Hello bidding, goodbye patient compliance

Steep cuts to CPAP reimbursement under Round 2 of competitive bidding will have a dramatic impact on patients, say providers.

“That is based on equipment, and not on the equipment, the service and the documentation that it requires,” said Wayne Knewasser, vice president of public relations and government affairs for Louisville, Ky.-based Premier Home Care, which did not win bids. “It's a concern.”

When CMS announced Round 2 payment amounts, CPAP equipment and supplies took a cut of 47%, on average. Unlike most other products covered by Medicare, CPAP coverage is contingent on patient compliance. CPAP users must become compliant with the therapy within 90 days to continue use.

Providers that have high patient compliance rates have done so by creating high-touch patient models, something that may go by the wayside under competitive bidding.

“No one can afford all the hand holding that is needed to keep people compliant with therapy,” said Eric Cohen, president of National Sleep Therapy, which won several Round 2 contracts. “We are looking at how do we still deliver high quality services to Medicare patients in a financially sustainable way? It can't be the same level of care.”

A lot of the face-to-face services—which providers say are an important part of initial therapy—will be the first things to go.

“We use respiratory therapists to do set-ups and go out to the home,” said Sam Jarczynski, president of RxStat in St. Petersburg, Fla., which also won Round 2 contracts. “A lot of that's going to go away. Compliance (issues) are going to come from the lack of hands-on fitting.”

All this means higher healthcare costs down the road, say providers.

“I think what Medicare has set themselves up for is they are going to pay for equipment that sits with the patient for three months and then gets returned,” said Cohen. “They'll spend a lot of money on testing and it's all going to be for naught.”