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Partnering with Patients: Self-Measured and Ambulatory Blood Pressure Monitoring

Friday, January 17, 2020   (0 Comments)
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The 2017 Hypertension Guideline calls for more emphasis on self-monitoring for high blood pressure diagnosis, treatment and management. Integration of self-measured blood pressure (SMBP) monitoring can help bridge the gap for patients who are hesitant to follow a treatment plan or who have hit a plateau. Including SMBP in your protocols may seem daunting, but clinics have access to many new resources and support to help. How are you integrating SMBP in your clinic? American Heart Association (AHA) would love to hear from you at WSA-chonicdiseasemanagement@heart.org.

Self-Measured Blood Pressure Monitoring

Out-of-office BP measurements are recommended to confirm the diagnosis of hypertension. Recent research estimates that up to 30% of patients with non-hypertensive in-office blood pressure readings have elevated blood pressures when measured outside of the office (Masked Hypertension). In addition, up to 35% of people with elevated office blood pressures may have normal blood pressures when measured outside of the office (White-Coat Hypertension). SMBP helps prevent these misclassifications and helps ensure patients are diagnosed more accurately.

In addition, out-of-office BP measurements are recommended for titration of BP-lowering medication, in conjunction with telehealth counseling or clinical interventions. Once patients are diagnosed with hypertension, SMBP can be used before subsequent office visits to easily and accurately determine if their blood pressure is controlled. While there is limited evidence that using SMBP alone in individuals with hypertension improves blood pressure control compared to usual care, there is strong evidence that using SMBP plus additional clinical support is more effective than usual care in lowering blood pressure and improving control among patients with hypertension. Furthermore, patients who engage in SMBP may be more likely to take action to improve their health in other ways.

Setting Up Your Program

Before launching a program, putting these elements in place will help you be successful:

  • Designate a healthcare provider champion to learn about the program and help colleagues succeed.
  • Determine how you will ensure all patients have access to monitors regardless of income. Consider adding a SMBP loaner device program for patients who are unable or unwilling to purchase one themselves.
  • Build in time to train staff on implementing the program in your practice.
  • Ensure adequate time is allocated in patient visits including flow for patient education and training on how to take and record their own BP.
  • Determine how you will accept patient recorded data and how you will track it in their medical record. One method that is available is American Heart Association’s Check. Change. Control. Tracker. This is an online tool that allows patients to track their blood pressure readings in their private online account. Clinicians can also register for the tool as medical professionals which would then allow their patients to connect with them directly online and share their blood pressure readings. If this option is not feasible for clinicians, they can also have their patient print their readings at home and bring them to their next visit or have the patient show the clinician their readings on their phone during the visit. In order to register for the tool you need a campaign code which can be received by emailing WSA-chonicdiseasemanagement@heart.org.


Training Patients

To support your patient training program, identify medical staff who can take responsibility for training and educating patients. Aim to identify at least 1 medical assistant as a trainer per clinician—plus a minimum of 1 floater MA/RN trainer for a practice. Conduct a training session for staff who will be educating patients. These “train the trainers” sessions should take about 1 hour.

 

For additional support, watch this short educational video that helps train care teams and patients on how to properly self-measure blood pressure.

After each “train the trainers” session, document any questions or issues raised by trainees and update your training materials to ensure all staff are fully prepared to educate patients on SMBP.

There are important steps patients need to take to accurately measure their blood pressure. It is helpful to communicate these steps face-to-face so you can demonstrate how to use the blood pressure device, how to accurately measure blood pressure (PDF) and how to use the blood pressure recording log (PDF). Use our Patient Training Reference Guide (PDF) to make sure you have covered all the important steps.

Paying for SMBP and Ambulatory BP Monitoring Policy Update

The American Medical Association (AMA) and the AHA have robust advocacy efforts and are collaborating on a shared policy platform to support blood pressure control in the clinic and community. One of the objectives of this collaboration is to increase coverage and reimbursement of clinician services and blood pressure devices.

In July 2019, CMS determined that there is sufficient evidence to cover Ambulatory Blood Pressure Monitoring for the diagnosis of hypertension:

  • For suspected white coat HTN, defined as an average office BP of systolic BP 130-159 mm Hg or diastolic BP 80-99 mm Hg on two separate clinic visits with at least two separate measurements made at each visit, and with at least two BP measurements taken outside the office which are <130/80 mm Hg.
  • For suspected masked HTN, defined as average office SBP 120-129 mm Hg or DBP 75-79 mm Hg on two separate clinic visits with at least two separate measurements made at each visit and with at least two blood pressure measurements taken outside the office which are ≥130/80 mm Hg.
  • Coverage of other indications for ABPM are at the discretion of the Medicare Administrative Contractors.

CPT codes that can be used as of January 1, 2020 to support SMBP:

  • 99473: SMBP using a device validated for clinical accuracy; patient education/training and device calibration
  • 99474: SMBP using a device validated for clinical accuracy; separate self-measurements of two readings, one minute apart, twice daily over a 30day period (minimum of 12 readings), collection of data reported by the patient and/or caregiver to the physician or other qualified health care professional, with report of average systolic and diastolic pressures and subsequent communication of a treatment plan to the patient.
    • Can be submitted monthly
    • Provider = $15.16 monthly for data review / communicating Tx plan
    • Measurement protocol includes taking 2 blood pressure readings one-minute apart in am and pm for 3-7 days
    • Data collection and reporting average systolic and diastolic blood pressure out of office readings

Professional Education

For a deeper dive into utilizing SMBP to help your patients, we have a one-hour webinar for physicians, their care teams and other participants on the appropriate use of Self-Measured Blood Pressure Monitoring (SMBP) in clinical practice. It’s a self-paced online webinar that reviews techniques and protocols that will help participants more effectively diagnose and manage patients with hypertension. It also provides 1 continuing education credit for participating.

For more information, to share your story, or to learn more contact AHA at WSA-chonicdiseasemanagement@heart.org.

 

 

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