National Coverage Analysis (NCA) View Public Comments

Ambulatory Blood Pressure Monitoring (ABPM)

Public Comments

Commenter Comment Information
Sherwood, Andrew Title: Professor of Behavioral Medicine
Organization: Duke University Medical Center
Date: 05/09/2019
Comment:
As a clinical researcher with over 30 years of experience in the use of 24-hour ambulatory blood pressure monitoring (ABPM), I wish to convey my most enthusiastic support for the expansion of Medicare and Medicaid coverage for both the diagnosis and clinical management of hypertension. Overwhelming evidence shows that office BP measurements offer a very limited view of an individual’s BP profile, which is inherently labile. In contrast, it is now well established that, compared to office BP,

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Scarpelli, Brian Title: Senior Global Policy Counsel
Organization: Connected Health Initiative
Date: 05/09/2019
Comment:

The Connected Health Initiative (CHI) appreciates the opportunity to provide input on the Centers for Medicare & Medicaid Services’ (CMS) Proposed Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM) (CAG-00067R2) dated April 9, 2019.1

CHI is the leading effort by stakeholders across the connected health ecosystem to responsibly advance the use of digital health innovations in the prevention and treatment of disease, supporting an environment in which

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Fizer, Charisse Title: Hospital Executive
Organization: SCNJ American Heart Association Board
Date: 05/09/2019
Comment:

I am writing in support of the AHA/ACA Guidelines recently published regarding ambulatory blood pressure monitoring

  • Recommend that CMS revise the clinical circumstances in which ABPM is appropriate and necessary to be consistent with prior guidelines including the 2017 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, including:
Margolis, Karen Title: Executive Director of Research
Organization: HealthPartners Institute
Date: 05/09/2019
Comment:
  1. The requirement of 3 months of lifestyle intervention prior to ABPM is not germane to whether a patient has or does not have hypertension, white coat hypertension (WCH) or masked hypertension (MH) as a diagnosis. This should be removed.

  2. The requirement of out-of-office measurement BEFORE a patient is eligible for ABPM is illogical and should be removed. ABPM is considered the gold standard for diagnosing hypertension, WCH, and MH. Other methods of out-of-office

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Barbot, Oxiris Title: Commissioner
Organization: New York City Department of Health and Mental Hygiene
Date: 05/09/2019
Comment:

Dear Dr. Jensen:

The New York City (NYC) Department of Health and Mental Hygiene (Health Department) submits this comment on the Proposed Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM). As we originally commented on November 8, 2018, we support the extension of Medicare coverage for patients who would benefit from ABPM for diagnostic confirmation or management of hypertension (HTN).

The proposed language for inclusion of ABPM in the Medicare National

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Havasy, Rob Title: Acting Executive Director
Organization: Personal Connected Health Alliance
Date: 05/09/2019
Comment:

The Personal Connected Health Alliance (PCHAlliance), a non-profit membership association, appreciates the opportunity to provide comment on the CMS Proposed Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM). Our comment supplements the information we provided to support CMS’ review, analysis and update of its National Coverage Decision (NCD) on Ambulatory Blood Pressure Monitoring on November 8, 2018. We believe that updating the Medicare ABPM National Coverage Decision (NCD)

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Kendrick, Martha Title: Partner
Organization: Akin Gump Strauss Hauer & Feld LLP on behalf of Hill-Rom
Date: 05/09/2019
Comment:

Dear Ms. Syrek Jensen,

Thank you for the opportunity to respond to the policies included in the Proposed Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM) (CAG-00067R2). Hill-Rom Welch Allyn supports the Centers for Medicare and Medicaid Services’ (CMS) proposed decision to cover ambulatory blood pressure monitoring (ABPM) for the diagnosis and management of hypertension in Medicare beneficiaries under specific circumstances. Hill-Rom appreciates your

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Franklin, Stanley Title: MD
Organization: University of California, Irvine
Date: 05/09/2019
Comment:
The regulations should allow 2 separate ABPM studies for masked hypertension: The first to identify masked hypertension and the second to confirm that the treatment has been successful for adequate treatment.
Handke, Bonnie Title: Vice President, Health Economics, Policy and Payme
Organization: Medtronic, Inc.
Date: 05/09/2019
Comment:

May 9, 2019

Tamara Syrek Jensen, J.D.
Director, Coverage and Analysis Group
Centers for Medicare & Medicaid Services
7500 Security Blvd.
Baltimore, MD 21244

Dear Ms. Syrek Jensen:

On behalf of Medtronic, I am pleased to respond to the Centers for Medicare & Medicaid Services’ (CMS’s) request for public comment on the proposed National Coverage Determination (NCD) for Ambulatory Blood Pressure Monitoring (ABPM).

