Home Mechanical Ventilators' Removal From Competitive Bidding 2021 Represents a Big Win for Respiratory Patients

JUNE 2020

Home Mechanical Ventilators' Removal From Competitive Bidding 2021 Represents a Big Win for Respiratory Patients

In a big win for patients needing home mechanical ventilation (HMV), the Centers for Medicare and Medicaid Services (CMS) has removed the HMV product category from Round 2021 of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program as a result of COVID-19. This action is the culmination of long-term efforts by organizations including CHEST, NAMDRC, the American Association for Respiratory Care, the American Thoracic Society, the Amyotrophic Lateral Sclerosis Association and pulmonologists across the country to ensure the quality of life for their patients needing HMV.

The HMV device can of course be used both invasively with a secured airway using a tracheostomy tube or non-invasively with a mask known as non-invasive ventilation (NIV) but the greatest concern for the pulmonary community is related to HMV use for NIV. As Peter Gay, MD, pulmonologist at the Mayo Clinic, Rochester explains, “This action puts a halt for now on the bidding process and the planned roll-out date of January 2021, but we should be reminded this represents only a delay and not a complete elimination of this plan. The immediate fear regarding HMV for NIV use was that physicians would need to develop alternative care plans for their patients-- including the consideration of a much more intrusive tracheostomy; reducing quality of life and requiring major lifestyle change for many patients so this has, at the least, been delayed. Especially in the COVID recovery environment and the already disastrous consequences to many durable medical equipment (DME) providers, this should not interrupt the flow of home mechanical ventilation to those in need.”

Round 2021 was the first time that Medicare had included HMVs in the DMEPOS Competitive Bidding Program. By removing HMVs from Round 2021 of the DMEPOS Competitive Bidding Program, any Medicare-enrolled DMEPOS supplier can furnish any of the types of ventilators where indicated and it should be covered under the Medicare program for invasive or NIV use. CMS is removing HMVs from Round 2021 of the DMEPOS Competitive Bidding Program due to the novel COVID-19 pandemic, the President’s exercise of the Defense Production Act, public concern regarding access to ventilators, and the HMV product category’s being new to the DMEPOS Competitive Bidding Program.

Dr. Gay indicated this may signal a more cooperative approach to the needs of respiratory patients, “For years both medical societies and patient advocate groups have been struggling with the issues regarding competitive bidding of DME. The fear, of course, for any and all DME is the same in that competitive bidding would drastically reduce the availability of equipment and services for home mechanical ventilation.”

“The crucial importance of this became prominent when home oxygen went into a competitive bidding category and all but eliminated the availability of liquid oxygen in the home due to a very unfavorable reimbursement rate,” according to Dr Gay. “That had the disastrous consequence of severely limiting the mobility of patients who were very oxygen dependent, which is vitally important to their rehabilitation and, therefore, survival. The patients most in need of home mechanical ventilation were indeed a relatively small population and represent a minuscule overall cost savings for CMS; however the situation had a huge impact on the most needy population of all, including the patients with progressive neuromuscular disease and end-stage COPD to the point of risking death. A huge reduction in the availability of home mechanical ventilation for those using a noninvasive interface had already occurred when the local coverage determination was announced unexpectedly on October 1, 2015 , effectively putting a halt to this use except for patients at ‘risk of imminent death,’ which was very difficult to define,” he explained.

Like many NAMDRC members and especially championed by the executive director, Philip Porte, Dr Gay has been a long-time advocate for ensuring that patients receive the best devices suited to their specific clinical needs. Dr Gay concluded, “Never before have pulmonary, critical care and sleep physicians attained such appreciation for their unique skills and I believe that there is a new realization at the CMS and even higher levels. When CMS with its tremendous resources partners with specialized physicians who determine the best course of action, amazing and clearly lifesaving achievement can take place.”

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