Presentation to MEDCAC Panel on NIPPV in Patients With COPD

AUGUST 2020

Presentation to MEDCAC Panel on NIPPV in Patients With COPD

In response to an invitation from the Medicare Evidence Development and Coverage Advisory Committee (MEDCAC), Lisa Wolfe, MD, FCCP, was chosen to represent CHEST at the July 22 panel. Dr. Wolfe presented scientific evidence on the types of noninvasive positive pressure ventilation (NIPPV) equipment that best support patients with chronic respiratory failure consequent to COPD. Dr. Wolfe is a member of CHEST’s Health Policy and Advocacy Committee and is a Professor of Medicine (Pulmonary and Critical Care) and Neurology at Northwestern University’s Feinberg School of Medicine. She is an expert in NIPPV therapy and home-based devices.

In advising MEDCAC in a written letter, CHEST leaders also pointed out that the severe COPD patient population is typically an amorphous group; in many cases patients present with overlapping clinical syndromes. These areas of overlap/comorbidities include OSA and obesity hypoventilation with severe COPD. A patient’s comorbidities frequently define different equipment needs for specific therapy. Their letter went on to emphasize that many patients requiring NIPPV in the outpatient setting are not only patients with COPD or represented in the overlap syndromes, but also include post-COVID-19 respiratory failure; end stage lung disease due to other disease groups, such as pulmonary fibrosis or other interstitial lung disease; neuromuscular diseases causing respiratory failure; thoracic restrictive disorders; and central sleep apnea.

They continued to advise that any comprehensive policy addressing home mechanical ventilation will require additional review to address these disease states as well as the appropriate devices to support these patients. Given the costs associated with the use of home mechanical ventilation (HMV) and the rapidly advancing technology and capabilities of equipment, CHEST suggested forming a technical expert panel (TEP) to provide recommendations to CMS to update the now-outdated national coverage determination.

From a historical perspective, the original respiratory assist device guidelines were established through a CHEST/NAMDRC task force dating back to 1998.

The new TEP would bring those recommendations up to current standards. CHEST would plan to join related societies in a TEP to make recommendations to CMS for revising the coverage policies, including defining chronic respiratory failure, mechanical ventilation, and mechanical ventilators. Whether CMS chooses to move forward in this effort themselves or prefers the clinical community to move ahead on its own, the letter stated that there is now urgency to begin. The HPAC is aware that most pulmonary medicine providers are frustrated by the current rapid expansion of HMV. TEP is a pathway to help to change the guidelines to get the right device to the right patient.

Watch future issues of Washington Watchline for further information on outcomes and actions from the MEDCAC panel meeting.

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