Medtronic is the

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Casey, Donald Title: President
Organization: American College of Medical Quality
Date: 05/09/2019
Comment:

The American College of Medical Quality is pleased to offer the following public comments to the Centers for Medicare and Medicaid Services regarding Proposed Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM) (CAG-00067R2) as follows:

1. Recommend that CMS revise the clinical circumstances in which ABPM is appropriate and necessary to be consistent with prior guidelines including the 2017 American Heart Association/American College of Cardiology Guideline for the

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Carey, Robert Title: Professor of Medicine
Organization: University of Virginia
Date: 05/09/2019
Comment:

CMS should revise the clinical circumstances in which ABPM is appropriate and necessary to be consistent with the 2017 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, including:

(1) Remove the requirement of 3 months of lifestyle interventions prior to ABPM use, as there is no empiric evidence to support first proceeding with lifestyle change before obtaining an

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Kovacs, MD, Richard Title: President
Organization: ACC
Date: 05/09/2019
Comment:

May 9, 2019

Tamara Syrek-Jensen, J.D.
Director, Coverage & Analysis Group
Centers for Medicare & Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

RE: Ambulatory Blood Pressure Monitoring (ABPM) National Coverage Determination Proposed Decision Memorandum (CAG-00067R2)

Dear Ms. Syrek-Jensen:

The American College of Cardiology (ACC) appreciates this opportunity to provide input on the proposed national coverage determination (NCD)

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Bhalla, Vivek Title: Director, Stanford Hypertension Center
Organization: Stanford University School of Medicine
Date: 05/09/2019
Comment:

Division of Nephrology
777 Welch Road, Suite DE
Stanford University School of Medicine
Stanford, CA 94304-5114
(650) 498-4809

May 8, 2019

Public Comment to CMS re: Proposed Decision Memo for Ambulatory Blood Pressure Monitoring (CAG-00067R2)

We are pleased to see that CMS has proposed a new guideline (A) for coverage of 24-hour ambulatory blood pressure monitoring (ABPM) to diagnose masked hypertension, in addition to

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Cohen, Jordana Title: Assistant Professor of Medicine and Epidemiology
Organization: University of Pennsylvania
Date: 05/08/2019
Comment:

As a nephrologist with a major clinical focus in the care of complex hypertension and research focus surrounding hypertension measurement, I share the concerns expressed by the AMA and AHA regarding the proposed CMS coverage. I strongly urge CMS to reconsider the clinical circumstances around which ABPM is covered, in order to be consistent with current guidelines. Specifically, I am not aware of any evidence that three months of lifestyle modifications are appropriate prior to screening

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Hayman, Laura Title: Chair, Advocacy Committee, & Prof of Nursing
Organization: Preventive Cardiovascular Nurses Association; UMass Boston
Date: 05/08/2019
Comment:

Consistent with AHA & AMA, PCNA, recommends that CMS revise the clinical circumstances in which ABPM is appropriate and necessary to be in line with prior guidelines including the 2017 AHA/ACC Guidelines for Prevention, Detection, Evaluation & Management of High Blood Pressure in Adults.

Specifically, consistent with AHA & AMA's recommendation, PCNA recommends removal of the 3 month requirement of lifestyle intervention prior to ABPM use because of lack of evidence supporting this

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Kulkarni, Rachana Title: MD
Organization: American Heart Association
Date: 05/08/2019
Comment:

Recommend that CMS revise the clinical circumstances in which ABPM is appropriate and necessary to be consistent with prior guidelines including the 2017 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, including:

  • Removal of the requirement of 3 months of lifestyle interventions prior to ABPM use, as there is no empiric evidence to support first proceeding with

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Oravetz, Philip Title: Chief Population Health Officer
Organization: Ochsner Health System
Date: 05/08/2019
Comment:

