Hypertension

How policy changes clear path for out-of-office BP monitoring

Out-of-office blood pressure measurements are recommended to confirm the diagnosis and make treatment decisions for patients with hypertension. Methods to obtain out-of-office measurements include 24-hour ambulatory blood pressure monitoring (ABPM) and self-measured blood pressure (SMBP).

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Recent policy updates by the Centers for Medicare & Medicaid Services (CMS) and the Internal Revenue Service (IRS) will make it easier for physicians to obtain out-of-office blood pressure measurements on patients and improve care for patients with suspected or diagnosed hypertension.

The AMA has developed online tools and resources created using the latest evidence-based information to support physicians to help manage their patients’ high BP. These resources are available to all physicians and health systems as part of Target: BP™, a national initiative co-led by the AMA and American Heart Association (AHA).

Here is how these policy changes from the CMS and IRS are paving the way for improved assessment and diagnosis of high blood pressure.

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Out-of-office blood pressure measurements with ABPM have a stronger correlation with cardiovascular outcomes and risk than office-based BP measurement. Twenty-four-hour ABPM can provide physicians with comprehensive information about a patient’s blood pressures throughout the day and night in order to properly classify and diagnose them.

In July, CMS made a national coverage determination expanding the indications to use ambulatory blood pressure monitoring for the diagnosis of hypertension in Medicare beneficiaries. This coverage continues to be available for beneficiaries with suspected white coat hypertension and now also includes those with suspected masked hypertension.

Certain requirements were specified by CMS for ABPM devices. According to the determination, ABPM devices must be:

  • Capable of producing standardized plots of BP measurements for 24 hours with daytime and nighttime windows and normal BP bands defined.
  • Provided to patients with oral and written instructions.
  • Have had a test run performed in the physician’s office.
  • Interpreted by the treating physician or treating non-physician practitioner.

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IRS eases access to SMBP

The Treasury Department and the IRS, in consultation with the Department of Health and Human Services, also took important steps that will help patients measure their blood pressure outside of the office.

The IRS expanded the list of preventive care benefits that high-deductible health plans paired with health savings accounts can cover before enrollees have met the deductible. These items have all been clinically proven to help keep a chronic condition from worsening.

The list includes blood pressure monitors for patients with hypertension. Having access to a home blood pressure device allows patients to use SMBP and to take an active role in their BP management. Using a validated device is an important component of accurate BP measurement and can help improve blood pressure control rates.

These two expanded coverage changes will enable physicians to more frequently obtain patient blood pressures outside the office to make better diagnosis and treatment decisions. Both ABPM and SMBP are recommended methods for out-of-office blood pressure measurements by the 2019 AHA Scientific Statement on BP Measurement in Humans and the 2017 ACC/AHA hypertension clinical practice guidelines.