eCQM: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (CMS 22v5)

eCQM:

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

CMS ID:

CMS 22v5

NQF Number:

N/A

NQS Domain:

Community/Population Health

Measure Type:

Process

MIPS High Priority Measure:

No

Eligible for Quality Programs:

  • Merit-Based Incentive Payment System (MIPS)
  • Medicaid EHR Incentive Program (Meaningful Use)

Description:

Percentage of patients aged 18 years and older seen during the reporting period who were screened for high blood pressure AND a recommended follow-up plan is documented based on the current blood pressure reading as indicated.

  • Numerator: Patients who were screened for high blood pressure AND have a recommended follow-up plan documented, as indicated, if the blood pressure is pre-hypertensive or hypertensive.
  • Denominator: All patients aged 18 years and older before the start of the measurement period with at least one eligible encounter (Office Visit or Nursing Home Visit) during the measurement period.
    • Denominator Exclusion: Patient has an active diagnosis of hypertension.

    • Denominator Exceptions:

      • Patient Reason: Patient refuses to participate (either blood pressure  measurement or follow-up) OR

      • Medical Reason: 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. This may include but is not limited to severely elevated blood pressure when immediate medical treatment is indicated.

Performance Benchmark for MIPS: 46.27%
For further benchmarks and details on how this measure will be scored within the Quality performance category of MIPS, please click
here.

Practice Fusion Suggested Workflow
Practice Fusion suggests the following workflow to help ensure that you gain numerator credit for this measure within the Practice Fusion EHR:

  1. Record the patient’s blood pressure in the encounter flowsheet
  2. Review the blood pressure categories listed in Table 1 to determine whether the blood pressure value falls into the pre-hypertensive or hypertensive categories. If the patient’s blood pressure is hypertensive, determine whether they have a previous blood pressure reading during the last 12 months that was also hypertensive.
  3. Review the appropriate follow-up activities and record them in the patient’s chart using the Practice Fusion EHR suggested workflows listed in Table 2.

Table 1: BP Categories and Required Follow-Up Activities

Blood Pressure Category

Required Follow-Up

Normal
BP values are < 120/80 mmHg

None

Pre-Hypertensive
BP values are equal to or between 120/90 mmHg and 139/89 mmHg

Referral to alternative provider/PCP that is ordered during the encounter

OR

Hypertension recommendations given during the encounter and a follow-up within one year is ordered during the encounter

1st Hypertensive Reading
BP reading is > = 140/90 mmHg
and is the first hypertensive reading in last 12 months

Referral to alternative provider/PCP that is ordered during the encounter

OR

Hypertension recommendations given during the encounter and a follow-up within 4 weeks is ordered during the encounter

2nd Hypertensive Reading
BP reading is > = 140/90 mmHg
and it is the second hypertensive reading in last 12 months

Referral to alternative provider/PCP that is ordered during the encounter

OR

Hypertension recommendations given during the encounter and the following are ordered during the encounter: anti-hypertensive medication therapy, laboratory test for hypertension and ECG diagnostic study

Once the patient’s blood pressure category and appropriate follow-up has been determined, use the Practice Fusion Suggested Workflows in Table 2 below to document the action in the patient encounter.

Table 2: Practice Fusion Suggested Workflows for Follow-up Activities

Follow-up Activities

Practice Fusion Suggested Workflow

Referral to alternative provider/PCP

  • In the Screenings/Interventions/Assessments section of the encounter, search for “Referral to general physician (procedure)” or “Referral to hypertension clinic” and select the item.

  • Record and save the following information in the modal window that opens:

    • Status: Ordered

    • Reason: Finding of hypertension

Hypertension recommendations

  • In the Screenings/Interventions/Assessments section of the encounter, search for a hypertension recommendation. Examples include:

    • Recommendation to exercise (procedure)

    • Weight control education (procedure)

    • Hypertension education (procedure)

    • Counseling about alcohol consumption (procedure)

  • Record and save the following information about the hypertension recommendation in the modal window that opens:

    • Status: Ordered

A follow-up within one year

  • In the Screenings/Interventions/Assessments section of the encounter, search for “Follow-up 1 year (finding)” and select the item.

  • Record and save the following information in the modal window that opens:

    • Status: Ordered

    • Reason: Finding of hypertension

A follow-up within 4 weeks

  • In the Screenings/Interventions/Assessments section of the encounter, search for “Follow-up 1 month (finding)” and select the item.