May 7, 2019

Tamara Syrek Jensen, J.D.
Director
Coverage and Analysis Group
Center for Clinical Standards and Quality
Centers for Medicare and Medicaid Services
Baltimore, MD 21244

Re: Proposed National Coverage Decision for Ambulatory Blood Pressure Monitoring (ABPM) (CAG-00067R2)

Dear Director Jensen:

On behalf of Ochsner Health System, I am writing to express our appreciation for the opportunity to comment on the Proposed

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Miller, Erika Title: Washington Representative
Organization: American Society of Pediatric Nephrology
Date: 05/08/2019
Comment:

To: Tamara Syrek Jensen, JD
Director, Coverage and Analysis Group
Centers for Medicare and Medicaid Services

From: American Society of Pediatric Nephrology

re: Proposed Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM) (CAG-00067R2)

The American Society of Pediatric Nephrology (ASPN) is pleased to offer comments on the proposed decision memo for ambulatory blood pressure monitoring (ABPM).

Founded in 1969, ASPN is

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Sumrell, Susan Title: Deputy Director, State Affairs
Organization: National Association of Community Health Centers
Date: 05/08/2019
Comment:

May 9, 2019

Tamara Syrek Jensen, JD
Director, Coverage and Analysis Group
Centers for Medicare and Medicaid Services

Re: Proposed National Coverage Determination for Ambulatory Blood Pressure Monitoring

Dear Ms. Syrek,

On behalf of the National Association of Community Health Centers, we are pleased to provide comments in response to CMS' Proposed Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM)

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Moses, Olivia Date: 05/07/2019
Comment:
(1) Specify nocturnal hypertension as an indication for Ambulatory Blood Pressure Management.
(2) Please require a specific blood pressure device validation protocol vs. referrals to a website for resources.
Ebinger, Joseph Organization: Cedars-Sinai Medical Center
Date: 05/07/2019
Comment:

ABPM in the diagnosis and management of hypertension is a vital tool for patients and clinicians. Indications for its use are clearly delineated by the American College of Cardiology and American Heart Association. Given this, the proposed changes should consider further alignment with the 2017 ACC/AHA guidelines on hypertension. Specifically, consideration should be given to removing the requirement for 3 months of lifestyle intervention prior to ABPM use, as evidence is lacking to support

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Robitscher, John Title: CEO
Organization: National Association of Chronic Disease Directors
Date: 05/07/2019
Comment:

May 8, 2019

Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

Re: CAG00067R2
Proposed Decision Memo for Ambulatory Blood Pressure Monitoring

Dear Sir/Madam,

On behalf of the National Association of Chronic Disease Directors (NACDD), we appreciate the opportunity to submit a comment on CMS’ proposed National Coverage Determination for Ambulatory Blood Pressure Monitoring (ABPM).

Given its

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Wilson, Amy Title: MD
Date: 05/07/2019
Comment:

I am a pediatric nephrologist, and as such provide ESRD care for some of the youngest beneficiaries of Medicare. I have multiple concerns about the current proposed policy.

1) The inclusion of only absolute BP thresholds to qualify for payment. In a young child, these values well exceed stage 1 and potentially even stage 2 hypertension thresholds, such that they would be inappropriate if applied to the pediatric population, and may well exclude from coverage our patients, even

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Konig, Madeleine Organization: American Heart Association
Date: 05/07/2019
Comment:

May 9, 2019

Tamara Syrek Jensen, J.D.
Director, Coverage and Analysis Group
Centers for Medicare and Medicaid Services
7500 Security Boulevard
Baltimore, MD 21244

Re: CAG-00067R2 Proposed National Coverage Determination for Ambulatory Blood Pressure Monitoring

Dear Ms. Syrek Jensen:

On behalf of the American Heart Association and the American Medical Association, we would like to thank the Centers for Medicare and Medicaid Services

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White, Philip Organization: Preventric Diagnostics
Date: 05/07/2019
Comment:

If you can’t measure it, you can’t understand it. If you can’t understand it, you can’t control it. If you can’t control it, you can’t improve it. Having an understanding of vascular health is vital for long-term health and provides critical information that can help physicians and payors identify problems before they become dangerous and life-threatening.

