- CMS Tuesday proposed covering Ambulatory Blood Pressure Monitoring (ABPM) for Medicare patients with suspected masked hypertension, in which blood pressure in a clinical setting may be lower than outside a doctor's office.
- Currently, the agency's national coverage determination only reimburses the diagnostic test for suspected white coat hypertension, when a clinical setting causes an increase in blood pressure.
- The proposed decision would cover ABPM once per year for eligible patients. It would leave additional indication decisions to the discretion of Medicare Administrative Contractors.
The proposed changes come nearly a year after the American Heart Association and American Medical Association formally requested CMS consider expanding coverage to align with 2016 recommendations from the U.S. Preventive Services Task Force.
ABPM allows physicians to monitor a patient's blood pressure over time, for at least a 24 hour period.
The medical groups argue appropriate diagnosis for hypertension is critical given the cost of managing cardiovascular disease.
"High blood pressure accounts for the second largest expenditure among CVD; in 2016, the United States spent $68 billion for high blood pressure and will spend an estimated $154 billion in 2035," AHA and AMA wrote in their formal request to CMS. "A more accurate diagnosis of hypertension can prevent hospitalizations, overtreatment, and other costly CVD-related outcomes, both direct and indirect, ultimately saving important resources for Medicare."
CMS said the new proposed decision memo comes in response to the stakeholder request. Administrator Seema Verma argued the proposal is "supported by many years of evidence" and would help ensure proper treatment for Medicare patients.
"With the prevalence of chronic diseases – including high blood pressure – increasing among Medicare beneficiaries, it is critical that our agency closely monitor the evidence for interventions that could improve health outcomes for patients with these conditions," Verma said in a statement.
AHA and AMA pointed to a review by the U.S. Preventive Services Task Force indicating office-based blood pressure monitoring "has an inconsistent predictive value and warrants confirmation through ABPM." The request letter notes on a population level, reclassifying based on ABPM results may have little effect on the percentage of people identified as having hypertension or blood pressure within a normal range.
"Nevertheless, from the individual perspective, ABPM can reduce misclassification to facilitate treatment tailored to an individual patient's accurate blood pressure patterns and thus can reduce overtreatment and the associated risks," AHA and AMA wrote.
CMS' coverage of ABPM for white coat hypertension dates back to 2001. CMS is asking for feedback on the proposed expansion of coverage within 30 days, and says it will issue a final decision within 60 days of the close of the comment period.