Tug of war on utilization

I got a reminder recently that I’ve been meaning to log into the HME Databank to see the impact of the COVID-19 pandemic on utilization for respiratory equipment, particularly ventilators and oxygen concentrators. 

The Databank, if you’re not familiar, is a database of Medicare data on some of the most popular DMEPOS codes. It includes total Medicare spend by code for all the codes included in the competitive bidding program and more. The most recent year for which it has data: 2020 (with 2021 likely coming in August of 2022). 

The reminder was a reader who inquired about utilization for vents, noting that he suspected it has increased significantly, and it has, particularly for E0466. From 2016 to 2020, Medicare spend on this code increased from $217,379,582 to $466,715,153, or 114.7%. But these are non-invasive vents used in the home and, therefore, their utilization is unlikely to be impacted by the pandemic. The undercurrent at play, here, is a growing body of research supporting the use of NIV for patients with varying conditions. 

(It turns out the reader was asking because he’s concerned CMS will see the increase in utilization for NIV and include it in the next round of competitive bidding – that would be a mistake, needless to say.) 

Oxygen concentrators should be a different story.

Countless people with COVID-19 have been discharged to their homes on this therapy. 
From 2019 to 2020, Medicare spend on E1390 increased from $467,926,746 to $495,522,979, or 5.9%. For perspective, from 2018 to 2019 – pre-pandemic – Medicare spend increased from $452,353,044 to $467,926,746, or 3.4%. So, a bit of a ramp up in utilization, but not much. 

It’s worth noting that, while demand for oxygen concentrators increased in 2020 due to the pandemic, office visits to physicians decreased, particularly in the first half of the year, also due to the pandemic, creating a tug of war on utilization.  In fact, a recent report from the American Medical Association shows Medicare spending on physician services fell an estimated $13.9 billion, or 14% below expected levels, in 2020. 

Fewer office visits, fewer prescriptions for oxygen concentrators. 

(It probably says something about the huge number of people with undiagnosed obstructive sleep apnea that utilization for CPAP devices – not buoyed by the increased demand from the pandemic, only impacted by the decrease in office visits and sleep studies – still increased from $134,920,966 to $141,928,641, or 5.2%, from 2019 to 2020.) 

Things might look a lot different when we see 2021 data.

Office visits are back up, as health care orchestrates a delicate balance between continued care and virus mitigation as the pandemic stretches on. 

But we may find ourselves in a tug of war on utilization again in 2021, with increased demand tampered by supply chain challenges. 

Stay tuned.