Expanding ABPM Improves Quality & Value-Based Outcomes

Identify hypertension -
Helps identify & stratify those

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Banegas, José Title: MD
Organization: Universidad Autónoma de Madrid, Spain
Date: 05/07/2019
Comment:

We are very glad to learn that the CMS has proposed expanding the coverage of ambulatory blood pressure monitoring (ABPM) from the previous policy of identifying white-coat hypertension (WCH) only to also identifying masked hypertension (MH). We thank the authors for basing their support for such proposal on the evidence provided by some of our studies (Spanish ABPM registry and ENRICA cohorts), among other published literature. We hereby comment on some specific aspects of the proposal to

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BAMAN, SARANG Title: MEDICAL DIRECTOR POPULATION HEALTH & RISK
Organization: ADVOCATE AURORA HEALTH
Date: 05/07/2019
Comment:

Hello,

I have the following comments regarding the proposed decision:

  • Recommend that CMS revise the clinical circumstances in which ABPM is appropriate and necessary to be consistent with prior guidelines including the 2017 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, including:
    • Removal of the requirement of 3 months of lifestyle

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Randolph, Richard Organization: R4Capital
Date: 05/07/2019
Comment:

Thank for considering our comments on this important policy change for ABPM.

In reading through the considerations it is clear that are a number of deviations from clear recommendation from experts and groups. ABPM is appropriate and necessary, and should be consistent with prior guidelines including the 2017 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults.

To

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Hartlaub, Paul Title: MD, MSPH
Organization: Ascension Medical Groupo
Date: 05/07/2019
Comment:
I agree with reimbursement, and would suggest adding the indication of hypertension or elevated blood pressure, related to recommendation to use out of office blood pressures to confirm diagnosis by USPSTF.
Rankin, Charlotte Title: Chief operating officer
Date: 05/06/2019
Comment:

To Whom it May Concern,

As a tenured nurse and current CNO/COO of a hospital in Northwest Arkansas, I would like to recommend that CMS revise the clinical circumstances in which ABPM is appropriate and necessary to be consistent with prior guidelines including the 2017 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, including:

  • Removal of the requirement of

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Williams, Yameeka Title: Board Member
Organization: American Heart Association - San Diego Division
Date: 05/05/2019
Comment:

We recommend that CMS revise the clinical circumstances in which ABPM is appropriate and necessary to be consistent with prior guidelines including the 2017 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, including:

  • Removal of the requirement of 3 months of lifestyle interventions prior to ABPM use, as there is no empiric evidence to support first proceeding with

    More

Wong, Nathan Title: Professor and Director, Heart Disease Prev Prog
Organization: UC Irvine
Date: 05/03/2019
Comment:
I think this is a very important proposal and I support it!
Dodge, Ann Organization: American Heart Association
Date: 05/03/2019
Comment:

Recommend that CMS revise the clinical circumstances in which ABPM is appropriate and necessary to be consistent with prior guidelines including the 2017 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, including: ?Removal of the requirement of 3 months of lifestyle interventions prior to ABPM use, as there is no empiric evidence to support first proceeding with lifestyle change

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Sanborn, Timothy Title: MD, MS
Organization: Medical College of Wisconsin
Date: 05/03/2019
Comment:

I recommend that CMS revise the clinical circumstances in which ABPM is appropriate and necessary to be consistent with prior guidelines including the 2017 American Heart Association/American College of Cardiology Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults, including:

Removal of the requirement of 3 months of lifestyle interventions prior to ABPM use, as there is no empiric evidence to support first proceeding with lifestyle

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Yarows, Steven Title: MD
Organization: IHA
Date: 05/03/2019
Comment:

I am a Internal Medicine physician and Hypertension Specialist I have been performing ABPM since the 1980's and found the procedure clinically incredibly useful I applaud the expansion of this underused device

As a practicing PCP, I find the proposed requirement of 3 months of lifestyle modification ridiculous Firstly, most practices are not capable of instruction nor monitoring/documentation. Secondly, waiting for 3 months practically just means that most of these patients

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Green, MD, MPH, Beverly B Title: SENIOR INVESTIGATOR and FAMILY PHYSICIAN
Organization: Kaiser Permanente Washington Health Research Institute and Kaiser Permanente Washington
Date: 05/03/2019
Comment:

re: CMS Proposed Decision Memo for Ambulatory Blood Pressure Monitoring (ABPM) (CAG-00067R2)

To whom it concerns
I am submitting public comment on behalf of myself, Beverly B Green MD, MPH as a physician and senior investigator whose area of research includes blood pressure (BP) measurement.
I am in agreement with the American Heart Association and American Medical Association recommendations that are being submitted with some modifications.

