A&D Medical

Maximizing Patient Care: The Significance of Accurate Biometric Measurements and Reliable Data Transmission in Remote Monitoring

Victoria Licona — Mon, 22 Apr 2024 05:30:01 +0000

Maximizing Patient Care: The Significance of Accurate Biometric Measurements and Reliable Data Transmission in Remote Monitoring

In today’s healthcare landscape, remote patient monitoring (RPM) has become a cornerstone for delivering proactive and tailored care, especially for managing chronic conditions like hypertension. However, the efficacy of RPM relies heavily on two pillars: accurate measurements and reliable data transmission. Let’s explore why these aspects are crucial to enhancing patient care and outcomes.

Importance of accurate biometric measurements

Accurate biometric measurements are essential for effective patient care. For healthcare providers, precise readings are necessary for informed decision-making regarding treatment plans, medication adjustments, and lifestyle interventions. In remote monitoring, measurement accuracy is even more critical because interactions are not face to face.

Early Intervention: Accurate readings enable early detection of deviations from target values and facilitate timely intervention to prevent complications.

Tailored Treatment Plans: Reliable data allow customization of treatment plans based on individual patient needs, ensuring optimal management, and minimizing risks associated with overtreatment or undertreatment.

Improved Patient Engagement: Patients who trust the accuracy of their measurements are more likely to engage in self-monitoring and adhere to prescribed interventions, leading to better health outcomes and increased satisfaction with care.

The Crucial Role of Reliable Data Transmission

The other critical component in remote patient monitoring is to make sure the data gets transmitted to the healthcare provider. Reliable data transmission is essential for using the data in patient care management. Here’s why healthcare professionals should prioritize this aspect:

Timely Intervention: Reliable data transmission enables healthcare providers to receive real-time updates on patients’ vital measurements, facilitating prompt intervention in case of abnormal values or emergent situations.

Data Location: Getting the data transmitted to an electronic health record or a preferred digital health platform that is convenient for healthcare provider review is essential to an effective program.

Data Accuracy and Integrity: Ensuring reliable data transmission maintains the accuracy and integrity of patient information, minimizing errors or inconsistencies that could compromise clinical decision-making.

Efficient Healthcare Delivery: Streamlining remote monitoring processes through reliable data transmission enhances healthcare delivery efficiency, reducing burdens on both patients and providers and enabling more effective resource utilization.

Accurate measurements and reliable data transmission are indispensable components of remote patient monitoring, crucial for optimizing patient care and outcomes. As healthcare professionals harness the potential of RPM, prioritizing the quality and reliability of these elements is paramount.

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AOBP – How to get accurate office measurements

Victoria Licona — Mon, 23 Oct 2023 20:52:32 +0000

AOBP – Why it is the gold standard in office measurement, How to get accurate office measurements

AOBP stands for “automated office blood pressure,” and it refers to a method of measuring blood pressure that is widely considered to be the gold standard in office measurement. It is considered more accurate than manual office measurement because it eliminates the potential for observer bias and human error.

Blood pressure measurement is a complex procedure that requires proper technique and attention to detail to obtain accurate readings.

The Effects of Human Error

Some examples of human errors that can affect blood pressure measurement include:

Improper cuff size selection – Using a cuff that is too small or too large for the patient’s arm can result in inaccurate readings.

Incorrect cuff placement – The cuff should be placed on the upper arm at heart level, and not too loose or too tight. An improperly placed cuff can affect the accuracy of the reading.

Inadequate rest period – Patients should be given sufficient time to rest before blood pressure measurement to avoid false high readings due to physical activity or stress.

Observer bias – The person taking the measurement may unintentionally influence the readings through personal bias or misinterpretation of sounds or numbers.

Recording errors – Mistakes in recording the measurement, such as recording the wrong numbers or forgetting to record a reading, can also impact the accuracy of the results.

An AOBP monitor can prevent many of these errors in addition to eliminating the white coat effect. This refers to the phenomenon where blood pressure readings are elevated in a clinical setting due to the anxiety or stress experienced by the patient.

To get accurate office measurements using AOBP, the following steps are typically taken:

The patient is seated in a quiet room with no distractions and is asked to remain still and quiet for at least 5 minutes prior to the measurement. The healthcare professional leaves the room, so the patient can be more relaxed.

A cuff is placed on the patient’s arm, and a device automatically inflates and deflates the cuff to measure blood pressure.

Multiple readings are taken over a period of time (usually 3-5 measurements are taken at intervals of 1-2 minutes), and the average of these readings is used as the patient’s blood pressure measurement.

For healthcare providers, the VDL is a reference to monitors that have proven accuracy when choosing a blood pressure monitor for their office, like Automated Office Blood Pressure (AOBP), kiosks or Ambulatory Blood Pressure Monitors (ABPM) or even recommending home monitors to patients.

The Validated Device List has listed A&D Medical devices on their website. This includes our best-selling blood pressure monitors. Below is a list of our approved devices that you can purchase for your clinic or home use:

To ensure the accuracy of AOBP measurements, it is important to use a calibrated device that has proven accuracy and is on the Validated Device List (VDL) and follow standardized measurement protocols. Additionally, it is important to ensure that the patient is properly prepared for the measurement and that the measurement is taken by a trained healthcare professional.

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The Importance of Validated Medical Devices

Victoria Licona — Tue, 18 Jul 2023 17:27:58 +0000

The Importance of Validated Medical Devices

In clinical settings, validated medical devices are essential because they enable reliable patient diagnosis, care, and monitoring. These devices have undergone extensive testing and validation to guarantee that they are secure, dependable, and accurate.

The confidence that readings or measurements are reliable and consistent is one of the key advantages of using validated medical devices. When it comes to identifying and managing chronic diseases like diabetes, hypertension, and heart disease, this is especially crucial. For healthcare providers to make educated judgments about patient care and to modify treatment plans as necessary, accurate measurements are crucial. Another benefit of using validated medical devices is that they can reduce the risk of errors or misinterpretation of results. For example, if a home blood pressure is not validated, it may provide inaccurate readings that can lead to incorrect therapeutic interventions, which can be dangerous for patients.

