Review Breast Cancer Screening Public Comment (CMS #125) and Discuss Controlling High Blood Pressure Measure Updates (CMS #165) Change Review Process Meeting August 20, 2015 Jenna Williams-Bader Anne Marie Smith Stephanie Rodriguez

2 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

3 BCS Recommendations for Vote Revise the age range from to 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

4 CBP Measure Update Revise measure to align with updated guidelines 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 =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

5 Current Numerator Measure intent is to ensure adequate control of blood pressure for patients 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.

6 Current Numerator Current Logic o 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)

7 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

8 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 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)

9 Numerator Update Updated Logic – Part 2 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: "Occurrence A of Encounter, Performed: Adult Outpatient Visit" satisfies all 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)

10 Numerator Update Updated Logic – Part 3 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: "Occurrence A of Encounter, Performed: Adult Outpatient Visit" satisfies all 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 < 150 mmHg)

11 Numerator Questions Does the updated numerator logic (in red) make sense? Does it capture the intent of the measure?

12 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