My modifications are

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Navar, Ann Marie Title: Assistant Professor of Cardiology
Organization: Duke University
Date: 05/02/2019
Comment:

I am pleased to see increased focus on ABPM and increasing coverage, as this is an important tool for clinicians treating hypertension.

I recommend that the guidelines follow the 2017 ACC/AHA hypertension guideline. Clinicians should not be discouraged from using ABPMs by requiring 3 months of "lifestyle intervention" first. All clinicians should be discussing lifestyle interventions regardless of ABPM decisions. Including this rewuirement will likely decrease utilization without

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Kronish, Ian Title: Associate Professor of Medicine
Organization: Columbia University Irving Medical Center
Date: 05/02/2019
Comment:

I would advocate for several changes to CMS proposed changes for Medicare coverage for ABPM:

  1. For masked hypertension, ABPM testing should be available for office BP 120-139/80-89.
    Rationale: While the current guidelines are based on cutpoints recommended by the 2017 AHA/ACC BP guidelines, the 2 leading primary care societies (AAFP, ACP) did not accept these cutpoints, and generally still follow JNC 7 but using a cutpoint of 140/90.

  2. Removal of the

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Radhakrishnan, Jai Title: Professor of Medicine
Organization: Columbia University
Date: 05/02/2019
Comment:
There is clear evidence that ABPM improves the diagnosis and managment of patients with hypertension.
This technique is a valuable adjunct in the clinic and I strongly support the proposal
Shimbo, Daichi Title: Physician
Date: 05/02/2019
Comment:

I think this is an important step to the successful implementation of ambulatory blood pressure monitoring (ABPM), an evidence-based method for assessing out-of-office blood pressure (BP). Given that several US (2017 AHA/ACC guideline and USPSTF) and international guidelines endorses ABPM for the diagnosis and management of high BP, it is imperative that the CMS revise the circumstances for which ABPM is appropriate and necessary.

I have read the decision summary and I have several

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barnhart-hinkle, blair Title: Director, Government Relations
Organization: Cleveland Clinic
Date: 05/01/2019
Comment:

Cleveland Clinic is a not-for-profit, integrated healthcare system dedicated to patient-centered care, teaching and research. Our health system is comprised of a main campus, 13 community hospitals, 19 family health centers and 3 wellness centers with over 3,600 salaried physicians and scientists. Last year, our system had over seven million patient visits and more than 229,000 hospital admissions

The following are the comments of Cleveland Clinic in response to the request for

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Reidy, Kimberly Title: MD
Organization: Albert Einstein College of Medicine, Children's Hospital at Mont
Date: 04/24/2019
Comment:

ABPM should be covered for all ABPMs (both for diagnosis and management) on pediatric patients as it has been shown to be superior to clinic blood pressure for diagnosis and management in this population. In particular, masked HTN is prevalent in many populations including children with CKD, ESRD, solid organ transplant, cancer, and sickle cell disease. (see studies cited below)

1: Shah S, Swartz S, Campbell J, Srivaths PR. Ambulatory blood pressures and central blood pressures

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Williams, Stephen Title: MD
Organization: New York University Langone Health
Date: 04/23/2019
Comment:
While coverage is provided for white coat hypertension, there needs to be clarity on coverage for White Coat Effect. These are 2 separate entities. White coat hypertension refers to individuals that are not on any antihypertensive medications, but may be found to be normotensive at home. White coat effective refers to patients that are on antihypertensives and may have high BP at the office, yet normal at home. These are a cohort that are at higher cardiovascular risk than white coat

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Dispenza, Thomas Title: Pediatric Cardiology Attending Physician
Organization: Hershey Medical Center
Date: 04/22/2019
Comment:

White coat hypertension is not an either/or diagnosis with true hypertension. In my experience, many patients have both. For patients with both problems, several ambulatory blood pressure monitor cycles in close, but not immediate, succession are needed to optimize antihypertensive management as a drug and dose is started. The response to that therapy needs to be gauged for further drug and dose adjustments to be made appropriately. With the new policy, ambulatory blood-pressure monitoring

