Deemed the “silent killer,” high blood pressure, or hypertension, increases the risk of stroke and heart disease, which are the leading causes of death in the US. Nearly half of adults in the US have high blood pressure or are taking medication to manage high blood pressure. Only about one in four adults with high blood pressure have their blood pressure under control.
Prevention and early detection are important. The US Preventive Services Task Force (USPSTF) provides the Grade A recommendations for hypertension screening in adults:
“The USPSTF recommends screening for hypertension in adults 18 years or older with office blood pressure measurement (OBPM). The USPSTF recommends obtaining blood pressure measurements outside of the clinical setting for diagnostic confirmation before starting treatment.”
Controlling high blood pressure is a vital step in preventing heart attacks, stroke, and kidney disease, and reducing the risk of developing other serious, life-threatening conditions. While there is no cure, providers can aid patients in managing their high blood pressure by encouraging a healthier lifestyle and, if necessary, prescribing medications.
While heart disease is still the number one killer in the US, death rates have decreased significantly due to earlier and better treatment of high blood pressure. The Centers for Medicare & Medicaid Services (CMS) has included Controlling High Blood Pressure, CMS165v9, as a quality measure for Medicare Savings Program (MSSP) and Medicare Advantage, defined as:
Percentage of patients 18 – 85 years of age who had a diagnosis of hypertension overlapping the measurement period and whose most recent blood pressure was adequately controlled (< 140/90 mm Hg) during the measurement period.
This patient-based measure is to be submitted once per performance period, which is 12 months, for patients with hypertension seen during the performance period. When reporting data through the CMS Web Interface for MSSP, medical record documentation is necessary to support the information submitted. To ensure accurate and complete reporting, follow the below best practices:
- Reporting requirements do not always match clinical guidelines. For reporting purposes, the most recent blood pressure reading during the measurement year must have a systolic BP < 140 mm Hg and a diastolic BP of < 90 mm Hg to be measure compliant.
- Blood pressure readings must be performed by clinician or remote monitoring device
- Do not include BP readings:
a. Taken during an acute inpatient stay or ED visit
b. Taken on same day as diagnostic test or procedure that requires a change in diet or medication
c. Reported or taken by the patient
- If no blood pressure is recorded during the measurement period, the patient’s blood pressure is assumed “not controlled”
- If there are multiple blood pressure readings on same day, use the lowest systolic and the lowest diastolic reading
From a clinical management perspective, other best practices include:
• Creating a standard process for performing repeat blood pressures during the same office visit.
• Using visual aids in the office/clinic to help with reminders to recheck blood pressures.
• Scheduling follow-up office visits or nurse visits for blood pressure rechecks.
• Referring patients to a pharmacist team member for medication review.
• Referring patients in need of financial assistance to Social Worker and/or Pharmacy.
• Conducting annual competency training for accurate blood pressure measurement.
• Reviewing scanned documents in the EHR for outpatient documentation of blood pressure readings (E/M ambulatory visit codes)?
• Encourage patients to monitor BP readings at home and report elevated readings to provider between office visits