Rationale for Establishing a Mechanism to Increase Reimbursement to Hypertension Specialists

Abstract

Hypertension is an important public health problem both in the United States and worldwide, contributing to many forms of cardiovascular and renal diseases. Although great strides have been made in the proportion of the US population that achieves recommended blood pressure targets, many Americans still have undertreated and uncontrolled blood pressure that increases the risk of expensive strokes, heart attacks, heart failure, and dialysis. Because hypertension is a common but heterogeneous and sometimes complex condition, the American Society of Hypertension (ASH) has, since 1999, designated physicians as “ASH Hypertension Specialists.” Such Hypertension Specialists (as defined by ASH's Specialist Program) are fully licensed physicians with a primary board certification who are competent in all aspects of the diagnosis and treatment of hypertension, as evidenced by passing a specific examination on these topics offered by ASH's Specialist Program. These physicians have a proven track record of controlling blood pressure in “resistant hypertensive” patients, the general population whom they serve, and educating other physicians to help them achieve higher blood pressure control rates among their patient populations. This report sets out a rationale for increased reimbursement for care of hypertensive patients by ASH‐Designated Hypertension Specialists.

Resistant Hypertension: Detection, Evaluation, and Management: A Scientific Statement From the American Heart Association

“…Retrospective studies have demonstrated improved BP control by hypertension specialists for patients referred for uncontrolled hypertension. 366,397 When BP control is not progressing the way the primary care provider thinks it should, the patient should be referred.…”

Aldosterone Antagonists or Renin-Guided Therapy for Treatment-Resistant Hypertension: A Comparative Effectiveness Pilot Study in Primary Care

“…2,3 Uncontrolled aTRH impacts ~7.5 million US adults, with roughly half having true TRH, which exceeds the number that can be practically managed through referral. 13 The prevalence of aTRH requires effective management strategies in usual primary care settings. aTRH is more common in Black than White adults.…”

“…Comparative effectiveness of these 2 strategies is important in usual care practices, since most patients with TRH are managed in these settings. 13 This pilot study was conducted to test the feasibility and preliminary effectiveness of either adding an AA or using RGT in adults with uncontrolled TRH in usual primary care settings. The feasibility analysis from this pilot study was published.…”

The Evolving Clinical Management of Hypertension

“…Hypertension specialists should also be effective in teaching colleagues best practices in achieving BP control as a critical part of preventing the expense, both in human terms and financially, of strokes, myocardial infarctions, heart failure, and dialysis. Dr William Elliott and a group of other leaders of ASH have put forward an argument to justify why hypertension specialists should now be regarded as a vital part of the cardiovascular prevention team, and why funding to optimize their participation in advancing better care of hypertension should be made available . Cardiovascular research and teaching now place emphasis on the importance of good hypertension control, and it is to be hoped that increasing numbers of clinicians interested in hypertension—which, after all, is probably the most common chronic condition in medical practice—will consider becoming qualified as ASH Hypertension Specialists.…”