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Bignall, Ray Title: Assistant Professor of Pediatrics
Organization: Nationwide Children's Hospital & The Ohio State University
Date: 04/22/2019
Comment:
As a pediatric nephrologist on the front-lines of the childhood obesity epidemic, the prompt diagnosis and treatment of hypertension is essential to preventing progressive cardiovascular disease in the future. I applaud the expanded indications for ABPM, and echo the comments of many of my pediatric colleagues who note the distinction regarding properly accounting for pediatric hypertension cut-offs that vary from adults; and I encourage CMS to suspend the requirement for a 3-month waiting

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Joseph, Andrea Title: Registered Nurse
Date: 04/21/2019
Comment:

I do agree with this non-invasive diagnostic proposal for tracking of the blood pressure of patients who have been identified as hypertensive. However, I would suggest that the monitoring of blood pressure should include guidelines for the patient to follow. The instructions must be clear and simple enough that patients with various literacy level can understand. The design and complexity of the blood pressure apparatus must be also considered. Measurement of the blood pressure is a

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Fogg, Marisa Title: RN
Date: 04/20/2019
Comment:
As a home health nurse I have found that many of my patients have undiagnosed hypertension. Many times they do not have access to a blood pressure monitoring device due to limited finances. I think by expanding the Ambulatory blood pressure monitoring requirements you will be helping so many people who would otherwise not be diagnosed or treated for hypertension. This action would be beneficial in preventing further complications ie; stroke and unnecessary hospital admissions.
Kimbrough, Tomeka Title: President
Organization: Just Think Ahead Insurance Organization
Date: 04/18/2019
Comment:
[PHI Redacted] and clients really needs their pressure analyze over longer periods of time when medications are not working. Plus with the new format in healthcare were providers sponsors the decision of the patients and not cost for running a business. Hopefully soon everyone will see what Healthcare Reform really means. Thanks
Urbina, Elaine Title: Director, Preventive Cardiology
Organization: Cincinnati Children's Hospital
Date: 04/18/2019
Comment:
For children <13 years where normal values for BP are determined by percentiles, not the cut-points (which are used for youth >= 13 years), I suggest that coverage to rule out white coat HTN be covered for children with BP%>=95th% to < 99th%+12 mmHg (definitions of stage I and II HTN in children). Similarly, for masked HTN, coverage should be for children with BP% between 90th and 95th%.
Roberts, Alice Date: 04/18/2019
Comment:
I fully support expanding coverage for 24-hour BP monitoring. That only white coat syndrome was an indication is crazy. Many patient go undiagnosed with hypertension if their BP is elevated at the doctor's office with diagnosis of hypertension. Also patients who have the diagnosis of hypertension that is not well controlled would benefit from this test.
Kupferman, Juan Title: Director, Pediatric Nephrology and Hypertension
Organization: Maimonides Medical Center
Date: 04/17/2019
Comment:
As a physician who specializes in pediatric hypertension I strongly believe that ambulatory blood pressure monitoring is not only important but ESSENTIAL to diagnose and manage children and adolescents with elevated blood pressure and hypertension. It accurately rules out white coat and masked hypertension same as in adults. It allows confirmation of hypertension in one single visit. It also allows assessment of nocturnal hypertension.
If hypertension is ruled out, it saves the cost of

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Stein, Mike Title: Physician
Date: 04/17/2019
Comment:
Will the proposed CMS expanded coverage apply to patients with the "White Coat Effect" term as described in the 2017 AHA Hypertension guidelines? CMS included a chart detailing the use of ABPM in the work-up of such patients in their proposed expanded ABPM review, but I did not see any comment in the CMS review regarding whether patients with the "White Coat Effect" would also be covered along with the "White Coat Hypertension" suspect patients. Thank you.
Castriotta, Richard Title: Professor of Clinical Medicine
Organization: University of Southern California
Date: 04/16/2019
Comment:
I strongly support the utilization of ambulatory blood pressure monitoring (ABPM) to identify and manage true sleep hypertension as the key factor associated with adverse cardiovascular events, as demonstrated by the work of Hermida et al. in the MAPEC Study (Eur J Clin Invest 2018; e12909. doi: 10.1111/eci.12909. Epub 2018) and the Hygia Project (European Heart Journal 2018; 39: 4159-4171doi:10.1093/eurheartj/ehy475). This should result in better patient care and considerable cost savings by

