension and the lifetime risk of developing hypertension is 90% (Winter KH, et al., 2013). 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 KH, et al., 2013). Hypertension is a major risk factor for ischemic heart disease, left ventricular hypertrophy, renal failure, stroke and dementia (Luehr D, et al., 2012). Prevention of hypertension and the treatment of established hypertension are complementary approaches to reducing CVD risk in the population, but prevention of hypertension provides the optimal means of reducing risk and avoiding harmful consequences. Periodic BP screening can identify individuals who develop elevated BP over time. More frequent BP screening may be particularly important for individuals with elevated ASCVD risk (Whelton PK, 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 GM and Oberhelman S, 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 SL, et al., 2012, Luehr D, 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 D, 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 2010 ACCF/AHA Guideline for the Assessment of Cardiovascular Risk in Asymptomatic Adults continues to support using a global risk score such as the Framingham Risk Score, to assess risk of coronary heart disease (CHD) in all asymptomatic adults (Greenland P, et al., 2010). Lifestyle modifications have demonstrated effectiveness in lowering blood pressure (JNC 7, 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 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 USPSTF.
Clinical Recommendation Statement
The U.S. Preventive Services Task Force (USPSTF) recommends screening for high blood pressure in adults age 18 years and older. This is a grade A recommendation.
Definition
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 (2017 Guideline) 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.
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:
* 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 (ETOH) Consumption
Transmission Format
TBD
Applicable Value Sets
| Category |
Value Set |
OID |
| Diagnosis |
Diagnosis of hypertension |
2.16.840.1.113883.3.600.263 |
| Encounter, Performed |
BP Screening Encounter Codes |
2.16.840.1.113883.3.600.1920 |
| Intervention, Not Ordered |
Dietary Recommendations |
2.16.840.1.113883.3.600.1515 |
| Intervention, Not Ordered |
Follow Up Within 4 Weeks |
2.16.840.1.113883.3.526.3.1578 |
| Intervention, Not Ordered |
Lifestyle Recommendation |
2.16.840.1.113883.3.526.3.1581 |
| Intervention, Not Ordered |
Physical Activity Recommendation |
2.16.840.1.113883.3.600.1518 |
| Intervention, Not Ordered |
Referral or Counseling for Alcohol Consumption |
2.16.840.1.113883.3.526.3.1583 |
| Intervention, Not Ordered |
Referral to Primary Care or Alternate Provider |
2.16.840.1.113883.3.526.3.1580 |
| Intervention, Not Ordered |
Weight Reduction Recommended |
2.16.840.1.113883.3.600.1510 |
| Intervention, Order |
Dietary Recommendations |
2.16.840.1.113883.3.600.1515 |
| Intervention, Order |
Follow Up Within 4 Weeks |
2.16.840.1.113883.3.526.3.1578 |
| Intervention, Order |
Lifestyle Recommendation |
2.16.840.1.113883.3.526.3.1581 |
| Intervention, Order |
Physical Activity Recommendation |
2.16.840.1.113883.3.600.1518 |
| Intervention, Order |
Referral or Counseling for Alcohol Consumption |
2.16.840.1.113883.3.526.3.1583 |
| Intervention, Order |
Referral to Primary Care or Alternate Provider |
2.16.840.1.113883.3.526.3.1580 |
| Intervention, Order |
Weight Reduction Recommended |
2.16.840.1.113883.3.600.1510 |
| Laboratory Test, Not Ordered |
Laboratory Tests for Hypertension |
2.16.840.1.113883.3.600.1482 |
| Laboratory Test, Order |
Laboratory Tests for Hypertension |
2.16.840.1.113883.3.600.1482 |
| Medication, Not Ordered |
Pharmacologic Therapy for Hypertension |
2.16.840.1.113883.3.526.1577 |
| Medication, Order |
Pharmacologic Therapy for Hypertension |
2.16.840.1.113883.3.526.1577 |
| 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 |
References
CITATIONAppleton, S. L., Neo, C., Hill, C. L., Douglas, K. A., & Adams, R. J. (2013). Untreated hypertension: prevalence and patient factors and beliefs associated with under-treatment in a population sample. Journal of Human Hypertension, 27, 453-462. doi:10.1038/jhh.2012.62ID
CITATIONGarrison, G. M. & Oberhelman, S. (2013). Screening for hypertension annually compared with current practice. Annals of Family Medicine, 11 (2), 116-121. doi:10.1370/afm.1467
CITATIONGreenland, P., Alpert, J. S., Beller, G. A., Benjamin, E. J., Budoff, M. J., Fayad, Z. A., Foster, E., Hlatky, M. A., Hodgson, J. M., Kushner, F. G., Lauer, M. S., Shaw, L. J., Smith, S. C., Jr, Taylor, A. J., Weintraub, W. S., Wenger, N. K., Jacobs, A. K., Smith, S. C., Jr, Anderson, J. L., Albert, N., … American Heart Association (2010). 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Journal of the American College of Cardiology, 56(25), e50–e103. https://doi.org/10.1016/j.jacc.2010.09.001
CITATIONLuehr, D., Woolley, T., Burke, R., Dohmen, F., Hayes, R., Johnson, M...., Schoenleber, M. (2012). Hypertension diagnosis and treatment; Institute for Clinical Systems Improvement health care guideline. Updated November, 2012
CITATIONReeves, L., Robinson, K., McClelland, T., Adedoyin, C., Broeseker, A., and Adunlin, G. (2020). “Pharmacist Interventions in the Management of Blood Pressure Control and Adherence to Antihypertensive Medications: A Systematic Review of Randomized Controlled Trials.” Journal of Pharmacy Practice. Available at https://doi.org/10.1177/0897190020903573. Accessed October 5, 2020
CITATIONU.S. Department of Health and Human Services, National Institutes of Health, National Heart, Lung, and Blood Institute & National High Blood Pressure Education Program (2003). The Seventh Report of the Joint National Committee on the Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7). NIH Publication No. 03-5233
CITATIONU.S. Preventive Services Task Force (USPSTF) (2007). Screening for high blood pressure: U.S. Preventive Services Task Force reaffirmation recommendation statement. Annals of Internal Medicine; 147(11):783-6
CITATIONWhelton, P.K., Carey, R.M., Aronow, W.S., Casey, D.E., Collins, K., Dennison Himmelfarb, C., Depalma, S.M., Gidding, S., Jamerson, K.A., Jones, D.W., MacLaughlin, E.J, Muntener, P., Ovbiaggele, B., Smith, S.C., Spencer, C.C., Stafford, R.S., Taler, S.J., Thomas, R.J., Williams, K. A., Williamson, J.D., Wright, J.T., (2018). 2017 ACC/AHA/AAPA/ABC/ACPM/AGS/APhA/ASH/ASPC/NMA/PCNA Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. Hypertension, 71(6), e13-e115. doi.org/10.1161/HYP.0000000000000065
CITATIONWinter, K. H., Tuttle, L. A. & Viera, A.J. (2013). Hypertension. Primary Care Clinics in Office Practice, 40, 179-194. doi:10.1016/j.pop.2012.11.008
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.
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CPT(R) contained in the Measure specifications is copyright 2004-2020 American Medical Association. LOINC(R) is copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2020 World Health Organization. All Rights Reserved.
Source:
https://ecqi.healthit.gov/ecqm/measures/cmsv1