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Hypertension improvement proj- ect: randomized trial of quality improvement for physicians and lifestyle modification for patients. Hypertension. 2009;54:1226 33. 20 Appendix A. HBP Measure Set Performance Measures for HBP Short Title: PM-1a: ACC/AHA Stage 2 HBP Control SBP <140 mmHg (Harmonizing Measure) PM-1a: Percentage of Patients 18 to 85 years of Age Who Had a Diagnosis of ACC/AHA Stage 2 HBP and Whose SBP Was <140 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 HBP with SBP <140 mmHg (harmonizes with current performance measure Controlling High Blood Pressure in widespread use) Numerator Patients with SBP <140 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications.


20 Appendix A. HBP Measure Set Performance Measures for HBP Short Title: PM-1a: ACC/AHA Stage 2 HBP Control SBP <140 mmHg (Harmonizing Measure) PM-1a: Percentage of Patients 18 to 85 years of Age Who Had a Diagnosis of ACC/AHA Stage 2 HBP and Whose SBP Was <140 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 HBP with SBP <140 mmHg (harmonizes with current performance measure Controlling High Blood Pressure in widespread use) Numerator Patients with SBP <140 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications. This performance measure harmonizes with NCQA HEDIS 2019, ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs.


This performance measure harmonizes with NCQA HEDIS 2019, ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs. National average rates of performance have been consistently <70% for several years for HEDIS. Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 1. BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-y ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs.


BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-y ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. (Class 2a, Level of Evidence: C-EO) Use of the EHR and patient registries is beneficial for identification of patients with undiagnosed or undertreated hypertension.55 57 (Class 1, Level of Evidence: B-NR) Treatment of hypertension with a SBP treatment goal of less than 130 mmHg is recommended for noninstitutionalized ambulatory community-dwelling adults ( 65 y of age) with an average SBP of 130 mmHg or higher.58 (Class 1, Level of Evidence: A) Adults with stage 2 hypertension should be evaluated by or referred to a primary care provider within 1 month of the initial diagnosis, have a combination of nonpharmacological and antihypertensive drug therapy (with 2 agents of different classes) initiated, and have a repeat BP evaluation in (Class 1, Level of Evidence: B-R) In adults with an untreated SBP greater than 130 mmHg but less than 160 mmHg or DBP greater than 80 mmHg but less than 100 mmHg, it is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.61 68 (Class 2a, Level of Evidence: B-NR) Resources: 1) Qualified Electronic Health Record,69 2) PCPI National Quality Registry Network (NQRN).70 3) American College of Cardiology Foundation (ACCF) American Heart Association (AHA) Physician Consortium for Performance Improvement (PCPI) Hypertension Performance Measurement Set.


(Class 2a, Level of Evidence: C-EO) Use of the EHR and patient registries is beneficial for identification of patients with undiagnosed or undertreated hypertension.55 57 (Class 1, Level of Evidence: B-NR) Treatment of hypertension with a SBP treatment goal of less than 130 mmHg is recommended for noninstitutionalized ambulatory community-dwelling adults ( 65 y of age) with an average SBP of 130 mmHg or higher.58 (Class 1, Level of Evidence: A) Adults with stage 2 hypertension should be evaluated by or referred to a primary care provider within 1 month of the initial diagnosis, have a combination of nonpharmacological and antihypertensive drug therapy (with 2 agents of different classes) initiated, and have a repeat BP evaluation in (Class 1, Level of Evidence: B-R) In adults with an untreated SBP greater than 130 mmHg but less than 160 mmHg or DBP greater than 80 mmHg but less than 100 mmHg, it is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.61 68 (Class 2a, Level of Evidence: B-NR) Resources: 1) Qualified Electronic Health Record,69 2) PCPI National Quality Registry Network (NQRN).70 3) American College of Cardiology Foundation (ACCF) American Heart Association (AHA) Physician Consortium for Performance Improvement (PCPI) Hypertension Performance Measurement Set. 4) NQF Measure 0018 Controlling High Blood Pressure (NCQA).22 Additional note: 2017 Hypertension Clinical Practice Guidelines relies on average BP readings. NCQA HEDIS relies on most recent BP reading: The member is numerator compliant if the BP is <140/90 mmHg. The member is not compliant if the BP is 140/90 mmHg, if there is no BP reading during the measurement year, or if the reading is incomplete (eg, the systolic or diastolic level is missing).


