• Measure 236 (NQF 0018): Controlling High Blood Pressure


    Reporting Options: 

    • IRIS Registry EHR: groups and individuals
    • EHR through your vendor
    • Claims based reporting

    Measure Type: Intermediate Outcome 

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

    CPT Codes:

    99201, 99202, 99203, 99204, 99205, 99212, 99213, 99214, 99215, 99341, 99342, 99343, 99344, 99345, 99347, 99348, 99349, 99350, G0402, G0438, G0439

    Note: Eye codes 92002, 92004, 92012, and 92014 are not included in this measure.

    Diagnosis Codes:

    Diagnosis for hypertension: I10

    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 STATEMENTS:

    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.

    Claims based reporting

    Instructions: This measure is to be reported once per reporting period for patients with hypertension seen during the reporting period. Only blood pressure readings performed by a clinician in the provider office are acceptable for compliance with this measure. Do not include blood pressure readings that meet the following criteria:

    • Blood pressure readings from the patient's home (including readings directly from monitoring devices).
    • Taken during an outpatient visit which was for the sole purpose of having a diagnostic test or surgical procedure performed (eg, sigmoidoscopy, removal of a mole).
    • Obtained the same day as a major diagnostic or surgical procedure (eg, stress test, administration of IV contrast for a radiology procedure, endoscopy).
    • If no blood pressure is recorded during the measurement period the patient’s blood pressure is assumed not controlled.

    Category II Codes:

    To describe both systolic and diastolic blood pressure values, each must be reported separately. If there are multiple blood pressures on the same date of service, use the lowest systolic and lowest diastolic blood pressure on that date as the representative blood pressure.

    Patient Not Eligible Denominator Exclusion:

    G9740  Hospice services given to patient any time during the measurement period

    Or

    G9231  Documentation of end stage renal disease (ESRD), dialysis, renal transplant before or during the measurement period or pregnancy during the measurement period

    Numerator

    Systolic pressure (Select one (1) code from this section):

    G8752 Most recent systolic blood pressure < 140 mmHg

    Or

    G8753 Most recent systolic blood pressure ≥ 140 mmHg

    AND

    Diastolic pressure (Select one (1) code from this section):

    G8754 Most recent diastolic blood pressure < 90 mmHg

    Or

    G8755 Most recent diastolic blood pressure ≥ 90 mmHg

    Or

    G8756  No documentation of blood pressure measurement, reason not given

    EHR Reporting

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

    These are the required elements to be documented at least once a year to meet the measure performance requirements.

    • Diagnosis of essential hypertension
    • Less than 140/90mmHg blood pressure measurement at most recent visit

    How CMS Scores Your Performance

    • If you report this measure for at least 50 percent of applicable patients during a reporting period, you will earn points based on the decile that corresponds to your performance rate. Not all measures offer points for every decile.
    • If you successfully report a measure for less than 50 percent of your patients, you will earn 3 points.
    • You can also earn bonus points because of the measure type and if you electronically report this measure (i.e., through an integrated EHR system).
    Decile/Points eCQM Benchmark (Integrated EHR) Claims Benchmark 
    3 50.00 - 55.39 58.02 - 63.90
    4 55.40 - 59.72 63.91- 68.36
    5 59.73 - 63.59 68.37 - 72.91
    6 63.60 - 67.38 72.92 - 76.91
    7 67.39 - 71.00 76.92 - 81.65
    8 71.01 - 75.33 81.66 - 86.95
    9 75.34 - 80.89 86.96 - 94.06
    10 >= 80.90 >= 94.07