CMS’s new vent guidelines spark provider adjustments

YARMOUTH, Maine – New coverage guidelines for home mechanical ventilation (HMV) are now in effect, and respiratory providers say they’re ready to help patients succeed in therapy, but they warn that some requirements may be difficult to meet. 

The guidelines, released June 9 and implemented Oct. 22, expand coverage of respiratory assist devices (RADs) for chronic respiratory failure, which is often associated with COPD; and establish coverage for HMVs for COPD. They come with several new requirements, including compliance monitoring and arterial blood gas (ABG) testing. 

“The biggest adjustment was dedicating time to refresh training, update our internal checklists, and make sure staff and ordering physicians were fully aligned with the new CMS requirements,” said Katelyn Fincher, respiratory care manager at M.R.S. at Home in Tifton, Ga. “Our foundation was already solid, so these were more refinements than big changes.” 

Compliance thresholds raise concerns for patient access  

One major change that concerns providers: Patients must use HMVs at least four hours per day on 70% of days in a 30-day period as determined by a clinician. With such a hard and fast rule, they worry about patients on the fringes of compliance and the implications of stopping their therapy. 

“We have processes in place to help patients understand what's at risk and understand that compliance is a key part of this therapy and we are 100% going to do everything we can to get patients their very best shot,” said Dr. William Frazier, chief medical officer at Viemed, based in Lafayette, La. “My real concern is the guy who barely misses compliance. If he's just under (the compliance requirements) – if he comes in at 3.5 hours or only uses it 60% of the time – he's endangered and that worries me.” 

The work of tracking usage is less of an issue, providers say. 

“(Tracking) has always been our policy,” said Brian Wilson, COO of Commonwealth Home Health Care in Danville, Va. “We already monitor oxygen compliance and if they’re not using the machine, we’re going to recommend it be picked up. Our patients are compliant.” 

ABG testing could pose rural challenges 

Another change raising concerns: Arterial blood gas (ABG) testing that’s now required for eligibility for both RADs and HMVs and within six months of starting therapy. In areas where these tests are not readily available in outpatient settings, the requirement may limit access, providers say. 

“That follow up for ABGs is not readily available a lot of times in rural areas,” said Wilson, “So, you run into problems when the patient can’t meet requirements and it’s not because of their clinical condition, it’s that they don’t have a way to get to a hospital to get the blood gas done.” 

The industry had specifically urged CMS to delay implementing this requirement. 

Future clarity expected 

Providers expect additional questions and guidance as they adapt to the new rules. 

“We continue to be in close contact with CMS as we are getting going to get some more clarity about exactly what some of the rules require,” Frazier said. “There'll be more conversation and more clarity in the future.” 

• Related: Win for patients, challenges for providers in new vent policy.  
• For more information: See CMS Change Request 14177.