As we are reviewing the outcomes for one of the quality measures, CMS-22/high blood pressure, we have noted a suggestion for an enhancement to the measure.  Since this measure encompasses facility-based providers, who are often situated within the emergency department, we noted that many of this measure's failures are attributed to a time delay in the generation of a referral for high blood pressure, due to the measure's criteria.  In actuality, the measure is being met within the encounter, after the patient has been admitted and in tandem with discharge from the ED.

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The scenario is thus:

• Patient, after-hours, arrives in the Emergency Department
• Patient's admission date is T (today)
• Patient is discharged after midnight (technically, 'tomorrow' or T+1)
• Although patient has pertinent referral/information for follow up, the measure registers as a 'fail' because the measure's associated 'pass' criteria was NOT met on the same day as the admission
• Technically, this is still the same encounter and we believe that CMS would agree that, in this scenario, the measure was, in fact, met because the high blood pressure was addressed within the ED encounter

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Would CMS please consider updating the measure to include that referral/follow-up/meeting of CMS-22 within 24 hours of the admission will qualify as having met that measure?   Minimally, would CMS allow for a 'pass' for this measure if it has been addressed within the same encounter?