VDL and Blood Pressure Monitors

There are many different types of blood pressure monitors available on the market, including manual sphygmomanometers, home blood pressure monitors, professional office blood pressure monitors, blood pressure kiosks, and ambulatory blood pressure monitors. However, not all these devices have been validated to ensure their accuracy and reliability. A recent study by Dr. Dean Picone from the University of Tasmania, Australia found that over 75% of blood pressure monitors are not validated.

The main cause of death and disability is uncontrolled high blood pressure (“BP”). For the proper diagnosis and treatment of hypertension, reliable blood pressure measurement is crucial. Whether or not the BP measurement instrument has undergone clinical accuracy validation is one critical factor in accurate measurement.

The American Medical Association (AMA) and NORC are trying to change how clinicians and consumers can reliably determine if a blood pressure monitor is validated. The AMA enlisted the National Opinion Research Center at the University of Chicago (NORC) to help in the design and management of an impartial process to identify which BP devices offered in the U.S. meet the AMA’s established criteria to validate clinical accuracy (the Validated Device Listing Criteria). This was done to address the growing issue of unvalidated devices being marketed in the US. A BP device’s compliance with the VDL Criteria for validation of clinical accuracy is determined by an independent review committee made up of doctors with advanced training in the field of blood pressure. The “US Blood Pressure Validated Device Listing” or “VDL” is a formal list of BP devices that have undergone clinical accuracy validation because of this independent evaluation procedure.

Reliable patient monitoring, treatment, and diagnosis in clinical settings depend on the use of validated medical equipment. They limit the possibility of errors or incorrectly interpreting results, give healthcare workers reliable and consistent measurements, and are necessary for regulatory compliance. It is crucial that healthcare workers exclusively employ medical equipment that has undergone validation in their daily work.

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Women and High Blood Pressure

Naz Tuvalles — Tue, 13 Jun 2023 03:19:27 +0000

Women and High Blood Pressure

Volume I, Issue IV

While the greeting card and flower industries offer the reminder this month to shower mom with affection, May also offers a couple of great opportunities for women to take stock of an aspect of their lives that often gets neglected in the act of being moms, grand-moms and significant others: their health.

National Women’s Health Week (May 13-19) and May Measurement Month (an offshoot of World Hypertension Day on May 17) both stress the importance of making small but important changes to your life to ensure better health in the long-term.

One of those small but important changes is simple: pay more attention to your blood pressure.

The reason? A common misconception is high blood pressure (or hypertension) rarely affects women. But ladies, that couldn’t be further from the truth: almost half of all adults with high blood pressure are women. And at 65 and older, women are actually more likely than men to get high blood pressure.

Why are women affected?

According to the American Heart Association (AHA), “while high blood pressure isn’t directly related to gender, throughout a woman’s life, health issues like pregnancy, pregnancy prevention (birth control) and menopause can increase the risk of developing high blood pressure.”

Tips for women

To that end, we’ve culled together some tips for women and better long-term health, with a particular emphasis on lowering blood pressure levels:

An Ounce of Prevention

Visit a doctor or nurse for a preventative check-up each year, but don’t leave the blood pressure monitoring solely to the professionals: recent studies show blood pressure levels are almost always higher or lower than normal at the doctor’s office. Make sure you also routinely check your blood pressure at home (see this great how-to video on getting the most accurate reading every time).

Get Active

Whether it’s a walk around the neighborhood or some serious cardio, physical activity is a great way to ensure long-term health while (bonus!) lowering your blood pressure levels.

Eat Heart-Healthy

What foods raise blood pressure? Lower it? Take advantage of the bevy of available recipes designed to lower blood pressure.

Don’t Worry, Be Happy

Pay attention to stress levels (did you see our blog on stress and blood pressure?) to lower BP readings in the long term.

May Measurement Month

This month, let’s join the ranks of millions and make a commitment to better heart health. Because when women come together, things have a way of getting done!

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6 Ways to Reduce Hypertension: World Hypertension Day

Victoria Licona — Wed, 17 May 2023 19:32:06 +0000

May 17th marks World Hypertension Day, a global initiative to raise awareness of hypertension and promote hypertension prevention, detection, and control. To support World Hypertension Day, we encourage everyone to check their blood pressure and spread awareness about hypertension in their communities, here are 6 ways to reduce hypertension.

Over 30% of the adult population in the world and more than a billion individuals worldwide suffer from hypertension. It is the main cause of heart disorders, especially coronary artery disease, and stroke. Additionally, chronic kidney disease, heart failure, arrhythmia, and dementia can all result from uncontrolled hypertension. Therefore, information regarding this illness should be shared widely.

There are many ways to prevent hypertension, here are the top 6 ways to reduce hypertension:

Get regular exercise

Reduce salt intake

Learn to manage tension or stress

Take a well-balanced diet rich in calcium, potassium, and magnesium

Limiting alcohol consumption

Avoiding tobacco use

How A&D can help:

At A&D Medical, we are dedicated to improving hypertension awareness and management through our blood pressure monitoring solutions. Hypertension, also known as high blood pressure, is a leading risk factor for cardiovascular disease, which is the leading cause of death globally. Regular blood pressure monitoring is essential for understanding and managing hypertension. Our products include a range of blood pressure monitors, including wireless and other options, to suit a variety of needs and lifestyles.

Track your health (blood pressure, pulse rate, blood glucose, oxygen saturation, weight, temperature, and respiratory rate) and automatically share your data with a healthcare provider with our free highly rated Heart Track app. A&D Medical is trusted by millions of patients to accurately measure blood pressure every day. The Heart Track App combines A&D’s expertise in connected blood pressure monitoring with an easy-to-use app to improve hypertension management. You can download our app using this link.

At A&D Medical, we are committed to providing accurate and reliable blood pressure monitoring solutions to help individuals and healthcare providers manage hypertension and cardiovascular health.