The member is not compliant if the BP is 140/90 mmHg, if there is no BP reading during the measurement year, or if the reading is incomplete (eg, the systolic or diastolic level is missing). If there are multiple BPs on the same date of service, use the lowest systolic and diastolic BP on that date as the representative BP. ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 21 Appendix A.


ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 21 Appendix A. Continued Short Title: PM-1b: ACC/AHA Stage 2 HBP Control SBP <130 mmHg (Enhancing Measure) PM-1b: Percentage of Patients 18 to 85 Years of Age Who Had a Diagnosis of ACC/AHA Stage 2 HBP and Whose SBP Was <130 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 HBP with SBP <130 mmHg (harmonizes with current performance measure Controlling High Blood Pressure in widespread use) Numerator Patients with SBP <130 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications.


Continued Short Title: PM-1b: ACC/AHA Stage 2 HBP Control SBP <130 mmHg (Enhancing Measure) PM-1b: Percentage of Patients 18 to 85 Years of Age Who Had a Diagnosis of ACC/AHA Stage 2 HBP and Whose SBP Was <130 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 HBP with SBP <130 mmHg (harmonizes with current performance measure Controlling High Blood Pressure in widespread use) Numerator Patients with SBP <130 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications. This performance measure enhances NCQA HEDIS 2019, ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs.


This performance measure enhances NCQA HEDIS 2019, ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs. Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 1. BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs.


BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. (Class 2a, Level of Evidence: C-EO) Use of the EHR and patient registries is beneficial for identification of patients with undiagnosed or undertreated hypertension.55 57 (Class 1, Level of Evidence: B-NR) Treatment of hypertension with a SBP treatment goal of less than 130 mmHg is recommended for noninstitutionalized ambulatory community-dwelling adults ( 65 y of age) with an average SBP of 130 mmHg or higher.58 (Class 1, Level of Evidence: A) Adults with stage 2 hypertension should be evaluated by or referred to a primary care provider within 1 month of the initial diagnosis, have a combination of nonpharmacological and antihypertensive drug therapy (with 2 agents of different classes) initiated, and have a repeat BP evaluation in (Class 1, Level of Evidence: B-R) In adults with an untreated SBP greater than 130 mmHg but less than 160 mmHg or DBP greater than 80 mmHg but less than 100 mmHg, it is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.61 68 (Class 2a, Level of Evidence: B-NR) Resources: 1) Qualified Electronic Health Record.69 2) PCPI National Quality Registry Network (NQRN).70 3) American College of Cardiology Foundation (ACCF) American Heart Association (AHA) Physician Consortium for Performance Improvement (PCPI) Hypertension Performance Measurement Set.


(Class 2a, Level of Evidence: C-EO) Use of the EHR and patient registries is beneficial for identification of patients with undiagnosed or undertreated hypertension.55 57 (Class 1, Level of Evidence: B-NR) Treatment of hypertension with a SBP treatment goal of less than 130 mmHg is recommended for noninstitutionalized ambulatory community-dwelling adults ( 65 y of age) with an average SBP of 130 mmHg or higher.58 (Class 1, Level of Evidence: A) Adults with stage 2 hypertension should be evaluated by or referred to a primary care provider within 1 month of the initial diagnosis, have a combination of nonpharmacological and antihypertensive drug therapy (with 2 agents of different classes) initiated, and have a repeat BP evaluation in (Class 1, Level of Evidence: B-R) In adults with an untreated SBP greater than 130 mmHg but less than 160 mmHg or DBP greater than 80 mmHg but less than 100 mmHg, it is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.61 68 (Class 2a, Level of Evidence: B-NR) Resources: 1) Qualified Electronic Health Record.69 2) PCPI National Quality Registry Network (NQRN).70 3) American College of Cardiology Foundation (ACCF) American Heart Association (AHA) Physician Consortium for Performance Improvement (PCPI) Hypertension Performance Measurement Set. 4) NQF Measure 0018 Controlling High Blood Pressure (NCQA).22 Additional note: 2017 Hypertension Clinical Practice Guidelines relies on average BP readings. NCQA HEDIS relies on most recent BP reading: The member is numerator compliant if the BP is <140/90 mmHg. The member is not compliant if the BP is 140/90 mmHg, if there is no BP reading during the measurement year, or if the reading is incomplete (eg, the systolic or diastolic level is missing).


