CPAP bundling: ‘Fix’ for non-existent problem

Friday, December 5, 2014

WASHINGTON – Providers don’t know what to make of CMS’s plan to implement bundled payments for CPAP, but say they doubt it’s a good thing.

“There’s nothing to go by yet, but the sheer concept is counterintuitive as far as patient care,” said Chris Rice, CEO of Riverside, Calif.-based Diamond Respiratory Care. “We want to keep them compliant and keep good supplies on them, but now we are flipping the coin and creating an incentive to provide fewer supplies.”

CMS has yet to release any further information about bundling, including identifying the 12 demo areas and what codes will be included.

One big question: how to account for supplies. Current Medicare guidelines allow supplies like cushions, headgear, tubing and filters to be replaced every three months. 

But every patient is different, say providers.

“You never have any idea of the frequency of supplies for specific people,” said Erik Parkhill, vice president of clinical operations/corporate compliance for Home Medical Professionals in Gainesville, Ga. “One may have so many a year and another may have three times as much. You’d have to do a lot of research back through the years and figure out your usage so that part is complicated.”

Bundling could also complicate basic business practice, say providers.

“It gives us less ability to see margins and it will make it impossible to figure out what’s making us money and what’s not,” said John Eberhart, president of Farmington, N.M.-based Eberhart Home Health. “It’s just another way to cut into reimbursement.”

Stakeholders believe CPAP was targeted for bundling because of its high utilization rates, but CMS already has safeguards in place to ensure providers aren’t billing for excess supplies, say providers.

“We already have to call patients and ask them about the functionality of each item and if they don’t need something we are finding that they don’t order it,” said Eric Cohen, president of Concord, N.H.-based National Sleep Therapy. “It seems like a fix for a problem that doesn’t really exist.”