If you are interested in learning more about hypertension and blood pressure monitoring, please visit our website at Blog – A&D Medical (andonline.com)

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Special Healthcare Provider ReportEnsuring Home Blood Pressure Monitors are Accurate for In-home Patient Use,Part I: Clinical Validation

Mayuri — Wed, 05 Apr 2023 15:04:24 +0000

Special Healthcare Provider Report
Ensuring Home Blood Pressure Monitors are Accurate for In-home Patient Use,
Part I: Clinical Validation

With excerpts from an interview with Jerry Wang, Director of Engineering, A&D Medical
Volume I, Issue VI

Accuracy in blood pressure monitors for mass market consumption has never been more critical, due to the following factors, which have resulted in something of a perfect storm in the healthcare field:

Shortages of trained healthcare practitioners;
An ever-growing population of patients with chronic disease; and
Consumers demanding to utilize technology to manage healthcare on their own.

As a result, the home blood pressure monitor has become a critical tool for long-term health management.

But as healthcare providers look to recommend blood pressure devices to their patients for accurate home use, two main factors have become clear: 1) the phrase “clinically validated” – once a go-to term for accurate products – has become a marketing term as opposed to a scientific one, and 2) educating patients on the correct way to take blood pressure readings remains critical.

In this blog post, we’ll look at the term “clinical validation,” and how to advise patients to research what it means – to ensure product accuracy at the on-set.

Clinical Validation

Clinical Validation: The Gold Standard?

Healthcare practitioners have a deep understanding of the process of clinical validation as it relates to devices like blood pressure monitors: The accuracy is determined by comparing device measurement to the measurement of a trained observer using a mercury sphygmomanometer and stethoscope.

But unfortunately, the phrase “clinically validated” has become as ubiquitous as other marketing claims because the process of clinical validation is not always followed to its fullest measure – or for each product line.

Patients need to understand all the aspects of the clinical validation process in order to assess manufacturer claims.

“Most healthcare practitioners understand the three major components that comprise clinical validation, including utilization of modern protocols, independent verification of accuracy, and publication in a peer-reviewed journal,” said Jerry Wang, Director of Engineering with A&D Medical. “But what they may not be aware of is that there are other factors that can impact the accuracy of an otherwise clinically validated product. It is those factors that can have major impact on the patient’s ability to assess their own health accurately, and make the healthy changes they need to make to their lifestyle.”

Other Factors

Other Factors that Can Impact Blood Pressure Monitor Accuracy

Each Product Must Be Validated

“Occasionally, companies will claim a certain level of accuracy in their products, which have met all the clinical validation standards,” said Mr. Wang. “But they will then modify the design in its next product cycle iteration in such a way that the original validation is no longer representative of the product – and not verify the new product line under the same clinical validation standards.”

As such, each new product and its peripheral components (such as cuffs) need to pass the standard clinical validation process.

Assurance of Mass Production Accuracy

“We will also occasionally see clinically-validated products that do not maintain the level of substantiated accuracy through the production process,” said Mr. Wang. “In order to ensure final products going onto the shelves at pharmacies or online through e-commerce venues, the following controls should be put in place across production lines.”

Design Control: the design, exactly as it is, is the one that needs to enter the production process.
Production Control: From end-to-end, the product resourcing, testing, manufacture, sampling and packaging, should be in control of the manufacturer. Without that level of precise control, manufacturers have no way of knowing if design or production has resulted in the tweaking of the design in a way that would negate accuracy results.
Consistency: The above manufacturing process as defined above needs to be tested for accuracy as well, to ensure long-term consistency in the production process.

Walking patients through not only the clinical validation process, but also the additional components required for product accuracy will put them on the path to choosing the most accurate home blood pressure monitor.

In our next blog post as part of this special series, we’ll look at educating patients on the right way to take blood pressure – and how you can do a simple in-office test with their home equipment to judge its accuracy.

Download the Whitepaper

Learn More About Our Products

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Reimbursement for Ambulatory Blood Pressure Monitoring

Mayuri — Wed, 05 Apr 2023 14:47:36 +0000

Reimbursement for Ambulatory Blood Pressure Monitoring

With the recent changes to the American Heart Association’s blood pressure classifications, many more Americans are now considered hypertensive. One of the main purposes of this change was to raise awareness and ensure that patients begin seeking treatment sooner.
This may have led to a rise in your practice of patients seeking advice about hypertension, and they may even be more familiar with terms like White Coat Hypertension than ever before.
As you consider prescribing Ambulatory Blood Pressure Monitoring (ABPM) for some of your patients, you may need to know about reimbursements. This quick guide is designed to help you know what to expect and provide some of the most common billing codes, including CPT, HCPCS, and ICD-10.

US reimbursement rates

Reimbursement for ABPM
In 2018, CMS announced that they are considering expanding reimbursement coverage for ABPM.

ABPM is covered once per year by Medicare & Medicaid for eligible patients with suspected white coat or masked hypertension.

Suspected white coat hypertension is defined as “an average office blood pressure of systolic blood pressure greater than 130 mm Hg but less than 160 mm Hg or diastolic blood pressure greater than 80 mm Hg but less than 100 mm Hg on two separate clinic/office 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." Suspected masked hypertension is defined as an "average office blood pressure between 120 mm Hg and 129 mm Hg for systolic blood pressure or between 75 mm Hg and 79 mm Hg for diastolic blood pressure on two separate clinic/office 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." Medicare
If you have a Medicare patient, ABPM must be performed for at least 24 hours to meet coverage criteria. The fee is determined by region of the United States.
2019 non-facility national average prices according to CMS.gov:

	Description	Fee Schedule*
93784	Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; including recording, scanning analysis, interpretation and report	$48.23
93786	Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; recording only	$24.09
93788	Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; scanning analysis with report	$5.34
93790	Ambulatory blood pressure monitoring, utilizing a system such as magnetic tape and/or computer disk, for 24 hours or longer; review with interpretation and report	$18.80

