New guidelines from the American Heart Association and the American College of Cardiology mean 30 million more U.S. adults could now be classified as having high blood pressure.
The updated guidance means primary care physicians will be having more discussions with patients regarding hypertension. Furthermore, physicians who engage patients to monitor their blood pressure, make lifestyle changes and take their medications may receive a bonus for controlling long-term costs. That’s because hypertension is one of many conditions targeted under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the federal law that seeks to reform Medicare payments while improving outcomes and reducing costs.
Beginning in 2019, physicians participating in the Merit-based Incentive Payment System (MIPS), one of two participation tracks under MACRA, will be penalized for costs that exceed anticipated amounts, or rewarded for keeping costs under the projected amounts.
By engaging patients, physicians choosing to report on hypertension measures may boost their quality scores and receive a bonus under MIPS. These three quality measures can help physicians gain points:
- Controlling high blood pressure (i.e., keeping it below 130/80mmHG during the measurement period).
- Improving blood pressure (i.e., lowering blood pressure at least 10mmHG as compared with the baseline or controlling it adequately).
- Screening for high blood pressure and follow-up documented (i.e., screening patients ages 18 years and older, and documenting a follow-up plan when patients are pre-hypertensive or hypertensive).
Many physicians don’t realize that their Medicare reimbursement will directly correlate with patient outcomes, says Glenn Krauss, CCS, CCDS, a reimbursement and documentation improvement consultant in Burlington, Vermont. Physicians who plan to report on hypertension measures need to start thinking now about how to improve outcomes, he adds.
Monitor patients’ hypertension regularly
The electronic health record (EHR) is one of many tools physicians can use to engage and monitor hypertensive patients to improve their MIPS score. For example, Stasia Kahn, MD, an internist at Symphony Medical Group in Carol Stream, Illinois, uses the EHR’s patient portal to remind patients to make an appointment quarterly. As many as 35% of her patients have the disease, and 75% use the practice’s portal.
“We’re very persistent with our alerts,” she says. Patients receive three automated portal messages reminding them to schedule an appointment. If they don’t respond, a nurse calls them to schedule a day and time. Though she doesn’t have any data that directly correlates the EHR reminders with improved outcomes, she suspects that this method of continual follow-up helps keep patients mindful of their health. Patients who don’t use the portal receive phone call reminders to schedule follow-up appointments every four months.
Every patient should undergo routine blood pressure checks when they’re in the office, says Gerti Tashko, MD, a Washington, D.C.-based endocrinologist and clinical hypertension specialist certified through the American Society of Hypertension. That’s the most effective way to identify cases of hypertension, he adds. This includes cases of borderline hypertension that, with diet and exercise, can potentially improve over time. About half of Tashko’s patients have hypertension as well as diabetes or metabolic syndrome, both of which complicate treatment.