Medicare Shared Savings Program Accountable Care Organization (ACO) Measures Deep Dive Series

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Garey Cook
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1 Medicare Shared Savings Program Accountable Care Organization (ACO) Measures Deep Dive Series At-Risk Population (HTN-2): Measure 28 Hypertension (HTN): Controlling High Blood Pressure ACO_QRM28PPTv9_0518_IA Approved

2 Measure 28: HTN: Controlling High Blood Pressure Objectives: Understand the acceptable documentation required to successfully satisfy the Hypertension measure Understand the following: Blood pressure parameters Dates and age parameters Acceptable exclusions 2

3 Measure 28: HTN: Controlling High Blood Pressure Measure Description: Percentage of beneficiaries age years old as of January 1, 2018, who had a diagnosis of essential (primary) Hypertension (HTN) documented on or before June 30, 2018 and whose blood pressure (BP) was adequately controlled (<140/90mmHg) during the measurement year. Note: In order to meet the measure, the blood pressure must be adequately controlled during the measurement year. Controlled is defined as: Systolic <140mmHg AND Diastolic <90mmHg. Only BP readings performed by a clinician in the provider office are acceptable for numerator compliance with this measure. 3

4 Measure 28: HTN: Measure Qualification Determine if the patient is qualified for the measure. The measure qualification answer is Yes or Not Confirmed - Diagnosis unless prior approval is received to select: No Other CMS Approved Reason This answer is only acceptable with approval from the Centers for Medicare & Medicaid Services (CMS) 4

5 Measure 28: HTN: Measure Qualification If the measure qualification answer is Yes, does the patient meet one of the following six accepted exclusions End stage renal disease (ESRD) Undergoing Dialysis History of Renal transplant Chronic kidney disease (CKD) stage 5 Pregnant during 2018 Patients age 65 and older in Institutional Special Needs Plans (SNP) or residing in long-term care with a POS (Place of Service) code 32, 33, 34, 54 or 56 any time during the measurement period Note: All SNF patients are NOT excluded from these measures they must be nursing home / custodial care residents or in a residential treatment facility. 5 Acceptable long-term care facilities are: nursing facilities, custodial care facilities, hospice, intermediate care facilities for individuals with intellectual disabilities or psychiatric residential treatment centers.

6 Measure 28: HTN: Controlling High Blood Pressure 1. Does the patient have a diagnosis of essential Hypertension on or before 06/30/2018 or any time prior to the measurement period and the diagnosis remains active as of 01/01/2018? Yes Documentation of essential HTN diagnosis on or before June 30, 2018 and HTN diagnosis is active in 2018 Not Confirmed - Diagnosis No documentation of confirmed essential HTN diagnosis on or before June 30, Is patient s BP recorded in 2018? 6 Yes Documentation of the most recent BP reading in 2018 which included the exact date (MM/DD/YYYY) of the systolic reading and diastolic reading No No documentation/incomplete documentation of BP reading in 2018

7 Measure 28: Quick Tips 7 The following exclusions cannot end before the start of the measurement period: ESRD, Pregnancy, CKD stage 5 The following exclusions can start before or during the measurement period: Patients undergoing dialysis, history of renal transplant BP from an emergent or emergency or surgical setting cannot be used. BP cannot be self-reported, including readings directly from monitoring devices. The most recent 2018 blood pressure reading taken in the provider s office is to be used. 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 the same day, use the lowest systolic and the lowest diastolic reading as the most recent blood pressure reading. This measure applies to patients with essential or primary HTN only. Secondary HTN is not included in this measure. For example, if the HTN is caused by hypothyroidism, this measure would not apply.

8 Measure 28: Skip Vs Performance Met Beneficiary Skip Not Qualified = Hospice, Death, Moved Out of Country, Medicare Not Primary Measure Skip Not Confirmed Diagnosis Denominator Exclusions End stage renal disease (ESRD) Undergoing Dialysis History of Renal transplant Chronic kidney disease (CKD) stage 5 Pregnant during Patients age 65 and older residing in long-term care facilities at any time during Acceptable long-term care facilities are: nursing facilities, custodial care facilities, hospice, intermediate care facilities for individuals with intellectual disabilities or psychiatric residential treatment centers.

9 Measure 28: Skip Vs Performance Met Performance Met Adequately controlled blood pressure at most recent visit (systolic blood pressure < 140 mmhg and diastolic blood pressure < 90 mmhg) Performance Not Met Blood pressure readings from patient s home or any readings not completed in provider office Blood pressure above recommended controlled blood pressure <140/90 Blood pressure not recorded in measurement period 9

10 Measure 28: Numerator & Denominator Inclusion in the Denominator: Beneficiary is qualified for the sample Medical record is available Age, diagnosis and timeframe qualifications met for the measure (see pages 3 and 5) Beneficiary is qualified for the measure (see page 4) Inclusion in the Numerator: Beneficiary with BP at the most recent visit is adequately controlled (systolic blood pressure < 140 mmhg and diastolic blood pressure < 90 mmhg) during the measurement period 10

11 Disclaimer: This presentation was current at the time it was published. The CMS Programs are subject to policy changes. Links to the resource documents have been provided in the following page(s) within this document for your reference. Review the link(s) for specific statutes, regulations, and other interpretive materials for a full and accurate statement of their contents. 11

12 Resources: CMS Quality Payment Program website: Payment-Program.html Educational Resources: Quality Payment Resource Library: Library/2018-Resources.html Quality Measure Specification Supporting Documents (with codes): Library/2018-Web-Interface-Measures-and-supporting-documents.zip 12

Medicare Shared Savings Program Accountable Care Organization (ACO) Measures Deep Dive Series

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