Diagnosis codes

ICD-10 Codes for ABPM
The above procedure codes should be used in conjunction with appropriate diagnosis codes, such as the below:

Diagnosis	ICD-10-CM
Essential (primary) hypertension	I10
Hypertensive heart disease without heart failure	I11.9
Other Forms of Angina Pectoris	I20.8
Orthostatic Hypotension	I95.1
Elevated blood pressure reading, without diagnosis of hypertension	R03.0
Syncope and collapse	R55
Encounter for examination of blood pressure without abnormal findings	Z01.30
Encounter for examination of blood pressure with abnormal findings	Z01.31

Source

Learn more about ABPM

Clinically Validated Devices
A&D Medical offers ABPM devices:

TM-2440 Series

*The information on this page is informational only and does not represent a guarantee or promise from A&D concerning coverage or reimbursement rates. Fees listed are an average of the Non-facility prices available for each code on the CMS.gov site as of December 2022. It is the provider’s responsibility to determine eligibility, coverage, coding, and all other requirements prior to the completion of services.

Disclaimer: private payor and Medicare fee schedules may be corrected or changed periodically.

Learn More About Our Products

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Ambulatory Blood Pressure Monitoring: A Thorough Approach to the Diagnosis & Treatment of Uncontrolled Hypertension

Mayuri — Tue, 04 Apr 2023 16:55:35 +0000

Ambulatory Blood Pressure Monitoring: A Thorough Approach to the Diagnosis & Treatment of Uncontrolled Hypertension

Known as the “silent killer”, uncontrolled hypertension is the leading cause of heart disease, stroke and death in the United States¹. Due to the prevalence of the disease, among other reasons, the American Heart Association (AHA) and American College of Cardiology (ACC) changed their blood pressure classifications to help raise awareness and begin the diagnosis and treatment of heart disease before it becomes as severe.
The early diagnosis of hypertension alone, however, is not enough to curb the issue. Healthcare providers must work effectively with their patients to control hypertension through proven methods, such as medication and lifestyle changes, to stall or eliminate the prognosis of heart disease and death.
In cases of undiagnosed and/or uncontrolled hypertension, the increased utilization of 24-hour Ambulatory Blood Pressure Monitoring (ABPM) can be a crucial step towards better diagnosis and management of hypertension.
Download the Whitepaper

The disease state of hypertension is so prevalent that it now affects over 100 million Americans, nearly 1/2 of the country’s population². Of these, only approximately 53% are controlled³, leaving nearly 40% of hypertensive Americans either undiagnosed or uncontrolled. To address the growing health risk, in 2017, the ACC and the AHA both updated the blood pressure (BP) guidelines, lowering thresholds to implement earlier interventions at a BP of 120/80 or higher⁴.
As a controllable condition, accurate diagnosis and management of hypertension is critical because it offers great potential to prevent heart attacks and strokes, and it can save patients and providers costs associated with myriad cardiovascular diseases. In fact, the ACC, the AHA⁴, and The Million Hearts 2022 initiative prioritized accurately identifying hypertension as the first step in the goal preventing 1 million heart attacks⁵, realistically reducing cardiovascular events by 30%, and all causes of mortality by 25%⁴.

Diagnosing Hypertension

Why is it So Hard to Diagnose Hypertension?
In some cases, hypertension may be easy enough for medical professionals to diagnose, but in others, it can pose quite a challenge because of its dynamic nature in relation to constantly changing and underlying influences, both internal and external.
In order to control for variables not normally present during the patient’s office visits, studies validate enlisting patients to perform home blood pressure monitoring (HBPM) in their environment for more definitive diagnosis than in-clinic monitoring⁶.
Unfortunately, however, there are several BP patterns that are not reflected in office or HBPM because they reflect a snapshot measurement and may not uncover some of the diagnosis patterns below.

BP Patterns

Blood Pressure Diagnosis Patterns
As discussed, diagnosing hypertension can be complicated by myriad BP patterns that may not be immediately apparent when the patient presents in the office for a consultation or checkup. In order to ensure proper and timely diagnosis, the full scope of BP patterns must be understood, especially given that many of these patterns are associated with increased complications.
Critical to the understanding of BP patterns is BP load: the percent of abnormally elevated BP measurements, specific to day and night guidelines. BP load is associated with future cardiovascular morbidity and mortality⁷ and can be experienced via several types of BP patterns.

BP Pattern: White Coat Hypertension
White Coat Hypertension (WCH) is when a patient’s BP is normal outside of the clinic but elevated in the clinic. The name “White Coat Hypertension” was assigned due to the suggestion that being in the presence of a medical provider can be stressful, thus raising BP. If a provider assumes that the patient’s BP is always at hypertensive levels when, in fact, they are truly experiencing WCH, it could lead to over-medicating, resulting in potential patient complications second to misdiagnoses.
Best practices suggest that WCH should be ruled out and monitored with suspicion, as there is growing evidence that a portion of patients with WHC have elevations in other stressed-induced situations as well^6,8.

Masked Hypertension
Masked Hypertension is when a patient presents with a normal BP in the clinic, but their BP is elevated outside the clinic. Detection of many masked or hidden hypertension patterns is impossible in the clinic, and, for the most part, by HBPM⁶. A study of 64,000 adults found that masked hypertension was associated with greater risk of all causes of mortality than sustained hypertension or WCH⁹.
Stress-Induced Hypertension
Stress-Induced Hypertension is identified when there is variability of BP during the patient’s daily life that is not likely to be captured in-clinic or HBPM⁶. An example may be a patient with a stressful job where their BP would consistently be considered hypertensive, even though their levels may return to normal outside of the stress-inducing situation¹⁰.
Morning Hypertension
Morning Hypertension, also known as Morning BP Surge (MBPS), is when average BP is ≥ 130/80 in the first 2 hours after awakening. MBPS is the dynamic phenomenon of BP changes in early morning hours. Morning hypertension is the single most powerful predictor of stroke, cardiovascular events, renal disease, and total mortality⁶.
Nocturnal Hypertension
Nocturnal Hypertension is defined as an average BP ≥110/65 mmHg during sleep hours, usually between 1 and 6 AM and when BP does not dip 10-20% during sleep, as is normal. Data supports Nocturnal Hypertension as a better predictor of worsened outcomes than daytime BP, and it is known to correlate with advanced brain, heart, kidney disease and poorer prognosis with increased cardiovascular events, hospitalizations and deaths⁶.
Within the Nocturnal Hypertension category are several sub-types:

