Please note: HEDIS excludes Medicare members age 66 and older as of December 31 of the measurement year who are:
- Diagnosed with frailty and advanced illness during the measurement year.
- Enrolled in an Institutional SNP (I-SNP) any time during the measurement year.
- Living long-term in an institution (LTI) any time during the measurement year. Organizations may use the LTI flag in the Medicare Part C monthly membership file.
The following table summarizes the 2019 HEDIS specifications:
- HEDIS uses the latest BP reading recorded (in the measurement year) after a diagnosis of hypertension. Obtain and document multiple readings during visit if initial reading is elevated.
- Be sure to document the number as recorded; the blood pressure should not be rounded. For example: do not enter 140/90 if you hear 138/88.
- Be sure to use correct diagnosis codes. Notations of “rule out HTN,” “consistent w/HTN,” “possible HTN” are not adequate confirmation of a hypertension diagnosis.
- Have sphygmomanometers checked and calibrated annually.
- Consider referral to a registered dietician for patients who require nutritional guidance
- Consider refresher training to help standardize BP measurement techniques among your staff. See below for more information.
Measuring Blood Pressure: Technique matters
The American Heart Association provides guidelines for blood pressure measurement that include the following instructions about proper technique:
- Patient should be seated comfortably, with back supported and legs uncrossed.
- If possible, measure blood pressure after patient has been sitting for five minutes.
- The cuff should be applied to bare skin, not over clothing.
- Patient’s arm should be supported at heart level.
- The cuff bladder should encircle ≥ 80% of the patient’s arm circumference.
- Mercury column should be deflated at 2 to 3 mm per second.
- Neither the patient nor the person taking the measurement should talk during the procedure.
BCBSRI adopts the recommendations of the Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC 7), published and developed by the National High Blood Pressure Education Program (NHBPEP) in coordination with the National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health (NIH). The full guideline is available on the National Heart, Lung, and Blood Institute (NHLBI) website. You can also view the BCBSRI clinical practice guideline for High Blood Pressure on our secure provider portal.