The member is not compliant if the BP is 140/90 mmHg, if there is no BP reading during the measurement year, or if the reading is incomplete (eg, the systolic or diastolic level is missing). If there are multiple BPs on the same date of service, use the lowest systolic and diastolic BP on that date as the representative BP. ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NMA, National Medical Association; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 22 Appendix A.


ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NMA, National Medical Association; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 22 Appendix A. Continued Short Title: PM-2: ACC/AHA Stage 1 HBP Control SBP <130 mmHg (Harmonizing Measure) PM-2: Percentage of Patients 18 to 85 Years of Age Who Had a Diagnosis of ACC/AHA Stage 1 HBP and Whose SBP Was <130 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 1 HBP with SBP <130 mmHg (harmonizes with current performance measure Controlling High Blood Pressure for ACC/AHA stage 2 HBP currently in widespread use) Numerator Patients with SBP <130 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 1 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications.


Continued Short Title: PM-2: ACC/AHA Stage 1 HBP Control SBP <130 mmHg (Harmonizing Measure) PM-2: Percentage of Patients 18 to 85 Years of Age Who Had a Diagnosis of ACC/AHA Stage 1 HBP and Whose SBP Was <130 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 1 HBP with SBP <130 mmHg (harmonizes with current performance measure Controlling High Blood Pressure for ACC/AHA stage 2 HBP currently in widespread use) Numerator Patients with SBP <130 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 1 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications. This performance measure harmonizes and supplements the existing measure for stage 2 with NCQA HEDIS 2019 (currently in draft form for public comment), ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs.


This performance measure harmonizes and supplements the existing measure for stage 2 with NCQA HEDIS 2019 (currently in draft form for public comment), ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs. There is currently no HEDIS or other standardized measurement of a national average rate of performance for stage 1 HBP. Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs.


Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-year ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. (Class 2a, Level of Evidence: C-EO) Use of the EHR and patient registries is beneficial for identification of patients with undiagnosed or undertreated hypertension.55 57 (Class 1, Level of Evidence: B-NR) Treatment of hypertension with a SBP treatment goal of less than 130 mmHg is recommended for noninstitutionalized ambulatory community-dwelling adults ( 65 y of age) with an average SBP of 130 mmHg or higher.58 (Class 1, Level of Evidence: A) Adults with stage 2 hypertension should be evaluated by or referred to a primary care provider within 1 month of the initial diagnosis, have a combination of nonpharmacological and antihypertensive drug therapy (with 2 agents of different classes) initiated, and have a repeat BP evaluation in (Class 1, Level of Evidence: B-R) In adults with an untreated SBP greater than 130 mmHg but less than 160 mmHg or DBP greater than 80 mmHg but less than 100 mmHg, it is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.61 68 (Class 2a, Level of Evidence: B-NR) Resources: 1) Qualified Electronic Health Record.69 2) PCPI National Quality Registry Network (NQRN).70 3) American College of Cardiology Foundation (ACCF) American Heart Association (AHA) Physician Consortium for Performance Improvement (PCPI) Hypertension Performance Measurement Set.


The member is not compliant if the BP is 140/90 mmHg, if there is no BP reading during the measurement year, or if the reading is incomplete (eg, the systolic or diastolic level is missing). If there are multiple BPs on the same date of service, use the lowest systolic and diastolic BP on that date as the representative BP. ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 23 Appendix A.


ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 23 Appendix A. Continued Short Title: PM-3: ACC/AHA Stage 2 and Stage 1 HBP Control SBP <130 mmHg (Composite Measure Combining PM-1b and PM-2) PM-3: Percentage of Patients 18 to 85 years of Age Who Had a Diagnosis of Either ACC/AHA Stage 2 or Stage 1 HBP and Whose SBP Was <130 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 or stage 1 HBP with SBP <130 mmHg (enhances current performance measure Controlling High Blood Pressure in widespread use based on current ACC/AHA guidelines by including patients with ACC/AHA stage 1 HBP) Numerator Patients with SBP <130 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 2 or stage 1 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications.


Continued Short Title: PM-3: ACC/AHA Stage 2 and Stage 1 HBP Control SBP <130 mmHg (Composite Measure Combining PM-1b and PM-2) PM-3: Percentage of Patients 18 to 85 years of Age Who Had a Diagnosis of Either ACC/AHA Stage 2 or Stage 1 HBP and Whose SBP Was <130 mmHg During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 or stage 1 HBP with SBP <130 mmHg (enhances current performance measure Controlling High Blood Pressure in widespread use based on current ACC/AHA guidelines by including patients with ACC/AHA stage 1 HBP) Numerator Patients with SBP <130 mmHg Denominator All patients 18 85 y of age with ACC/AHA stage 2 or stage 1 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions End-stage renal disease, kidney transplantation, pregnancy, BP readings taken during an inpatient stay Denominator Exceptions Documentation of a medical reason (eg, treatment intolerance, significant risk of treatment intolerance, especially for frail patients 65 y of age) Documentation of a patient reason (eg, economic/access issues) Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Healthcare provider (healthcare provider, physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system) Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Effective management of BP in patients with hypertension can help prevent cardiovascular events, including MI, stroke, and the development of HF, and reduce the risk of death from these complications. This performance measure harmonizes and supplements the existing measure for stage 2 with NCQA HEDIS 2019 (currently in draft form for public comment), ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs.


This performance measure harmonizes and supplements the existing measure for stage 2 with NCQA HEDIS 2019 (currently in draft form for public comment), ICSI, VHA, NQF Measure 0018, Medicaid, Medicare Physician QPP (formerly PQRS), MSSP, Million Hearts, physician feedback/QRUR, physician VBM, QHP, QRS commonly used in payment programs, public reporting, quality improvement (internal to the specific organization), and regulatory and accreditation programs. There is currently no HEDIS or other standardized composite measurement of a national average rate of performance for stage 2 and stage 1 HBP combined. Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-y ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs.


Clinical Recommendations 2017 Hypertension Clinical Practice Guidelines4 BP should be categorized as normal, elevated, or stage 1 or 2 hypertension to prevent and treat high BP.27 46 (Class 1, Level of Evidence: B-NR) Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension and for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions.47 50 (Class 1, Level of Evidence: ASR ) For adults with confirmed hypertension and known CVD or 10-y ASCVD event risk of 10% or higher, a BP target of less than 130/80 mmHg is (Class 1, Level of Evidence: SBP: B-RSR , DBP: C-EO) For older adults ( 65 y of age) with hypertension and a high burden of comorbidity and limited life expectancy, clinical judgment, patient preference, and a team-based approach to assess risk/benefit are reasonable for decisions regarding intensity of BP lowering and choice of antihypertensive drugs. (Class 2a, Level of Evidence: C-EO) Use of the EHR and patient registries is beneficial for identification of patients with undiagnosed or undertreated hypertension.55 57 (Class 1, Level of Evidence: B-NR) Treatment of hypertension with a SBP treatment goal of less than 130 mmHg is recommended for noninstitutionalized ambulatory community-dwelling adults ( 65 y of age) with an average SBP of 130 mmHg or higher.58 (Class 1, Level of Evidence: A) Adults with stage 2 hypertension should be evaluated by or referred to a primary care provider within 1 month of the initial diagnosis, have a combination of nonpharmacological and antihypertensive drug therapy (with 2 agents of different classes) initiated, and have a repeat BP evaluation in (Class 1, Level of Evidence: B-R) In adults with an untreated SBP greater than 130 mmHg but less than 160 mmHg or DBP greater than 80 mmHg but less than 100 mmHg, it is reasonable to screen for the presence of white coat hypertension by using either daytime ABPM or HBPM before diagnosis of hypertension.61 68 (Class 2a, Level of Evidence: B-NR) Resources: 1) Qualified Electronic Health Record.69 2) PCPI National Quality Registry Network (NQRN).70 3) American College of Cardiology Foundation (ACCF) American Heart Association (AHA) Physician Consortium for Performance Improvement (PCPI) Hypertension Performance Measurement Set.


