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View Public Comments for Ambulatory Blood Pressure Monitoring (ABPM) (CAG-00067R2)

Champion, Roy

Sir or Ma'am, might I suggest that CMS issue a policy statement that supports the reimbursement for both ABPM and HBPM for the diagnosis and treatment of hypertension. I say this for a few reasons:

  • First, the AHA, ACC, AMA, and the USPSTF to name but a few all have formal guidelines supporting this as a standard of care.
  • Second, as a nurse with approximately 30 years combined experience in both the military and civilian sectors, I can assure you that ABPM & HBPM are well established standards of care that have a long track record of leading to high-value cost-effective care.
  • Third, I recently facilitated a HTN improvement initiative whereas 2550 patients with previously persistent uncontrolled HTN were given a home BP monitor and encouraged to use it. By the 3rd office visit well over half had their HTN under control. So much so, providers were actually able to decrease the total number of meds and yet maintain control. At the 1 yr mark, 79% achieved and maintained HTN control. The retrospective review showed an actual cost savings Rx of $7 PMPM net and a medical care cost savings of $200 PMPM.

Putting this into perspective, Hypertension and Diabetes are both obesogenetic disorders. Similar causes: lifestyle, genetics, etc. but different presenting s/s: elevated blood pressure vs elevated blood sugars. Now think about this, what are the side effects of insulin? How many drugs does insulin interact with? And yet, we would never dare prescribe insulin to a patient without checking their home glucose readings. In fact, often times, patients are given a sliding scale based on their home glucose readings. Now, what are the side effects of an RAS antagonist? How many drugs do they interact with? What about beta-blockers, calcium channel blockers, etc? Yet, we have no problems as an industry prescribing these without the same caution we place on insulin?

Fact, ABPM and HBPM provide actionable bio-feedback for both the provider and patient regarding their HTN control rates on the average date. It results in high-value health care and has repeated been shown to be cost effective in as little as 3 months.