NHIA white paper outlines negative impact of competitive bidding on home enteral nutrition

ALEXANDRIA, Va. – The National Home Infusion Association (NHIA) has released a new white paper, “Trends in Home Enteral Nutrition—The Impacts of Competitive Bidding on Access and Quality,” that documents the declining payment structure for the clinical services needed to support patients on this therapy.  

An estimated 220,000 individuals in the United States rely on home enteral nutrition (HEN), a therapy that demands clinical coordination, specialized equipment, disease-specific nutrition formulas, and a multidisciplinary team to ensure safety, efficacy and quality of life, the NHIA says. 

The impact of competitive bidding and other payer policies 

Although government reports say that competitive bidding has not negatively impacted access to HEN, NHIA reviewed publicly available Medicare DME utilization data and found the number of suppliers billing for HEN kits has decreased by 31% over the past decade, while the number of Medicare beneficiaries accessing HEN has declined by 27%. 

The association says the market conditions created by competitive bidding may also influence other payer policies. One in four HEN providers are considering or planning to discontinue providing HEN formulas or supplies due to cost pressures, according to reports. 

NHIA recommends reforms 

NHIA believes that certain reforms would improve outcomes and the quality of life in HEN patients, while lowering the total cost of care. It recommends that CMS: 

• Perform a comprehensive study of HEN services, patient access and impacts on overall costs of care; 

• Develop new supplier standards to reflect clinical support expectations and standardized outcomes; and 

• Develop a new service code for clinical activities such as performing nutritional assessments, monitoring nutritional status, making formula changes, troubleshooting problems and providing nutrition education and support. 

Read the white paper.