Vents: Stakeholders disagree on way forward

Friday, September 23, 2016

WASHINGTON – Despite widespread agreement that the ventilator product category needs major improvements, the HME industry is divided on how that should be done.

“We have a lot of support on Capitol Hill, but some of the large manufacturers and AAHomecare are opposing it,” said Stephen Cooper, counselor at K&L Gates, which has provided “technical support” to Congress for recently introduced bills that would create medical necessity standards for determining the appropriate use of vents and would provide a 20% increase in reimbursement on Jan. 1.

The BREATH Act was introduced in the House of Representatives (H.R. 6012) by Rep. Larry Bucshon, R-Ind., on Sept. 13, and in the Senate (S. 3195) bySens. Bill Cassidy, D-La., and Chuck Grassley, R-Iowa, in July.

AAHomecare dislikes how the bills tie together the 20% increase in reimbursement for vents with a decrease in utilization by 20%. Per the bill, if utilization for vents doesn’t go down 20% in 2017, the government has the authority to cut reimbursement the following year by the difference between 20% and the actual decrease in utilization.

“The bill gives you a bump for one year,” said Tom Ryan, president and CEO of AAHomecare. “Who knows what the utilization will be?”

AAHomecare prefers a revamp of the national coverage determination for vents. Several pulmonary groups, including the American Association of Respiratory Care, the American College of Chest Physicians and the National Association for Medical Direction of Respiratory Care, have asked CMS to reconsider its NCD. In particular, they would like the agency to create a specific clinical definition of respiratory failure, as well as definitions for mechanical ventilators/ventilation, and to create objective, consistent criteria for providing the products.

“This bill allows the (Department of Health and Human Services) secretary to establish policies and standards for determining the appropriate use for ventilators when they don’t even define ventilators properly,” Ryan said.

Cooper says that, while it’s challenging not to have everyone on board with the bills, plenty of rank-and-file providers support it. It all depends on their patient mix.

“If you’re a provider of vents and you want to treat really sick people, you are getting killed,” he said. “If you are providing vents to sleep apnea patients with very mild COPD, you are still doing OK.”