With Sustained Nocturnal Hypertension, the uncontrolled daytime BP stays elevated during sleep.
Nighttime Surge is a temporary increase in BP. Increased BP variability during sleep can explain nighttime surge and is a unique and critical factor for increased cardiovascular events. Each of the below sub-types are abnormal patterns where BP doesn’t decrease, as normal, and it can be higher while sleeping than during awake periods:

Non-Dippers	BP decline of ≤10%
Reverse Dippers (Risers)	BP dips ≤0% compared to waking hours
Extreme Dippers	BP dips abnormally, > 20%⁶

Regardless of the specific sub-type of nocturnal BP patterns a patient is diagnosed with, the increased BP variability during sleep is a unique and critical factor for increased cardiovascular events⁶.
Orthostatic Changes
Orthostatic Hypertension occurs when a BP is elevated while a patient is standing. In contrast, Orthostatic Hypotension occurs when a BP drops by 20 mmHg when a patient is standing. Orthostatic Hypotension often precipitates syncope or falls in the frail or elderly population, which can lead to a host of adverse and potentially life-threatening events⁶.
BP Variability
BP Variability (BPV) is diagnosed when there are transient fluctuations in BP that is independent of the mean BP. It is often associated with arterial stiffness and poor cardiovascular outcomes. The instability of BPV is seen in many of the above hypertension patterns, including orthostasis-related position changes⁶.
Resistant Hypertension
Resistant Hypertension is an elevated BP in patients who are not controlled after use of a variety of antihypertensive agents. Resistant Hypertension often calls for further evaluation of treatment efficacy^11,6.
The full scope of BP patterns that can affect a diagnosis of hypertension is nuanced before even considering additional internal and external influences. Consequently, traditional in-office and HBPM techniques may not be sufficient to diagnose hypertension.

The Solution

The Solution: Ambulatory Blood Pressure Monitoring
Due to the complexities of diagnosing hypertension, scores of studies have provided convincing evidence that ambulatory blood pressure monitoring (ABPM) is the recommended technique for diagnosing hypertension because it accounts for many of the internal and external influences that can obfuscate in-office diagnosis, even when supplemented by HBPM.
Additionally, ABPM has been proven to not only better diagnose hypertension, but it may help providers understand the state of BP and better predict cardiovascular, cerebral, and end organ damage better than any other non-invasive BP measuring tool¹². ABPM also has the unique ability to help providers better diagnose their patients via thorough data analysis of BP load and patterns so appropriate therapeutic treatment plans can be implemented.

White Coat Hypertension: ABPM is so successful in monitoring and diagnosing these cases that CMS began reimbursing ABPM as the gold standard for confirming suspected diagnosis of WCH in 2002¹³.
Masked Hypertension: HBPM may occasionally be enough to pick up on hypertensive readings and diagnose Masked Hypertension, yet people often remain inadequately diagnosed and controlled with conventional BP monitoring¹⁵. Therefore, ABPM is the preferred monitoring tool^4,14 because the automatic monitoring captures BP load at preset intervals during normal activities of daily living without interruption.
Stress-Induced Hypertension: Due to its round-the-clock nature, ABPM is used to identify cycles or periods of elevated BP without interrupting the patterns of the patient, a critical factor in diagnosis of this BP pattern.

Morning Hypertension: ABPM or automated timed monitoring are the only non-invasive tools that can detect Morning Hypertension correctly⁶.
Nocturnal Hypertension: ABPM should be the preferred method for identification of nighttime dipping and other nocturnal BP patterns due to its ability to monitor consistently, even while the patient is asleep⁶.
Orthostatic Hypertension: Because of its correlation with syncope and falls, ABPM is preferred in diagnosing Orthostatic Hypertension because it provides the most conclusive interpretation of the underlying BP pattern⁶.
BP Variability: Due to the nature of BP Variability, fully understanding the BP patterns a patient experiences throughout the course of the day is essential. ABPM is the only method that can achieve such tracking.
Resistant Hypertension: ABPM is valuable in order to better tailor interventions, such as choice of antihypertensives based on their pharmacologic characteristics, timing of dosing, and even integrated specialty support to achieve constant BP control.

Correctly diagnosing the hypertension pattern via ABPM will aid in guiding interventions and treatment toward normalizing BP because it provides clinicians with more data for better choice and timing of medications, and it will reduce variability in measurements. In sum, the improved insights gained from utilizing ABPM in a variety of BP pattern cases can not only help provide the most conclusive interpretation of the underlying BP pattern, but it can minimize preventable morbidity and mortality due to the tailored treatment plans possible with improved data from ABPM.

Screening with ABPM

Who Should Be Screened with Ambulatory BP Monitoring?
ABPM should be used adjunctly with HBPM for threshold staging for accurate diagnosis and therapeutic management.
Specifically, ABPM should be routinely used for high risk patients as a reference standard to confirm the diagnosis of hypertension¹². High risk patients are those with HBPM ≥ 120/80, a history of cardiovascular event, suspected WCH, suspected nocturnal hypertension (based on comorbidities of sleep apnea, diabetes, chronic kidney disease), and documented organ damage.
Beyond typical high-risk patients, ABPM screening is also recommended for those with a predicted prevalence for developing hypertension of ≥ 16%, based on the Hypertension Prevalence Estimator Tool, which is used to predict the percent of the patient population that will develop hypertension¹⁶.
Additionally, age, gender, race, and many comorbidities impact the development of hypertension and should also be considered when considering ABPM screening. With even one comorbidity, such as obesity or diabetes, the risk for hypertension increases exponentially, as seen in Table 1.

