How’s that for reason?


While trying to parse together the news last Friday that CMS was dropping non-invasive vents from Round 1 2017, Managing Editor Theresa and I came to the conclusion that the agency figured out it needed to work out some kinks with this product category before putting it out to bid.

“How refreshing” was, I think, Theresa’s reaction.


This is not to say, of course, that non-invasive vents won’t be included in a future round of competitive bidding, but it’s evidence, nonetheless, that there is some sense of reason at CMS.

Theresa will be calling the usual suspects this week to get further intel on CMS’s decision to drop non-invasive vents from competitive bidding and overhaul the product category.

Why is the agency dropping five existing codes and replacing them with two new codes? Why does it believe this will help to prevent the codes from being used to bill for pressure support vents that are used as positive airway pressure devices for treating OSA rather than respiratory failure?

Something that would help to restore reason to this product category: local coverage determinations with specific criteria for vents. Will this be part of CMS’s overhaul? One can hope.

Reason and CMS came to mind this week, too, when I read the results of a study concluding that Medicare beneficiaries in the initial nine test markets for competitive bidding are receiving only a portion of the diabetes supplies they need. As a result, there was a higher number of deaths and hospitalizations in these markets in 2011, according to the study’s backers, the National Minority Quorum.

The forum argues that CMS needs to be held to the same standards as other clinical trials involving humans.

“A clinical trial’s safety review board looking at these findings would stop a trial out of an abundance of caution for patients,” said the forum’s president and CEO, Gary Puckrein.

How’s that for reason?