Vent providers fear worst

YARMOUTH, Maine - The lack of clear guidance for non-invasive ventilators could make it difficult to calculate bids for the product and could, ultimately, compromise patient care, say providers.

“The fact that we do not have rules surrounding how often we should be in the home will make it difficult for providers to bid on a high-service package,” said Max Hoyt, vice president of government relations for Lafayette, La.-based Viemed Healthcare. “This sets the industry up for bidding on equipment drop-off models only, which will be detrimental for patient care.”

CMS caught stakeholders by surprise in March when it announced non-invasive vents would be included in Round 2021 of the competitive bidding program, despite receiving several hundred comments arguing against it.

While there is a vague National Coverage Determination for vents, CMS has declined requests from the pulmonary community to issue Local Coverage Determinations, say providers.

“I'm still calling on CMS to develop a concrete LCD with empirical criteria that defines respiratory failure and what is needed for a patient to qualify for NIV therapy,” said Eric Mongeau, vice president of sales & marketing for Norwood, Mass.-based Reliable Respiratory.

CMS has sought for several years to reduce utilization for non-invasive vents. The agency included them in Round 1 2017 of the bid program, a plan it eventually scrapped; and reduced reimbursement by about 33% in 2016.

“They decreased the reimbursement and now they are trying to bid it out of existence,” said Gregory LoPresti, CEO of Clinton, N.Y.-based Upstate Homecare. “Whether it's Medicare or other payers, they just want to know, 'Is someone willing (to accept the reimbursement)?' Yes, but is it safe? Does that mean it's OK?”

Further indication that CMS doesn't understand what's involved with providing non-invasive vents: a new bid structure that is based on lead-item pricing. While other categories, including walkers and commodes, also include related items and accessories, the vent category does not.

“We provide a lot of ancillary items that those patients need free of charge, and a lot of clinical support free of charge,” said Jack Hogan, president and CEO of Waterbury, Conn.-based Health Complex Medical. “That's all baked into that one reimbursement. We're really just being asked to cut our rate and offer no other support.”

While so far, the industry's arguments seem to have fallen on deaf ears, stakeholders say they plan to continue to fight.

“We remain committed to being engaged with Congress and CMS,” said Hoyt. “We all have to raise our voices in unison to get CMS to do the right thing for our patients.”