1. Azara Proprietary & Confidential Controlling High Blood Pressure 2014 Measure Changes Improving Patient Outcomes through Data

2. Azara Proprietary & Confidential 2 2 0018 Controlling High Blood Pressure Measure Update Measure Title & Steward # Measure Description Measure Comparison MU 2011 vs MU 2014 What did the old measure include What changes are applied to the new measure What are current considerations due to measure update Azara CQM’s

3. Azara Proprietary & Confidential 3 3 0018 Controlling High Blood Pressure LOINC New LOINC BMI % codes added e.g., LOINC values were not available in the 2011 version LOINC New LOINC BMI % codes added e.g., LOINC values were not available in the 2011 version SNOMED codes related to ESRD, HTN, and Pregnancy were removed from the population of encounter types for the denominator. Systolic BP was removed from the numerator population 12929001, 163030003, 251070002, 251071003 SNOMED codes related to ESRD, HTN, and Pregnancy were removed from the population of encounter types for the denominator. Systolic BP was removed from the numerator population 12929001, 163030003, 251070002, 251071003 ICD 9 and 10 Codes Diagnosis Routine general medicine visits types under the V codes e.g., V70.8 were removed as well as ESRD, HTN and Pregnancy codes as an indicator for patients to be included in the denominator. Alternative more current codes for CKD, ESRD and Pregnancy were added ICD 9 and 10 Codes Diagnosis Routine general medicine visits types under the V codes e.g., V70.8 were removed as well as ESRD, HTN and Pregnancy codes as an indicator for patients to be included in the denominator. Alternative more current codes for CKD, ESRD and Pregnancy were added Specific encounter types were removed., e.g., 99217, 99218, 99219, 99220 where the encounter is from a hospital observation. This should have no impact on practices external from an hospital system. The addition of home health services codes will expand the potential denominator for the measure period especially if the practice performs extensive home health encounters. These patients are not excluded from the reporting Specific encounter types were removed., e.g., 99217, 99218, 99219, 99220 where the encounter is from a hospital observation. This should have no impact on practices external from an hospital system. The addition of home health services codes will expand the potential denominator for the measure period especially if the practice performs extensive home health encounters. These patients are not excluded from the reporting Population Criteria Additional specificity in exclusion population for patients that had a Dx of ESRD or CKD stage 5 or had a Vascular access procedure, Kidney transplants or Dialysis treatment. The impact on primary care practices should be limited unless their patients had these services rendered before or during the measure period. The denominator will decrease based on the prevalence of their population needing these specialty services. Population Criteria Additional specificity in exclusion population for patients that had a Dx of ESRD or CKD stage 5 or had a Vascular access procedure, Kidney transplants or Dialysis treatment. The impact on primary care practices should be limited unless their patients had these services rendered before or during the measure period. The denominator will decrease based on the prevalence of their population needing these specialty services. MU 2014 Measure Update Change Summary What’s New with MU 2014 Measure Controlling High Blood Pressure CPT Codes & HCPCS SNOMED

4. Azara Proprietary & Confidential 4 4 0018 Controlling High Blood Pressure Controlling High Blood Pressure (MU 2014) Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90mmHg) during the measurement period Controlling High Blood Pressure 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. Numerator Patients 18-85 years of age who had a diagnosis of essential hypertension within the first six months of the measurement period or any time prior to the measurement period Denominator

5. Azara Proprietary & Confidential 5 5 0018 Controlling High Blood Pressure Explanation and Impact of Changes Population Criteria Additional specificity in exclusion population for patients that had a Dx of ESRD or CKD stage 5 or had a Vascular access procedure, Kidney transplants or Dialysis treatment. The impact on primary care practices, should be limited unless their patients had these services rendered before or during the measure period. The denominator will decrease based on the prevalence of their population needing these specialty services. Added Exclusions to the initial population Occurrence A of Diagnosis, Active: Chronic Kidney Disease, Stage 5" OR: "Procedure, Performed: Vascular Access for Dialysis" OR: "Encounter, Performed: ESRD Monthly Outpatient Services" OR: "Procedure, Performed: Kidney Transplant" OR: "Procedure, Performed: Dialysis Services" OR: "Intervention, Performed: Other Services Related to Dialysis" OR: "Intervention, Performed: Dialysis Education“ starts before or during “Measurement Period” Controlling High Blood Pressure (Measure) Population Criteria

6. Azara Proprietary & Confidential 6 6 0018 Controlling High Blood Pressure Explanation and Impact of Changes (CPT Codes) CPT Codes Removed : -Outpatient Encounter (hospital observation)  Specific encounter types were removed., e.g., 99217, 99218, 99219, 99220 where the encounter is from a hospital observation. This should have no impact on practices external from a hospital system.  The addition of home health services codes will expand the potential denominator for the measure period especially if the practice performs extensive home health encounters. These patients are not excluded from the reporting  See Excel file for detail on ALL coding changes. CPT Codes Added: -Home Health Services CPT Code Changes

7. Azara Proprietary & Confidential 7 7 0018 Controlling High Blood Pressure Explanation and Impact of Changes Health Care Common Procedure Codes (HCPCS) HCPCS Codes Added: -Annual Wellness Visit - G0438 G0439 HCPCS Code Changes  Using the G code to identify the status of a patient’s encounter e.g., G0438 and G0439 will render the patient to be included in the denominator  See Excel file for detail on all coding changes.

8. Azara Proprietary & Confidential 8 8 0018 Controlling High Blood Pressure Explanation and Impact of Changes ICD 10/ ICD 9 Codes ICD-10-CM Removed -End Stage Renal Disease -Pregnancy ICD-9-CM Removed -Outpatient Encounter -End Stage Renal Disease -Hypertension -Pregnancy ICD-10-CM Added -End Stage Renal Disease -Pregnancy ICD-9-CM Added -Chronic Kidney Disease, Stage 6 ICD 9/ICD 10 Code Changes  Routine general medicine visits types under the V codes e.g., V70.8 were removed as well as ESRD, HTN and Pregnancy codes as an indicator for patients to be included in the denominator.  Alternative more current codes for CKD, ESRD and Pregnancy were added  See Excel file for detail on all coding changes.

9. Azara Proprietary & Confidential 9 9 0018 Controlling High Blood Pressure Explanation and Impact of Changes SNOMED- CT Codes Removed -End Stage Renal Disease e.g., 194780003 and 194781004 -Hypertension-e.g., 11511004 -Pregnancy e.g., 101047019 -Systolic Blood Pressure Systematized Nomenclature of Medicine Codes (SNOMED-CT) SNOMED-CT Codes Added -Chronic Kidney Disease, Stage 7 -Dialysis Education -Dialysis Services -Vascular Access for Dialysis -Other Services Related to Dialysis SNOMED codes related to ESRD, HTN, and Pregnancy were removed from the population of encounter types for the denominator. Systolic BP was removed from the numerator population 12929001, 163030003, 251070002, 251071003 See Excel file for detail on all coding changes. SNOMED-CT Code Changes ⁻End Stage Renal Disease ⁻Essential Hypertension ⁻Face-to-Face Interaction ⁻Kidney Transplant ⁻Pregnancy

10. Azara Proprietary & Confidential 10 0018 Controlling High Blood Pressure Explanation and Impact of Changes LOINC CODES New LOINC BMI % codes added e.g., LOINC values were not available in the 2011 version. See Excel file for detail on all coding changes. LOINC Code Changes LOINC Codes Added -Systolic Blood Pressure 8480-6 -Diastolic Blood Pressure Diastolic 8462-4