[CQM-3962] Question about Numerator Criteria 3 & 4 (First & Second Hypertensive BP) Created: 03/25/20  Updated: 04/03/20  Resolved: 04/01/20

Status: Closed
Project: eCQM Issue Tracker
Component/s: Guidance, Measure

Type: EC eCQMs - Eligible Clinicians Priority: Critical
Reporter: Rana Fahad Arshad (Inactive) Assignee: Mathematica EC eCQM Team (Inactive)
Resolution: Answered Votes: 0
Labels: None

Attachments: PNG File Jira.png    
Contact Name: Rana Fahad Arshad
Contact Email: rfahad@pemr.com
Contact Phone: 407 401 9889 x 410
Solution: The follow up actions for the associated blood pressure reading must occur the same day as the encounter in which the blood pressure is taken (which is used to determine which blood pressure classification level the patient falls under) in order to meet the measure logic requirements. As is noted within the measure logic, the follow up actions all have a timing of "same day as start of" in relation to the encounter that was used to obtain the blood pressure measurement used in the measure calculation.


Therefore, if a patient has a first hypertensive blood pressure reading on March 1, that same day the patient should also have either 1) an order to follow up within 4 weeks AND an order/recommendation for a lifestyle modification, or 2) a referral to an alternate or primary care provider.

As for the second hypertensive blood pressure recording, the interventions only apply to the encounter where the second hypertensive reading is identified. The "same day as start of" logic also applies to the timing of the follow up actions for a second hypertensive blood pressure reading.
Solution Posted On:
2020 Performance Period EC eCQMs:
CMS22v8/NQFna
Measure Title: Question about Numerator Criteria 3 & 4 (First & Second Hypertensive BP)
Impact: Hello, My question is in regards to achieving Numerator Criteria 3 & 4 (First & Second Hypertensive Blood Pressure).

In case of First-Hypertensive Blood Pressure recording, it says that make lifestyle recommendation & Follow-up within 4 weeks OR Referral. So, in order to achieve Numerator, are we supposed to order two interventions separately on same encounter i.e. 1 for Lifestyle recommendation and other for Follow-up or Referral?

In case of Second Hypertensive Blood Pressure recording, if First-Hypertensive intervention was not ordered then are we supposed to make 2 interventions orders i.e. 1 for lifestyle recommendation and other Medication/Lab/Diagnostic Study/Referral? Or it does not matter that First-Hypertensive intervention was ordered or not. Either way, we have to order a lifestyle recommendation AND Medication/Lab/Imaging Order/Referral?

Kindly elaborate, Thanks!
Last Commented Date:

 Description   

Hello, My question is in regards to achieving Numerator Criteria 3 & 4 (First & Second Hypertensive Blood Pressure).

In case of First-Hypertensive Blood Pressure recording, it says that make lifestyle recommendation & Follow-up within 4 weeks OR Referral. So, in order to achieve Numerator, are we supposed to order two interventions separately on same encounter i.e. 1 for Lifestyle recommendation and other for Follow-up or Referral?

In case of Second Hypertensive Blood Pressure recording, if First-Hypertensive intervention was not ordered then are we supposed to make 2 interventions orders i.e. 1 for lifestyle recommendation and other Medication/Lab/Diagnostic Study/Referral? Or it does not matter that First-Hypertensive intervention was ordered or not. Either way, we have to order a lifestyle recommendation AND Medication/Lab/Imaging Order/Referral?

Kindly elaborate, Thanks!

 Comments   
Comment by Rana Fahad Arshad (Inactive) [ 04/03/20 ]

Thank you very much for the explanation. Appreciate your help.

Comment by Mathematica EC eCQM Team (Inactive) [ 04/02/20 ]

The measure logic for CMS22v8 specifies that if any of the acceptable reasons under Denominator Exceptions were indicated for not performing an intervention, whether it is pertinent to a pre-hypertensive, first hypertensive, or second hypertensive blood pressure reading, the denominator exception criteria would be satisfied.

Comment by Rana Fahad Arshad (Inactive) [ 04/02/20 ]

Appreciate your response above

I also got concern about the cases of EXCEPTION.

If we have Pre-Hypertensive BP recording, we will mark it as Hypertensive Followup Interventions Not Ordered Due to Patient Refusal.

If we have First-Hypertensive BP recording, we will mark it as Hypertensive Followup Interventions Not Ordered Due to Patient Refusal.

If we have Second-Hypertensive BP recording, we will mark it as Hypertensive Followup Interventions Not Ordered Due to Patient Refusal OR 

Antihypertensive Medication Not Ordered Due to Patient Refusal; OR

Lab Test for Hypertension Not Ordered Due to Patient Refusal; OR

Diagnostic Study Not Ordered Due to Patient Refusal

Is this how Exception cases work or we can mark Anti-hypertensive Medication/ Lab Test/ Diagnostic Study Not Ordered even in case of Pre-Hypertensive and/or First-Hypertensive BP recording?

Looking forward to a timely response, Thanks!

Comment by Mathematica EC eCQM Team (Inactive) [ 04/01/20 ]

We continue to investigate the issue noted in your ticket and will provide a response as soon as we are able. Thank you for your patience.

Comment by Mathematica EC eCQM Team (Inactive) [ 03/25/20 ]

Thank you for submitting your question. We will review your ticket and provide a response as soon as possible.

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