Table 1

			White			Black			Hispanic
AGE	CoMorbidity	Male	Total 6%	Female	Male	Total 9.7%	Female	Male	Total 3.5%	Female
18-44	0	8.40%		3.50%	9.90%		9.30%	5.20%		1.70%
	1	21.10%	16.30%	11.60%	27.80%	22.60%	17.40%	13.90%	10.90%	7.90%
	2	38.20%	37.70%	37.30%	64.80%	58.50%	52.20%	54.60%	39.60%	24.70%

45-64	0	32.30%	29.50%	26.80%	46.10%	46%	45.90%	26.30%	25.10%	23.90%
	1	46.90%	48%	49.20%	60%	63.20%	66.40%	44%	41.10%	38.30%
	2	70.90%	69.10%	67.30%	87%	86.50%	86.10%	64.50%	66%	67.60%

65-74	0	51.90%	53.60%	55.30%	71.50%	70.60%	69.70%	41.10%	53.20%	65.30%
	1	64.20%	66.50%	68.80%	80.90%	84.50%	88%	63.80%	69.80%	75.80%
	2	77%	83.50%	90%	86.10%	89.10%	92.10%	74.50%	79.50%	84.50%

For example, for age 18-44 whites with 0 risk, 1 risk factor, 2 risk factors the prevalence would be 6%, 16.3%, 38%, respectively, of developing hypertension and further disease. By using ABPM to screen adults who have a certain percentage, say 16% or 20% or more prevalence of developing hypertension, healthcare providers can detect morbid hypertension patterns which otherwise would go undiscovered until advanced disease occurs. Early diagnosis and halting of preventable and irreversible effects of cardiovascular disease through early intervention is possible with ABPM screening.

ABPM Usage

How is ABPM Used, and What Data Will it Provide?
ABPMs can easily be configured by a nurse or medical assistant to monitor the patient’s BP at specific preset time periods, such as every 20-30 minutes in the awake hours, and every 60 minutes during the patient’s reported anticipated sleep period.
The device should be worn for a minimum of 24 hours so it can capture dynamic readings while the patient is engaged in usual activity, in their home and work environments, and during their sleep periods.
After the 24 hours, the information is downloaded to a computer for review.
The numerous readings provide a plethora of information for clinical decision making as to the person’s actual BP load and BP patterns as well as time and date stamped BP and pulse measurements. Additionally, some ABPM devices provide other critical details, such as activity levels, ambient temperature, and barometric pressure, which may aid in diagnosis.
Beyond the basic raw data, the software will provide the clinician helpful tools, such as graphs and diagrams, to highlight the BP loads, sleep percentages, a variety of means (including 24-hour, daytime, and nighttime means), high/low BP measurements, Circadian/Nocturnal rhythms, and irregular pulses.
Altogether, this data paints a picture of not only hypertension but of the patient’s unique patterns to elicit proper decision making for clinical management.
The initial target of managing BP should be aimed at evaluating morning BP. After morning control, the next goal would be to measure dynamic BP during the sleep cycles with ABPM and with a goal to keep nocturnal BP controlled at <110/656. What Type of Providers Should Use ABPM?
Given the urgency aimed at lowering BP thresholds, including a focus on early intervention to reverse heart and brain disease progression, morbidity and mortality, ABPM should be used by primary care providers, health departments, obesity and diabetic clinics, wellness centers, managed health groups, nurse or pharmacy hypertensive clinics, along with cardiology and renal specialty clinics.
With its wide range of diagnostic capabilities, efficiency, and ease of use, ABPM should be used early and frequently when hypertension is suspected, given the large number of patients who are going undiagnosed or suffering consequences of uncontrolled hypertension.
ABPM has been recognized by many as a gold standard in diagnosing hypertension^5,6, and as of 2015, the United States Preventative Services Task Force (USPSTF) found it to be the best method to diagnose and confirm hypertension¹². The CMS also set the standard that ABPM is a valid, useful and cost-effective tool for diagnosing hypertension WCH when it added reimbursements for the procedure in 2002¹³.
Beyond medical providers, ABPM is becoming the standard of care among groups like AETNA¹⁷, HealthNet, Kaiser and Columbia University when diagnosing and evaluating BP patterns such as WCH, Masked Hypertension, and more.

Benefits of ABPM

How Can ABPM Improve Patient Satisfaction, Increase Survival Rates, and Decrease Cost?
ABPM has been shown to improve the accuracy of a hypertension diagnosis and the clinician’s understanding of BP patterns that a patient may experience, but how does it improve outcomes and increase survival, all while decreasing costs?

Improved Patient Satisfaction
Patients experience increased satisfaction when they are given education about how the results are used to guide appropriate lifestyle, nutritional, pharmaceutical, and other medical specialty interventions.
Patients who participate by wearing ABPM and who are involved in their self-care are more capable of improving their conditions.
Additionally, use of ABPM reduces repetitive office visits for BP monitoring for diagnosis, so patients will have less loss of work and lifestyle changes that accompany physical and psychological limitations of consequences of uncontrolled hypertension.

Increased Survival Rates and Decreased Costs

For the patient, ABPM can help increase survival rates while decreasing their costs because, while hypertension is a preventable disease, it is a predictor for other, more serious conditions, such as heart attack, stroke, and cardiovascular events, among others. By controlling hypertension, the patient does not experience those health or financial risks of future complications they might have experienced.
For example, a heart attack victim can have between $760,000 and $1 million in healthcare-related costs¹⁸. It is estimated that ABPM screening in Japan alone will save patients nearly $90 billion dollars over 10-year period. Potentially even more importantly, the same study estimates that during this same time period, ABPM will also save over 10,000 lives and reduce strokes by 60,000¹⁹.
Another study found that the use of ABMP to be cost effective for patients, even if total annual hypertension treatment costs were as little as $300²⁰ due to reduced heart attacks and strokes and other financial savings, such as the cost of unnecessary treatments due to WCH, repetitive office visits, subsequent costs due to uncontrolled hypertension and resulting conditions, and more.
On the clinician’s side, many providers are seeing the benefits of regularly using ABPM in their practices because it is so useful in uncovering hidden hypertensive patterns via reimbursable procedures that no other non-invasive modality can detect. Additionally, ABPM data gives way for clinicians to diagnose and make management decisions that they could not without this screening tool. For this reason, ABPM pays for itself by reducing the clinician’s time spent diagnosing and managing each potentially hypertensive case or advanced disease states.
Additionally, some devices even offer the ability to double as an office BP monitor when not in use in an ambulatory capacity, further improving the ROI of the device.

