The hypertension "epidemic" hearkens back to boxer Joe Louis' words regarding a smaller, quicker opponent — light heavyweight Billy Conn, "You can run, but you can't hide!"
No matter what specialty of medicine or surgery you practice, or whether you are a primary-care provider, elevated blood pressure represents a recurring problem that will not go away. Furthermore, hypertension is often accompanied by comorbid conditions such as diabetes mellitus, obesity, CKD-3, and systolic dysfunction which complicates blood pressure treatment, according to researchers at University of Miami Miller School of Medicine.
The downside of this epidemic is clear, untreated blood pressure is fraught with multiple target organ complications. In fact, approximately 80 percent of first strokes are a consequence of preventable risk factors such as hypertension. According to the University of Miami researchers, as many as 80 percent of first stroke patients have hypertension compared to the 47 percent with a lipid disorder, 34 percent with diabetes, and 15.1 percent who smoke.
Since the management of hypertension is both demanding and iterative — often squeezed into a 20-minute time slot amidst a bewildering array of A1Cs, and other health maintenance requirements — identifying and treating blood pressure appropriately should be rewarded. There is no doubt that blood pressures below target are a laudable goal adding quality years to patients' lives. But on another level, does all the time and effort dedicated to hypertension improve a hardworking physician's bottom line?
Financial Incentives
A recent article in Medical Economics which addressed Hepatitis C management in the context of MACRA (Medicare Access and CHIP Reauthorization Act) — a Merit-based Incentive Payment System (MIPS) —observed that providers will receive either a bonus or penalty depending on the quality of their practice. The MACRA program has the potential to significantly reward providers for the effective management and reporting of patient care. There are many factors determine payment under MACRA, but the main theme is the more effective and accurate a provider can be in the diagnosis, management, and reporting of patient care (whether it be hypertension or any other condition), the more potential there will be for that provider to receive increased revenue. This represents a transition from the old fee-for-service reimbursement methodology to a quality-focused, "Merit-Based" formula. In other words quality is replacing quantity.