Elizabeth Linderbaum, MPP, NACHC Deputy Director of Regulatory Affairs, contributed to this post.
Forty-five percent (45%) of health center patients suffer from hypertension, compared to 32% of the general population.1 The good news is that high blood pressure (BP) is the leading modifiable risk factor for coronary heart disease, stroke, and congestive heart failure, and contributing factor for chronic kidney disease and dementia.
For health centers, Self-Measured Blood Pressure (SMBP) devices are an important tool in preventing and managing hypertension. Yet, recent moves by the Centers for Medicare and Medicaid (CMS) will make it difficult for health centers to use them for patients. CMS issued a preliminary recommendation to reject SMBP devices as DME, a key step in getting them covered for reimbursement. This decision would dramatically hamper the ability of health center care teams to empower more people to self-manage their blood pressure. NACHC is urging health centers to weigh in.
SMBP devices allow health center care teams to reach more people, more equitably, more quickly, and more cost effectively – in the comfort of a patient’s home. The American Medical Association and America Heart Association agree that the SMBP device meets all five categories required to qualify for durable medical equipment (DME) benefits.
1. SMBP Devices Satisfy All Durable Medical Equipment (DME) Designation Criteria
Can withstand repeated use
SMBP devices are made to withstand repeated use.
|Criteria #2: Effective with respect to items classified as DME after January 1, 2012, has an expected life of at least 3 years.||The recommended replacement time is every 5 years, exceeding the minimum 3-year lifespan threshold.|
Is primarily and customarily used to serve a medical purpose
|CMS asserts that because “SMBP devices are generally not used by the patient to self-manage hypertension, but rather require clinical intervention to manage their medical condition…” they do not meet this standard. Yet, according to clinical guidelines, hypertension is treated with lifestyle modifications as well as medication. SMBP devices provide patients with real-time blood pressure (BP) measurement information that patients may respond to immediately, like remembering to take their medication, making dietary changes, adding exercise, and adjusting other health habits that impact BP levels. A common, true story: An uninsured Somali patient at a Washington state health center had high blood pressure (BP), diabetes, lipidemia, and transportation issues. By tracking her BP and other vitals at home with her own SMBP device, she took steps to drop 10 pounds and decreased her blood pressure within five months.|
|Criterion #4: Generally, is not useful to an individual in the absence of an illness or injury.||SMBP devices are indicated for individuals with suspected or diagnosed hypertension for diagnosis or blood pressure management purposes.|
Is appropriate for use in the home.
|The SMBP device is appropriate for use at home. Another name for an SMBP device is “home blood pressure monitor.”|
2. SMBP Devices Help Patients Self-Manage Their Health
A person with the #1 killer in the U.S., hypertension – also known as the “silent killer” – can respond to elevated BP levels immediately with lifestyle changes. The SMBP device offers immediate feedback, so people can take immediate action (see our response to Criteria #3) rather than having to wait for an appointment with a provider between BP readings.
SMBP is considered the gold standard for BP management. The pattern of readings—7 days of monitoring over 3 days, for a total of 12 readings—provides a more accurate picture of a patient’s true blood pressure. This allows patients to react and understand the impact of medication and lifestyle on their blood pressure. SMBP data shared with the care team enables accurate diagnosis and clinical assessment of a patient’s blood pressure over time as well as better medication titration.
3. SMBP Devices Works Similarly to Blood-Glucose Monitors, a DME
An SMBP device is a useful chronic disease management tool4 like a blood glucose monitor (which already qualifies for DME). Both devices reduce overtreatment, risk of emergency room visits, death, and severe illness – all while empowering patients to self-care with appropriate action.
Patients with diabetes rely on physician-created treatment plans similar to patients with hypertension. In both cases, patients use the data from their devices and their treatment plan to quickly respond to their readings.
4. SMBP Coverage Aligns with CMS’ Health Equity Goal
Despite its effectiveness, lack of reimbursement for SMBP devices has stymied widespread adoption and use of the SMBP device. Classifying SMBP devices as a DME can break down SDOH barriers especially for more vulnerable patients. This step furthers CME’s goals to achieve better health equity nationwide.
Coverage of SMBP devices as a DME would enable essential workers, people in rural areas, and people with transportation or childcare challenges, and low-income health center patients to self-manage their blood pressure information in partnership with their care team via telehealth. No matter a health center patients’ location, SMBP devices can help ensure they have equitable access to better manage their health.
Health centers have until May 31st to provide comments to CMS about SMBP designation. Letters can be sent to HCPCS@cms.hhs.gov by 5PM ET on May 31.