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Type: EC eCQMs - Eligible Clinicians
Resolution: Done
Priority: Major
Component/s: Measure
Labels:
- LOGIC

Solution:

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Thank you for your question. It is very difficult to provide a response to your question based on the way the information provided, which is limited, and appears to be test cases. Additionally it is not clear whether the scenarios represent all of the previous BPs a single patient has in their EHR, or they represent distinctly different patient cases. That said, the numerator for CMS22v7, Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented, is looking at the most recent blood pressure.

· For "Blood Pressure Normal at Most Recent Screening Encounter" if the most recent BP is normal (SBP < 120 mmHg and DBP < 80 mmHg) then the numerator is met.
· For "Has Prehypertensive Reading With Interventions" if the most recent BP is considered pre-hypertensive (SBP > 120 and < 140 mmHg, and DBP > 80 and < 90 mmHg), and an intervention is performed the numerator is met.
· For "Has First Hypertensive Reading With Interventions" if the most recent BP is high (SBP >= 140 mmHg, and DBP >= 90 mmHg), and there are not other high BPs in the year prior to the encounter with the most recent high BP, and follow-up within 4 weeks or referral to another provider was performed then the numerator is met.
· For "Has Second Hypertensive Reading With Interventions" if the most recent BP is high, and the most recent BP prior to this one within the year prior to this one is also high, and an intervention is performed then the numerator is met.

Based on the information you provided, this case would not qualify for the first and second numerator criteria because the most recent BP was not normal and was not prehypertensive. If the reporting period is 2019 then BPs from 2017 are outside of the look back period for previous high BPs. If the most recent blood pressure screening encounter was on 1/1/2019, then the last blood pressure encounter would be within the year prior to that or 1/1/2018. Beyond that we are not able to comment due to the reasons noted above.

For us to provide more meaningful responses, it would be helpful to limit the question to the area of primary concern or interest within the logic itself, instead of providing pieces of scenarios that may be prone to misinterpretation outside of the context of the full measure. For example, instead of asking please confirm which scenario(s) will qualify, it might be better to ask what the acceptable time frame is for previous hypertensive BPs to meet requirements for the "Has Second Hypertensive Reading With Interventions" criteria. Then the focus of our responses could be on the relevant logic instead of testing cases, which may differ in other key parameters and result in different answers. We hope this helps with any future questions.

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Thank you for your question. It is very difficult to provide a response to your question based on the way the information provided, which is limited, and appears to be test cases. Additionally it is not clear whether the scenarios represent all of the previous BPs a single patient has in their EHR, or they represent distinctly different patient cases. That said, the numerator for CMS22v7, Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented, is looking at the most recent blood pressure. · For "Blood Pressure Normal at Most Recent Screening Encounter" if the most recent BP is normal (SBP < 120 mmHg and DBP < 80 mmHg) then the numerator is met. · For "Has Prehypertensive Reading With Interventions" if the most recent BP is considered pre-hypertensive (SBP > 120 and < 140 mmHg, and DBP > 80 and < 90 mmHg), and an intervention is performed the numerator is met. · For "Has First Hypertensive Reading With Interventions" if the most recent BP is high (SBP >= 140 mmHg, and DBP >= 90 mmHg), and there are not other high BPs in the year prior to the encounter with the most recent high BP, and follow-up within 4 weeks or referral to another provider was performed then the numerator is met. · For "Has Second Hypertensive Reading With Interventions" if the most recent BP is high, and the most recent BP prior to this one within the year prior to this one is also high, and an intervention is performed then the numerator is met. Based on the information you provided, this case would not qualify for the first and second numerator criteria because the most recent BP was not normal and was not prehypertensive. If the reporting period is 2019 then BPs from 2017 are outside of the look back period for previous high BPs. If the most recent blood pressure screening encounter was on 1/1/2019, then the last blood pressure encounter would be within the year prior to that or 1/1/2018. Beyond that we are not able to comment due to the reasons noted above. For us to provide more meaningful responses, it would be helpful to limit the question to the area of primary concern or interest within the logic itself, instead of providing pieces of scenarios that may be prone to misinterpretation outside of the context of the full measure. For example, instead of asking please confirm which scenario(s) will qualify, it might be better to ask what the acceptable time frame is for previous hypertensive BPs to meet requirements for the "Has Second Hypertensive Reading With Interventions" criteria. Then the focus of our responses could be on the relevant logic instead of testing cases, which may differ in other key parameters and result in different answers. We hope this helps with any future questions.
Measure Type:
EP

Hi Team,

We have a Query regarding Numerator condition of CMS22v7:

Numerator:

( "Blood Pressure Normal at Most Recent Screening Encounter" is not null )
or ( "Has Prehypertensive Reading With Interventions" )
or ( "Has First Hypertensive Reading With Interventions" )
or ( "Has Second Hypertensive Reading With Interventions" )

Definition:
*Has First Hypertensive Reading With Interventions *
"High Blood Pressure at Most Recent Screening Encounter" is not null
and not "Last Blood Pressure Within One Year High"
and ( exists ( "Hypertensive Interventions at Most Recent Blood Pressure Encounter" )
and exists ( "Follow Up Within 4 Weeks" )
)
or exists ( "Referral to Alternate Provider" )

*Last Blood Pressure Within One Year High *
"Last Diastolic One Year Prior to Encounter High" is not null
or "Last Systolic One Year Prior to Encounter High" is not null

*Last Diastolic One Year Prior to Encounter High *
"Last Diastolic One Year Prior to Encounter" LastDiastolic
where LastDiastolic.result >= 90 'mm[Hg]'

*Last Diastolic One Year Prior to Encounter *
Last(["Physical Exam, Performed": "Diastolic blood pressure"] DiastolicBP
with "Most Recent Blood Pressure Screening Encounter" LastBPEncounter
such that DiastolicBP.relevantPeriod starts 1 year or less before start LastBPEncounter.relevantPeriod
sort by start of relevantPeriod
)

For the above condition mentioned above, please confirm which scenario(s) of patient will Qualify:
Patient Age >18
Measurement Period: 01-01-2019 00:00:00 to 12-31-2019 23:59:59
Encounter codes are present
DiastolicBP = 95mmHg on 01-01-2019 12:00:00
SystolicBP = 145mmHg on 01-01-2019 12:00:00
LastBPEncounter: 01-01-2019 12:00:00

Scenario 1:
Year Prior Systolic Value = 130 mmHg on 01-01-2018 12:00:00
Year Prior Diastolic Value = 85 mmHg on 01-01-2018 12:00:00

Scenario 2:
Year Prior Systolic Value = 130 mmHg on 01-01-2017 12:00:00
Year Prior Diastolic Value = 85 mmHg on 01-01-2017 12:00:00

Scenario 3:
Year Prior Systolic Value = 130 mmHg on 02-02-2017 12:00:00
Year Prior Diastolic Value = 85 mmHg on 02-02-2017 12:00:00

Scenario 4:
Year Prior Systolic Value = 130 mmHg on 02-02-2018 12:00:00
Year Prior Diastolic Value = 85 mmHg on 02-02-2018 12:00:00

Please confirm which scenarios will Qualify for above patient

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