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Elijovich, Fernando Title: Professor of Medicine
Organization: Vanderbilt University
Date: 04/15/2019
Comment:

USPSTF recommends obtaining BP outside of the clinical setting for CONFIRMATION OF DIAGNOSIS in every subject older than 18 who has been screened for high blood pressure. The proposed rule falls severely short of this recommendation

The major reason for USPSTF's recommendation is that office BPs are recognized as being inaccurate, and misclassify subjects in both directions (as hypertensive when actually normotensive and viceversa) in about 15-20% of cases. Furthermore, nocturnal

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Saland, Jeffrey Title: Chief, Pediatric Nephrology and Hypertension
Organization: The Mount Sinai Medical Center, New York
Date: 04/15/2019
Comment:

I am pleased the policy includes reference, though brief, to the evaluation of children with elevated blood pressure.

I would like to see that expanded as there is reasonably good evidence that ABPM reduces cost of evaluation, diagnostics, and treatment of elevated BP in children. Also good evidence that it provides information that is unique to ABPM and associated with cardiovascular disease in at risk populations (like with CKD).

It would be very useful for the guidelines

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Sarmiento, Samuel Date: 04/15/2019
Comment:
Please support this cause
Richardson, Suzanne Title: MSN, RN
Date: 04/15/2019
Comment:
Medicare beneficiaries need cost effective, easy to access means to monitor blood pressure in the ambulatory setting. In the absence of standardization of the method and practice of obtaining blood pressure readings across practice sites, it is necessary to find a "control." The most patient-centric way is to provide the patient with the tool to self-monitor. In addition to the value of readings collected in a consistent and controlled environment, patients are easily able to measure blood

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Weinstein, Adam Title: Pediatric Nephrologist
Date: 04/14/2019
Comment:

I applaud that this is being updated. I'd encourage the recognition that pediatric blood pressure cutoffs differ from adults, and that in what is covered for children under age 18 years of age, that these cutoffs be used (and not 130/80 per se).

An additional comment is that masked hypertension is quite prevalent in patients with chronic kidney disease, so this diagnosis may be a factor worth mentioning.

Flynn, Joseph Title: Professor of Pediatrics
Organization: University of Washington
Date: 04/13/2019
Comment:
The expanded indications for ambulatory BP monitoring in the draft coverage determination are appreciated. However, the requirement for a 3-month waiting period during which behavioral modification should be implemented should be dropped. The most recent AHA/ACC hypertension guidelines do not include such a waiting period, and neither does the US Preventative Services Task Force recommendation for use of ABPM. The waiting period and requirement for lifestyle change in the interim before

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Trachtman, Howard Organization: NYU Langone Health
Date: 04/12/2019
Comment:
The report on ABPM is thorough and clear. I would only recommend one additional point, namely authorizing the use of this device in pediatric patients. Although ABPM may not be as closely linked with adverse long term consequences in pediatric versus adult patients, it improves the accuracy of the diagnosis. Therefore, it helps prevent mislabeling children and adolescents as hypertensive and avoids unnecessary treatment.
Ross, Samuel Title: Project Manager
Organization: Northwestern University
Date: 04/12/2019
Comment:

To whom it may concern:

I strongly support the proposal to expand coverage of ABPM. Having worked on an AHRQ-funded national initiative on cardiovascular quality improvement (EvidenceNow), it repeatedly came to my attention that insurance companies were not covering these devices. Additionally, it was noted that low cost devices available from pharmacies were not reliable.

The inability to monitor BP between office visits became a significant barrier to identifying accurate

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Grimm, Paul Title: Medical Director of Pediatric Kidney Transplant
Organization: Stanford University
Date: 04/12/2019
Comment:
The lack of mentioning pediatrics and especially pediatric patients with chronic kidney disease or kidney transplant is a glaring error. As a pediatric kidney transplant physician, I use ambulatory blood pressure monitoring on every patient above the age of 6 to detect masked hypertension. These patients are at high risk for masked hypertension, office blood pressure measurement is very difficult because of the anxiety and behavioral issues, the long-term complications of cardiovascular

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