ORIGINAL
PAPER
Rationale for Establishing a Mechanism to Increase Reimbursement to Hypertension Specialists William J. Elliott, MD, PhD;1 Brent Egan, MD;2 Thomas D. Giles, MD;3 George L. Bakris, MD;4 William B. White, MD;5 Torry M. Sansone6 From the Division of Pharmacology, Pacific Northwest University of Health Sciences, Yakima, WA;1 Department of Medicine, The Medical University of South Carolina, Charleston, SC;2 Department of Medicine, Tulane University School of Medicine, New Orleans, LA;3 Department of Internal Medicine, The University of Chicago, Chicago, IL;4 Department of Internal Medicine, The University of Connecticut School of Medicine, Farmington, CT;5 and The American Society of Hypertension, Brooklyn, NY6
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. J Clin Hypertens (Greenwich). 2013;15:397– 403. ª2013 Wiley Periodicals, Inc.
In the most recent National Health and Nutrition Examination Survey (NHANES 2007–2008), approximately 29% of American adults had hypertension.1 Although the prevalence of hypertension has remained stable since 2000,1 the age-associated increase in hypertension prevalence, and the increase in the absolute numbers of older Americans2 leads to the conclusion that, in 2010, approximately 77.8 million American adults were affected, making this the most common form of cardiovascular disease in the United States.3 Nationwide data indicate that hypertension has the highest population-attributable risk for stroke (the fourth leading cause of death in 2010, the most recent data currently available,4 and the leading cause of permanent disability since 1928), is one of the three most important risk factors for heart disease (which has been the leading cause of death in the United States from 1917 to 20104), is a major predisposing risk factor for heart failure (the number one cause of hospitalization in Medicare beneficiaries since 1990), and a major cause of end-stage renal disease (the most expensive item, on a per-person-year basis, in the Federal budget).3 In addition, hypertension is the third most significant risk
factor for peripheral vascular disease (the most common cause of lower-limb amputations), and the number one risk factor for vascular dementia (the number 8 cause of death in 2010, and the second-most common cause of nursing home placement). Perhaps because hypertension is the most common reason for an adult to consult a physician for treatment of a chronic condition,3,5 the cost of hypertension in 2009 in the United States was estimated at $50.1 billion.3 More importantly, the National Committee on Quality Assurance (NCQA) has calculated, nearly identically for the past 8 years (2002–2010), that better control of hypertension nationwide would be the medical intervention that is likely to save the most lives (5217–61,490), and the second most hospital dollars ($1.348 to $2.052 billion) annually, based on otherwise unexplained variations in medical costs.6
Address for correspondence: William J. Elliott, MD, PhD, Professor of Preventive Medicine, Internal Medicine and Pharmacology, Pacific Northwest University of Health Sciences, 200 University Parkway, Yakima, WA 98901 E-mail:
[email protected] Manuscript received: February 2, 2013; accepted: February 10, 2013 DOI: 10.1111/jch.12090 Official Journal of the American Society of Hypertension, Inc.
HETEROGENEITY OF HYPERTENSION Hypertension is a complex condition that varies greatly in severity. Although there was once the hope that a single medication, given once daily, might be able to control blood pressure (BP) in the majority of patients with the condition, recent data indicate that the majority of patients require 2 medications to achieve and maintain BP control (traditionally defined as BP
