'Challenging’ product put out to bid
BALTIMORE – CMS’s decision to include non-invasive vents in competitive bidding is a “knee-jerk” reaction to a spike in billing that could have adverse consequences for patients, say providers.
“I see the potential for some adverse effects, some failures, and some deaths,” said Bill Hart, director of clinical services for Auburn Hills, Mich.-based Advent Home Medical. “I have companies in mind that are all about quantity, not quality.”
CMS announced in April that it had added non-invasive vents (E0464) as a product category for Round 1 2017. The category will only be bid in eight of the 13 competitive bidding areas.
In September 2014, CMS launched a widespread prepay review for non-invasive vents in response to a spike in billing.
“It’s just a knee-jerk reaction to utilization,” Kim Brummett, senior director of regulatory affairs for AAHomecare. “If they see a spike in orthotics, is that next?”
Of primary concern for bidding vents is the lack of Local Coverage Determinations with specific coverage criteria. That could open the door for inexperienced providers to submit bids, say providers.
“It takes a specialty provider to do it correctly but nowhere in the guidelines does it say a respiratory therapist or other clinician is required to do setup,” said Ron Jenkins, CEO of Longwood, Fla.-based Respitec Medical. “These are challenging patients.”
Many of these patients also require oxygen—a separate category under the bid program. If a provider wins for one category but not the other, things could get complicated, providers say.
“I don’t know any vent provider that would let somebody else be part of the services,” said Bob Lichtenstein, president of Hollywood Medical Supply in Hollywood, Fla. “That’s just asking for a lawsuit or bad patient care.”
For Hart, the concerns go even deeper. While many vent providers focus on COPD patients, Advent Home Medical cares for patients with serious neuromuscular conditions like ALS and muscular dystrophy.
“We are trying to allow these human beings to have a little dignity and it would be shame to throw this into the bid arena and have the lowest bidder taking care of these patients,” he said. “With all the improvements in technology, we are able to ward off the need for immediate invasive ventilation.”
AAHomecare has put together a workgroup to assess issues related to vents, including whether it’s time to request an LCD for vents, said Brummett.