The member is not compliant if the BP is 140/90 mmHg, if there is no BP reading during the measurement year, or if the reading is incomplete (eg, the systolic or diastolic level is missing). If there are multiple BPs on the same date of service, use the lowest systolic and diastolic BP on that date as the representative BP. ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 24 Appendix A.


ABPM indicates ambulatory blood pressure monitoring; ACC, American College of Cardiology; AHA, American Heart Association; ASCVD, atherosclerotic cardiovascular disease; BP, blood pressure; CVD, cardiovascular disease; DBP, diastolic blood pressure; EHR, electronic health record; HBP, high blood pressure; HBPM, home blood pressure monitoring; HEDIS, Healthcare Effectiveness Data and Information Set; HF, heart failure; ICSI, Institute for Clinical Systems Improvement; MI, myocardial infarction; MSSP, Medicare Shared Savings Program; NCQA, National Committee for Quality Assurance; NQF, National Quality Forum; PCPI, Physician Consortium for Performance Improvement; QCDR, Qualified Clinical Data Registry; QHP, Qualified Health Plan; QPP, Quality Payment Program; QRS, Quality Rating System; QRUR, Quality and Resource Use Reports; SBP, systolic blood pressure; VBM, Value-Based Payment Modifier; and VHA, Veterans Health Administration. 24 Appendix A. Continued Short Title: PM-4: Nonpharmacological Interventions for ACC/AHA Stage 2 HBP PM-4: Percentage of Adults 18 to 85 Years of Age Who Had a Diagnosis of ACC/AHA Stage 2 HBP Who Have Documentation of a Discussion of Intensive Lifestyle Modification With Their Healthcare Providers During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 HBP who have a documented discussion of intensive lifestyle modification in 1 visits during the measurement year Numerator Patients who have a documented discussion of intensive lifestyle modification at least once in the performance year and in accordance with ACC/AHA guidelines on nonpharmacological therapy Denominator All patients 18 85 y of age with ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions BP readings taken during an inpatient stay Denominator Exceptions None Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Nonpharmacological therapy in combination with drug therapy is an integral part of management of ACC/AHA stage 2 hypertension.


Continued Short Title: PM-4: Nonpharmacological Interventions for ACC/AHA Stage 2 HBP PM-4: Percentage of Adults 18 to 85 Years of Age Who Had a Diagnosis of ACC/AHA Stage 2 HBP Who Have Documentation of a Discussion of Intensive Lifestyle Modification With Their Healthcare Providers During the Measurement Year Measure Description: Percentage of patients with ACC/AHA stage 2 HBP who have a documented discussion of intensive lifestyle modification in 1 visits during the measurement year Numerator Patients who have a documented discussion of intensive lifestyle modification at least once in the performance year and in accordance with ACC/AHA guidelines on nonpharmacological therapy Denominator All patients 18 85 y of age with ACC/AHA stage 2 HBP who had at least 1 outpatient encounter with a diagnosis of HBP during the first 6 mo of the measurement year or any time before the measurement period Denominator Exclusions BP readings taken during an inpatient stay Denominator Exceptions None Measurement Period 12 mo/measurement year Sources of Data Paper medical record/prospective data collection flow sheet, Qualified Electronic Health Record, QCDR, electronic administrative data (claims), expanded (multiple source) administrative data, electronically or telephonically transmitted BP readings Attribution Physician group practice, accountable care organization, clinically integrated network, health plan, integrated delivery system Care Setting Outpatient (office, clinic, home, or ambulatory) Rationale Nonpharmacological therapy in combination with drug therapy is an integral part of management of ACC/AHA stage 2 hypertension. Prompt and frequent discussion of lifestyle modification among patients with ACC/AHA stage 2 hypertension is important because of the elevated risk of ASCVD events. Dietary modification is a fundamental approach to the prevention and management of hypertension and complements pharmacological management of hypertension.