Product Lines:
Advantage MD, Dual Eligible Special Needs Plans (D-SNP), EHP, Priority Partners, and USFHP.

Eligible Population:
Members 18-85 years old as of December 31 of the measurement year.

Definition:
Members 18-85 years of age who had a diagnosis of hypertension (HTN) and whose BP was adequately controlled (systolic and diastolic both LESS THAN 140/90 mm HG) during the measurement year.

• Representative BP: The most recent (last BP of the year) BP reading during the measurement year on or after the second diagnosis of hypertension (system calculates).

If multiple BP readings are noted in the chart on the same date; the lowest systolic and lowest diastolic BP result will be used.

Report Stratification by race and ethnicity.

Continuous Enrollment:

• The measurement year.

Best Practice and Measure Tips

• Allow patient to rest for at least 5 minutes before taking the BP. Select appropriately sized BP cuff, and place cuff on bare arm.
• Ensure patient is seated with feet on the floor, back supported and arm supported at heart level.
• If office uses manual blood pressure cuffs, do not round up the BP reading.
• If initial BP is > 140/90, retake the member’s BP after they’ve had time to rest. If remains elevated, ensure member follows up for BP check.
  • Since the last BP in the year is used, have member follow up for elevated BPs prior to the end of the year or follow Guidelines for Member Reported BP Readings if a visit is not possible
• Implement process and procedures for staff to follow to accurately take BP reading. See American Medical Association (AMA) Control High BP best practices for recommendations and opportunities for improvement (https://www.ama-assn.org/system/files/2019-01/measure-accurately-best-practices.pdf).
• Educate member of the important of managing blood pressure. Provide resource such as flayer and tracking log.
  • AMA Self-measured blood pressure (SMBP) quick guide (https://www.ama-assn.org/system/files/2020-06/7-step-smbp-quick-guide.pdf)
  • AMA Self-measured blood pressure log (https://targetbp.org/wp-content/uploads/2017/10/SMBP-Recording-Log_TBP_Update.pdf)
• BP reading taken during an Urgent Care visit is acceptable.

Multiple BPs on same date of service:

• It is preferred to not average BP since the lowest systolic and lowest diastolic are to be used.
• If the only BP is an average BP, if it is documented “average BP today: 139/70”it is eligible for use.

Guidelines for Member Reported BP Readings documented in the medical record:

• Must indicate date BP was taken.
• Only a digital device for member reporting BP reading is acceptable. If the documentation does not specify how the member reported BP was taken, then it can be assumed to have been a digital device.
• May obtain BP during telephone visits, e-visits or virtual check-ins. Have members take BP prior to visit to report during visit.
• My Chart communications with BPs reported must indicate date taken.
• There is no requirement there be evidence the BP was collected by a PCP or specialist.
• Provider - during a face to face visit.
  • The date the BP was taken by the member must be documented. If the date is not documented, the member reported BP cannot be used. This only applies to the face to face visit.

BP readings taken the same day member receives a common low-intensity or preventive procedure can be used. Examples include, but aren’t limited to:

• Eye exam with dilating agents
• Injections (e.g., allergy, Depo Provera,® insulin, lidocaine, steroid, testosterone toradol, or vitamin B-12),
• Intrauterine device (IUD) insertion.
• Tuberculosis (TB) test
• Vaccinations.
• Wart or mole removal
• Fasting Blood Tests

Do not include BP readings:

• Taken during an acute inpatient stay or an ED visits.
• Taken on the same day as a diagnostic test or procedure that requires a medication regimen, change in diet or medication on or one day before the day of the test or procedure, with the exception of fasting blood tests. 
  • Examples include, but are not limited to: Colonoscopy, Dialysis, Infusions, Chemotherapy, Nebulizer treatment with albuterol
• Member taken manual BPs reported are not acceptable at this time.
• Documented as a range or threshold.
• An incomplete BP reading (systolic or diastolic only).
• An aortic systolic/diastolic noninvasive central blood pressure measurement.

Measure Exclusions

Required Exclusions:

• Palliative Care
• Members in hospice or using hospice services anytime during the measurement year.
• Members who died any time during the measurement year.
• Frailty
• Frailty and Advanced Illness
• Living in Long Term Care
• End-stage renal disease (ESRD): dialysis, nephrectomy or kidney transplant
• Members with a diagnosis of pregnancy
• Non-acute inpatient admission
  • This includes rehabilitation, nursing home, inpatient mental health, etc.

Measure Codes

• Hypertension 
  • ICD-10: I10
• Diastolic Less than 80 
  • CPT-CAT-II: 3078F
• Diastolic 80-89 
  • CPT-CAT-II: 3079F
• Diastolic Greater than/Equal to 90 
  • CPT-CAT-II: 3080F
• Systolic Less than 130 
  • CPT-CAT-II: 3074F
• Systolic 130-139
  • CPT-CAT-II: 3075F
• Systolic Greater than/Equal to 140 
  • CPT-CAT-II: 3077F