Conclusion

In keeping with the new ACC/AHA guidelines and goals to minimize cardiovascular events by 30%⁴, there is growing evidence that ABPM is a key diagnostic tool in assessment and management of hypertension.
Because ABPM can uncover BP patterns that cannot be detected in-office or with HBPM, it should be a go-to tool in any healthcare provider’s toolkit when faced with diagnosing and controlling hypertension, which is a proven factor in improving cardiovascular outcomes and limiting the development of patient morbidity or additional conditions.
If you are interested in utilizing ABPM in your practice, please contact us to find out more.
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Efficient and Effective Ambulatory Blood Pressure Monitoring (ABPM)

Mayuri — Tue, 24 Jan 2023 21:19:42 +0000

Efficient and Effective Ambulatory Blood Pressure Monitoring (ABPM)

With 50 million Americans living with hypertension, there is a high demand for effective ways to help diagnose and manage this condition before it leads to worse issues. Ambulatory blood pressure monitoring (ABPM) can be a useful tool for monitoring and managing abnormal blood pressure within your practice.

In contrast to readings done in specific clinical settings or at home, with ABPM, blood pressure is measured at specified intervals over the course of 24 to 48 hours, which can create a more complete picture of what is happening to blood pressure during a patient’s daily activities. It can be especially useful in cases where the diagnosis is complicated, such as borderline hypertension, stress-induced hypertension, morning or nocturnal hypertension, masked hypertension, or “white coat hypertension,” in which a patient’s blood pressure is affected by being in the clinic.

Significant limitations to the effective application of ABPM technology include cost, patient compliance, and the need for specialized equipment. Most of these can be mitigated with more efficient and effective approaches. Indeed, a well-designed, well-run program can increase patient satisfaction, improve outcomes, and even generate revenue in cases where ABPM is reimbursable.

Here are a few ways to get more value from your ABPM implementation.

Ensure Patient Compliance

Of all the challenges to establishing an effective ABPM program, ensuring patient compliance may be the most difficult to control. It requires faith on your part, simply because you can’t observe patients when they’re out and about. To make the program more reliable, you should focus on compliance from the beginning and have plans in place well before the first patients are selected and onboarded.

Select the right patients for the ABPM test. Starting with high-risk patients (including those with HBPM ≥ 120/80, a history of cardiovascular events, suspected white coat hypertension, suspected nocturnal hypertension with comorbidities, and documented organ damage) who understand the benefits of ABPM, appreciate the importance of their own participation in managing their health.

Then, make the process as safe, comfortable, and friction-free as possible for patients. Invest in simple, easy-to-use, high-quality, clinically tested equipment—this will make things easier for patients and add some prestige to your practice. The Validated Device List is a great resource for finding ABPMs that have been tested for accuracy. Ensure your patients have been trained on the equipment and how to document activity. Some devices have integrated training and applications that make this process easier and faster. Always ask detailed questions and troubleshoot issues as they arise. This allows you to continuously improve your ABPM program as you go.

Think in systems

Even with cooperative patients, you can still face challenges if your tools and technology don’t work well together or your system isn’t intuitive. Rather than looking at ABPM as a checklist, you can make it more effective and efficient when you regard it as a larger, integrated system and see how all the parts connect. As always, choosing the right tools is of paramount importance.

For example, if your ABPM program works as designed, it will generate a lot of data. Therefore, you should have comprehensive plans for managing, analyzing, and reporting the results, which is easiest if you have it all in one place. There are cloud-based all-in-one systems that can remove much of the friction from this process. Regardless, make sure you have this covered. Information is only as useful as your systems for gathering and making sense of it.

Understand your results

Data generated from ABPM is different from blood pressure monitoring in the clinic. Ensure your relevant team members are well-trained in gathering data, documenting it in an EHR/EMR, and properly interpreting it, depending on their specific responsibilities. Then, create systems for organizing everything, keeping it all together whenever possible. Also, make sure your equipment is reliable at every point in an efficient, well-organized process.

ABPM technology is evolving, but cost and compliance issues should not prevent you from establishing an efficient and effective program when you make the right moves upfront. Invest in the right equipment, planning, training, and onboarding before you begin, and you can achieve optimal results while making a difference in the lives of those touched by hypertension.

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6 Essential Steps to Implement a Remote Patient Monitoring Program

Mayuri — Tue, 08 Nov 2022 20:21:32 +0000

6 Essential Steps to Implement a Remote Patient Monitoring Program

Technological advances have transformed the landscape of healthcare—particularly in the last few years, with the unprecedented demands of the worldwide COVID-19 pandemic—and remote patient monitoring, or RPM, is becoming more and more normalized and integrated.

RPM has clear benefits for providers and patients alike: it can streamline processes, reduce costs, and improve experience and outcomes. It can be particularly useful for managing hypertensive patients because its advantages are clear and potentially transformative. And, as a bonus, it can also be a very profitable addition to your practice when implemented correctly.

However, when implementing an RPM program in your practice, you should plan every step of the process thoroughly and deliberately. Every case will be different, but there are a few essential steps to keep in mind when developing a remote patient monitoring program for blood pressure management.

Step 1: Assemble your team

As a first step in building out an RPM program, you should ensure you have all the resources you will need. As is always the case, your most important and powerful resources are people.

