Competitively bid vents? Providers fear worst

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Friday, November 15, 2019

YARMOUTH, Maine – There are too many unknowns and there is too much at stake for CMS to include non-invasive ventilators in its competitive bidding program, providers say.

The “Safeguarding Medicare Access to Respiratory Therapy (SMART) Act of 2019,” introduced last month in the House of Representatives, would help to finally create a comprehensive coverage policy governing the use of non-invasive vents in the home, they say.

“I’ve been pushing for standards of care since I could remember,” said Roxanne Vennard, president of Ascent Respiratory Care in Greenwood Village, Colo. “What we are all striving for are better quality outcomes.”

H.R. 4945 calls for the creation of a technical expert panel to help the Department of Health and Human Services develop a policy for non-invasive vents.

The bill would also delay the inclusion of non-invasive vents in the bid program for five years, but providers would like to see them excluded permanently. The level of care and service for vents is high and also varies by patient, something the program doesn’t account for, they say.

“We’ve got patient disease severity—nothing is addressed there,” said Max Hoyt, vice president of government relations for Lafayette, La.-based Viemed Healthcare. “There are no minimum levels of service and there are lower-quality vents that only generate low pressure.”

CMS recently sent all bidders in the non-invasive vent category bona fide documentation request letters, asking them to substantiate their bids, something stakeholders support.

“We’ve put a lot of pressure on CMS to do more bona fide bid checking,” says Kim Brummett, senior director of regulatory affairs for AAHomecare. “There’s lots of concern over the vent category because of all the things that go into servicing the patient that nobody sees.”

Still, Hoyt fears the bid program, with its hyper focus on driving down costs, will create a race to the bottom non-invasive vents.

“You’ll get the lowest-priced equipment with a minimum amount of service and (some contract suppliers) taking only the least sick patients out there,” he said. “The incentives are in the wrong areas. The patient is going to lose and the good providers offering high-touch service will be penalized, as well.”