Massachusetts: Providers stave off vent cut

Monday, April 25, 2011

BOSTON - Providers here scored a victory in February when Blue Cross Blue Shield of Massachusetts backed off its plan to cap ventilator payments.

"BCBS reached out to us to really understand the issue and reversed their decision," said Brian Simonds, director of Springfield-based Baystate Home Infusion and Respiratory Services. 

In July 2010, the insurer sent out a confidential request for information (RFI) to providers, with an eye to reducing its provider network and reducing payments. Then BCBS announced in November that it would begin capping ventilator payments at 13 months on Jan. 1, 2011, and proposed creating a maintenance and service payment every six months.

"That's just completely inappropriate (for vents)," said Karyn Estrella, executive director of The New England Medical Equipment Dealers association. "This is equipment that has a high level of service and clinical oversight."

Simonds wrote a letter outlining the clinical value of ventilator therapy.

"We do a fair number of vents," said Simonds. "All the points that I tried to raise really brought it to their attention that this was not an equipment transaction." hme