Vulnerable patient population at risk

Tuesday, May 26, 2015

By including non-invasive vents in competitive bidding, CMS has “overlooked” the most fragile patients: those with serious neuromuscular conditions, say providers.

Brian Simonds serves, on average 40 vent patients at any given time—three or four of whom have conditions like ALS. He describes them as patients in wheelchairs who maintain active lifestyles, thanks to vents.

“These are extremely vulnerable people,” said Simonds, director of Baystate Home Infusion & Respiratory Services in Springfield, Mass. “But, they’re kind of mobile, and they use the vents as a kind of sip and puff.”

Most neuromuscular conditions are degenerative, but non-invasive vents can stave off tracheostomies and invasive ventilation, say providers. 

“Under competitive bidding, that’s going to change and people are going to get overlooked,” said Bill Hart, director of clinical services for Auburn Hills, Mich.-based Advent Home Medical.

Hart worries that if the bidding program causes upheaval in the non-invasive vent market, it could have a ripple effect, causing physicians to go with invasive ventilation instead.

“There are deeper decisions for patients being trached instead of trying to live another year with non-invasive ventilation,” he said.

With such a high-risk population, putting life-sustaining equipment out to bid downplays what HME providers do best, they say.

“The whole bid process is racing to the bottom and destabilizing what we do, which is keep very high-risk patients at home,” said Simonds. “If you are going to start playing around with this benefit, it’s scary.”