Controlling High Blood Pressure

Updated Rationale

ACP does not support “NQF#0018/MIPS Quality#236 - Controlling High Blood Pressure" for application at the proposed levels of attribution: Individual Clinician, Group/Practice, Health Plan, and Integrated Delivery System, because of uncertain validity. The PMC believes that this measure has high impact and there is ample evidence to demonstrate that treating patients towards an appropriate blood pressure goal results in decreased heart attacks and strokes. However, the committee has concerns with the strict BP control across the whole patient population, especially for older patients. The committee feels that the measure denominator age range should either be 18-60 years or there should be different BP targets for stratified age groups. Based on AAFP/ACP guidelines, the PMC does not believe that less than 140 is ideal for every hypertensive patient across all age groups. Moreover, the committee thinks that by assessing the most recent BP from the measurement period, the measure deviates from actual practice. Physicians managing hypertension usually rely on a series of BP readings to make a diagnosis or a treatment decision. To make the measure more meaningful, the measure developers need to consider altering that component, and allow the use of either the median or the mode BP during the measurement period. The committee also believes that the numerator should allow the inclusion of home BP readings that are reviewed and entered in the EHR by the patient’s clinical team, and that the specifications need to add some additional clarification on what digital transmission of remote BP entails. The committee feels that the measure should allow risk adjustment to include clinical, demographic, and social risks in the calculations, particularly to consider for physicians treating a higher proportion of marginalized patient populations.