  • Record and save the following information in the modal window that opens:

    • Status: Ordered

    • Reason: Finding of hypertension

Anti-hypertensive medication therapy

  • In the Medications or Plan section of the encounter, order or record a prescription for anti-hypertensive medication therapy. Examples include:

    • Ramipril 5 MG Oral Tablet

    • Nadolol 40 MG Oral Tablet

    • Timolol 20 MG Oral Tablet

  • Ensure that the medication has a start date associated and, if added in the Medications section, that the “Attach medication to this encounter” box has been checked.

Laboratory test for hypertension

  • Enter a lab order or result for hypertension (e.g. CBC with ordered manual differential panel). Only structured hypertension lab results with a valid LOINC code will generate numerator credit. Results can be sent electronically by a connected lab or entered manually. LOINC codes that qualify for this measure are:

    • LOINC 24321-2, 24323-8, 24356-8, 24357-6, 24362-6, 2888-6, 57021-8, 57782-5, and 58410-2

ECG diagnostic study

  • In the Screenings/Interventions/Assessments section of the encounter, search for “EKG study” or “EKG 12 channel panel” and select the item.

  • Record and save the following information in the modal window that opens:

    • Status: Ordered

    • Start Date: Date ordered

To view a complete list of the follow-up findings and anti-hypertensive medication therapies that qualify for numerator credit, please visit the United States Health Information Knowledgebase (USHIK). This site is produced by the Agency for Healthcare Research and Quality (AHRQ) in partnership with CMS and the National Library of Medicine (NLM). A free Unified Medical Language System® (UMLS) license, available from NLM, is required to access USHIK. Additional Measure Information
  • Please note that referrals sent electronically using the Practice Fusion EHR referral workflow must also be recorded in the Screenings/Interventions/Assessments section of the chart note in order to receive numerator credit.

  • To be recognized for the denominator exclusion, the patient must have at least one of the following diagnosis codes recorded in his or her chart:

    • Diagnosis of hypertension (ICD-10 H35.039, I10, I11.0, I11.9, I12.0, I12.9, I13.0, I13.10, I13.11, I13.2, I15.0, I67.4)

  • If the patient refuses blood pressure measurement or there is a medical reason why the blood pressure cannot be measured, you can use the suggested workflow recorded in Table 3.

  • If the patient refuses the follow-up treatment, you can use the suggested workflow recorded in Table 3.

  • Both the systolic and diastolic blood pressure measurements are required for inclusion. If there are multiple blood pressures on the same date of service, the most recent blood pressure recorded will be used as the representative blood pressure.

  • Eligible professionals who report the measure must perform the blood pressure screening at the time of a qualifying visit by an eligible professional and may not obtain measurements from external sources. The intent of this measure is to screen patients for high blood pressure and provide recommended follow-up as indicated.

Table 3. Suggested Workflow for BP Measurement Denominator Exceptions

Denominator Exception Criteria

Practice Fusion Suggested Workflow

Patient Refused Blood Pressure Screening

  • In the Screenings/Interventions/Assessments section of the encounter, search for “Diastolic Blood Pressure” or “Systolic Blood Pressure” as applicable and select the item.

  • Record and save the following information in the modal window that opens:

    • Status: Not Performed

    • Reason: Refusal of treatment by patient

    • Start Date: Current date

Blood Pressure Reading not done - Medical or Other reason not done

  • In the Screenings/Interventions/Assessments section of the encounter, search for “Diastolic Blood Pressure” or “Systolic Blood Pressure” as applicable and select the item.

  • Record and save the following information in the modal window that opens:

    • Status: Not Performed

    • Reason: Medical contraindication, Procedure contraindicated, OR Treatment not tolerated

    • Start Date: Current date

Patient Refused Blood Pressure Screening Follow-Up

  • In the Screenings/Interventions/Assessments section of the encounter, search for the applicable follow-up from Table 2 and select the item.

  • Record and save the following information in the modal window that opens:

    • Status: Not Performed

    • Reason: Refusal of treatment by patient

    • Start Date: Current Date

More Information

eCQMs

  1. How does the eCQM Dashboard work?
  2. eCQM: Preventive Care and Screening: Screening for Depression and Follow-Up Plan (CMS 2v6)
  3. eCQM: Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented (CMS 22v5)
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  5. eCQM: Documentation of Current Medications in the Medical Record (CMS 68v6)
  6. eCQM: Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-up Plan (CMS 69v5)
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  20. eCQM: Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents (CMS 155v5)
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  23. eCQM: Controlling High Blood Pressure (CMS 165v5)
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