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?What about the Blood Pressure in Telemedicine?Medicare coverage of home BP measurement under some circumstances:Medicare covers ambulatory blood pressure monitoring for suspected white coat HTN or masked HTN: provider confirm the machine is accurate in office.Quality of home monitoring/Evidence base for HTN monitoring at homeThe USPSTF specifically states that "In addition to office blood pressure measurement, ABPM and HBPM may be used to confirm a diagnosis of hypertension after initial screening" (US Preventive Services Task Force, 2019).Reference: authors concluded that ABPM (24-hour, daytime, or nighttime) is a better predictor of long-term CV outcomes than OBPM (manual sphygmomanometry) and should be considered the reference standard for evaluating BP noninvasively.Blood pressure can be measured by patients at home or in other environments. A small body of evidence suggests, but does not confirm, that home blood pressure monitoring may predict patient outcomes (Piper et al, 2014). Whelton et al (2017) stated that home BP measurement maybe a more practical approach in clinical practice.Accuracy of Home BP Measurements Ringrose 2018 ()To address patient‐specific variability in blood pressure measurements, it has been proposed that patients should bring their home device to their practitioner for “calibration” testing. These involve performing five same‐arm sequential measurements and following a protocolized analytic plan to calculate mean differences between the device and auscultation. If the mean differences between sequential readings are <5‐10?mm?Hg as per the analytic protocol, the monitor is deemed acceptable.Allowable Vital Signs Under CMSTempWeightHRPainRRLMPBPOxygen saturationHeightGlucose CMS Regulations re: VSUnder CMS regulations there are numerous covered codes that would require vital signs, for example a transitional care management visit, diabetes management, etc. appears CMS is granting exceptions from reporting requirements and extensions for clinicians and providers participating in Medicare quality reporting programs with respect to upcoming measure reporting and data submission for those programs.MIPS eligible clinicians who have not submitted any MIPS data by April 30, 2020 will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year. based on timeCould recommend this approach too Guidelines for Live, On Demand Primary and Urgent Care, 2014. protocols should be developed for live, on demand services. Such protocols are beyond the scope of these guidelines and practitioners are advised to review specialty society guidelines and the evidence published in the peer-reviewed literature. However, protocols should include the following components: Named condition and corresponding ICD code; Scope of condition amenable to treatment by telemedicine based on medical evidence, or at a minimum, precedent for successful management based on peer-reviewed guidelines or expert opinion. The mode of intervention required to diagnose and treat the condition (i.e., under what circumstance and regulatory framework is telephonic care adequate, is videoconferencing required, are peripheral devices needed or other diagnostic tests, or is an in-person visit needed); Documentation required to appropriately assess the patient’s condition including history and any video-based examination including required components needed to visualize, demonstrate or test; Parameters under which the condition can be treated; Parameters under which the condition may not be treated and require referral to alternate modes of management; and Parameters under which prescribing can and cannot be done. ................
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