To start, you should designate leaders who understand the benefits and challenges of an RPM program and ensure they have the bandwidth to see it through. These include:

An operational lead who understands the ins and outs of running an RPM program
A clinical lead (preferably an expert physician) from each department included in the RPM program
An executive stakeholder to help maintain organizational buy-in

Your core team should be thoroughly knowledgeable on the subject of using RPM for hypertension and willing to commit to the program for the long haul.

Step 2: Clarify and codify your process

Once you have your team in place, make sure to plan and document each step of your process in detail, including:

What training relevant staff (ex. RPM general training, software, hardware) will receive and who will train them
How to select eligible patients
How to onboard new patients
What the staff will do to ensure patient adherence and satisfaction with the program
What will your billing process look like
Who will help patients or staff troubleshoot
Who is in charge of ongoing maintenance and growth

RPM is relatively new and still developing, and many medical professionals are still learning how to incorporate these tasks into their daily workflow. If it seems overwhelming, you’re not alone! You can work with trusted experts in RPM, and they can help you work through any roadblocks.

Step 3: Set your goals

Before your RPM program is up and running, you will also want to establish what you expect to accomplish. The clearer you are on your expectations initially, the more likely you are to get what you want out of the program. When you are planning with your organization and team, agree on “SMART” goals:

Specific: Describe your intended outcomes in detail
Measurable: What data, metrics, and outcomes will let you know you’re succeeding?
Achievable: Understand your situation and be realistic
Relevant: How will the success of your RPM program benefit your patients and your organization at large?
Time-bound: Deadlines are lifelines—know what you want and when you plan to get it

For an RPM program around managing hypertension, example goals could include:

Bringing a certain percentage of patients closer to the ideal target of 130/80 mmHg
Increasing average blood pressure control in patients in the program by a certain percentage
Hitting patient satisfaction targets
Obtaining a specific ROI or billing goal

Step 4: Make it easy on your patients

As with most programs, simplicity and convenience are essential to patient adherence and compliance. To give your RPM program for hypertension management its best shot at long-term success, take care to select an initial group of patients you think can follow instructions and provide feedback as a beta before rolling out the program across your practice. This will give you a chance for your team to get comfortable and to adjust your processes and patient-facing documentation and explanations to make sure they are clear.

Additionally, the technology you use should be of top quality: reliable, appealing, and easy to use. The more wisely you invest in your products, the more likely it is that your RPM program will lead to better outcomes.

To find a top quality blood pressure monitor, look for a device

That has validated accuracy
That is simple to use (fewer buttons are usually easier!)
That has a range of cuff sizes or other features that are important to your patient demographic

Step 5: When picking eligible patients, consider reimbursement

Certain patients will be more optimal candidates for RPM than others, and, as always, insurance will be a factor.

Make sure your team is thoroughly knowledgeable on how reimbursement works, how Medicare and insurance providers treat RPM, and the specific billing codes you will use. These rules can change, and it’s important to keep up to make sure your program is an ongoing success.

Step 6: Spark enthusiasm across your organization

Every great team needs a cheering section. To make sure patients and stakeholders are fully on board with your organization’s new remote patient monitoring program for blood pressure management, don’t be afraid to get excited and share (HIPPA-compliant) success stories with your team and your patients. For patients, hearing that the program has positively impacted someone’s life, or for staff, knowing the financial difference this is making on the practice can help increase engagement and excitement.

Conclusion

By understanding the potential benefits of RPM and preparing for your program, you and your practice can be a part of the future of care. With a strong team and a clearly outlined process that is patient-focused, you will be set to improve patient outcomes and establish a profitable RPM practice.

If you’d like to know more about A&D Medical’s remote patient monitoring products, please contact our experts here.

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A&D Medical

Maximizing Patient Care: The Significance of Accurate Biometric Measurements and Reliable Data Transmission in Remote Monitoring

Maximizing Patient Care: The Significance of Accurate Biometric Measurements and Reliable Data Transmission in Remote Monitoring

Importance of accurate biometric measurements

The Crucial Role of Reliable Data Transmission

AOBP – How to get accurate office measurements

AOBP – Why it is the gold standard in office measurement, How to get accurate office measurements

The Importance of Validated Medical Devices

The Importance of Validated Medical Devices

Women and High Blood Pressure

Women and High Blood Pressure

Why are women affected?

Tips for women

An Ounce of Prevention

Get Active

Eat Heart-Healthy

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May Measurement Month

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Special Healthcare Provider ReportEnsuring Home Blood Pressure Monitors are Accurate for In-home Patient Use,Part I: Clinical Validation

Special Healthcare Provider Report Ensuring Home Blood Pressure Monitors are Accurate for In-home Patient Use, Part I: Clinical Validation

Clinical Validation

Other Factors

Reimbursement for Ambulatory Blood Pressure Monitoring

Reimbursement for Ambulatory Blood Pressure Monitoring

US reimbursement rates

Diagnosis codes

Learn more about ABPM

Ambulatory Blood Pressure Monitoring: A Thorough Approach to the Diagnosis & Treatment of Uncontrolled Hypertension

Ambulatory Blood Pressure Monitoring: A Thorough Approach to the Diagnosis & Treatment of Uncontrolled Hypertension

Diagnosing Hypertension

BP Patterns

The Solution

Screening with ABPM

ABPM Usage

Benefits of ABPM

Conclusion

Efficient and Effective Ambulatory Blood Pressure Monitoring (ABPM)

Efficient and Effective Ambulatory Blood Pressure Monitoring (ABPM)

Ensure Patient Compliance

Think in systems

Understand your results

6 Essential Steps to Implement a Remote Patient Monitoring Program

6 Essential Steps to Implement a Remote Patient Monitoring Program

Step 1: Assemble your team

Step 2: Clarify and codify your process

Step 3: Set your goals

Step 4: Make it easy on your patients

Step 5: When picking eligible patients, consider reimbursement

Step 6: Spark enthusiasm across your organization

Conclusion

Special Healthcare Provider Report
Ensuring Home Blood Pressure Monitors are Accurate for In-home Patient Use,
Part I: Clinical Validation