Review Breast Cancer Screening Public Comment (CMS #125) and Discuss Controlling High Blood Pressure Measure Updates (CMS #165) Change Review Process Meeting

Review Breast Cancer Screening Public Comment (CMS #125) and Discuss Controlling High Blood Pressure Measure

Updates (CMS #165)

Change Review Process MeetingAugust 20, 2015

Jenna Williams-BaderAnne Marie Smith

Stephanie Rodriguez

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BCS Public Comment Summary

• 2 comments – Agree with grace period and alignment with

USPSTF guideline– Clarification question about why eCQM and PQRS

specs differ (diagnostic vs. screening mammogram)

• We did not receive feedback on adding exclusion criteria– Exclude women who have had a bilateral

mastectomy or two unilateral mastectomies:• Right and left unilateral mastectomy• History of bilateral mastectomy• Unilateral mastectomy with bilateral modifier • Absence of left/right breast

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BCS Recommendations for Vote• Revise the age range from 40-69 to 50-74 years

of age

• Extend numerator timeframe from 24 months to 27 months to allow a 3-month grace period

• Do not add the ““14 days apart” timing to the current exclusion “Exclude women who have had two unilateral mastectomies”

• Add the following exclusion criteria:– Exclude women who have had a bilateral mastectomy or two

unilateral mastectomies:• Right and left unilateral mastectomy• History of bilateral mastectomy

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CBP Measure Update

• Revise measure to align with updated guidelines - 2014 Evidence-Based Guideline for the Management of High Blood Pressure in Adults– In the general population aged >= 60 years, initiate pharmacologic

treatment to lower blood pressure (BP) at systolic blood pressure (SBP) >=150 mm Hg or diastolic blood pressure (DBP) >=90 mm Hg and treat to a goal SBP <150 mm Hg and goal DBP <90 mm Hg

– In the general population <60 years, initiate pharmacologic treatment to lower BP at SBP >=140 mm and Hg DBP >=90mm Hg and treat to a goal SBP <140 mm Hg and DBP <90mm Hg

– In the population aged >=18 years with diabetes, initiate pharmacologic treatment to lower BP at SBP >=140mm Hg or DBP >=90mm Hg and treat to a goal SBP <140 mm Hg and goal DBP <90 mm Hg

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Current Numerator

Measure intent is to ensure adequate control of blood pressure for patients 18-85 years of age who are diagnosed with hypertension

Current Numerator Statement• Patients whose blood pressure at the most recent

visit is adequately controlled (systolic blood pressure < 140 mmHg and diastolic blood pressure < 90 mmHg) during the measurement period.

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Current Numerator

• Current Logico AND: Most recent:

• "Occurrence A of Encounter, Performed: Adult Outpatient Visit" satisfies all o overlaps "Occurrence A of Diagnosis, Active: Essential

Hypertension" o during "Measurement Period" o overlaps "Physical Exam, Performed: Diastolic Blood

Pressure (result)" o overlaps "Physical Exam, Performed: Systolic Blood Pressure

(result)" o AND: "Physical Exam, Performed: Diastolic Blood Pressure" satisfies

all • Most recent: during "Occurrence A of Encounter, Performed:

Adult Outpatient Visit" • (result < 90 mmHg)

o AND: "Physical Exam, Performed: Systolic Blood Pressure" satisfies all

• Most recent: during "Occurrence A of Encounter, Performed: Adult Outpatient Visit"

• (result < 140 mmHg)

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Updated Numerator

• Patients 18–85 years of age who had a diagnosis of hypertension and whose BP was adequately controlled during the measurement year based on the following criteria:– Patients 18–59 years of age whose BP was

<140/90 mm Hg– Patients 60–85 years of age without a diagnosis of

diabetes whose BP was <150/90 mm Hg– Patients 60–85 years of age with a diagnosis of

diabetes whose BP was <140/90 mm Hg

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Numerator Update• Updated Logic – Part 1

o AND: Age >= 17 year(s) at: "Measurement Period" o AND: Age < 59 year(s) at: "Measurement Period" o AND: Most recent:

• "Occurrence A of Encounter, Performed: Adult Outpatient Visit" satisfies all o overlaps "Physical Exam, Performed: Diastolic Blood








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o AND: Age >= 59 year(s) at: "Measurement Period" o AND: Age < 85 year(s) at: "Measurement Period" o AND NOT: "Diagnosis, Active: Diabetes" overlaps "Measurement

Period" o AND: Most recent:









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o AND: Age >= 59 year(s) at: "Measurement Period" o AND: Age < 85 year(s) at: "Measurement Period" o AND: "Diagnosis, Active: Diabetes" overlaps "Measurement Period" o AND: Most recent:









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Numerator Questions

• Does the updated numerator logic (in red) make sense?

• Does it capture the intent of the measure?

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Next Steps: Public Comment

• Revised changes will be posted to JIRA for a two-week public comment period

• Comments will be reviewed and presented at the next CRP meeting before a final recommendation is made

• Measures updates will be implemented during 2016 Annual Update

Documents

Review Breast Cancer Screening Public Comment (CMS #125) and Discuss Controlling High Blood Pressure Measure Updates (CMS #165) Change Review Process Meeting