Editor's Note

Truly Misguided Decision-Making

CMS is doubling down on including non-invasive vents in Round 2021. How is the HME industry responding? How can you help?

• By David Kopf
• Dec 01, 2019

Doesn’t it drive you nuts when someone doubles down on a bad idea? What level of intractability do you have to achieve to commit to a position that you know, deep down, is simply awful to hold? I’ve been asking myself that since CMS announced in March that it would add non-invasive ventilators to the list of products covered by Round 2021 of competitive bidding.

At the time, the level of shock from the industry was understandably severe — we’re talking about vulnerable patients that use these devices. People who use non-invasive vents include patients with neuromuscular diseases such as ALS, as well as end-stage COPD and other terminal respiratory conditions. From my point of view, the decision seemed downright cruel. I think Tom Ryan, the president and CEO of the American Association for Homecare put it well at that time:

“Subjecting these highly specialized, service-intensive products to a reimbursement methodology designed to find the lowest-cost providers will ultimately have the effect of further narrowing the relatively small number of companies that supply ventilators and driving some of the most effective and caring vent providers out of the Medicare program,” he stated back then. “Access to these ventilators will become more limited and many current patients will be separated from companies and respiratory professionals who have been with them for years.”

Sharing the industry’s shock, Reps. Morgan Griffith (R-Va.) and Peter Welch (D-Vt.) circulated a Congressional sign-on letter in the House in May that asked HHS Secretary Alex Azar and CMS Administrator Seema Verma to reverse the decision to add non-invasive ventilators to Round 2021.

The House letter made clear that Congress “never specifically directed the Secretary to competitively bid ventilators, and Medicare has never attempted to bid any items within its entire DME category of devices requiring frequent and substantial servicing.” The letter went on to say, “CMS has never proposed including ventilators in the program through rulemaking and we would encourage you to solicit such input on the record before doing so.”

In October, Verma responded individually to the 180 Representatives that signed Reps. Griffith’s and Welch’s letter, saying that Medicare had implemented measures to protect access. However, the response didn’t address other concerns in the House sign-on letter, such as the idea that CMS needed to ensure that Medicare payment for critical services such as home ventilatory care were adequate, as well as the fact that up until its vent decision, CMS had never included items that required frequent and substantial servicing as part of its bid program.

Rep. Griffith responded to CMS’s “non-response” in comments he made later that month in a hearing on Administration healthcare policy by the Oversight & Investigations Subcommittee of the House Energy & Commerce Committee.

“I just got your letter yesterday afternoon in response to that letter, where you said we’re not going to do it on invasive,” he stated. “But here’s the problem I have: I have a rural district, as does my friend Mr. Welch. What happens is that if you go to this cost-only issue, you’re going to make someone drive 45 minutes to an hour … if the low-cost supplier is only located in town. I would ask you to really take a look at that because, in the rural districts, our folks are not going to get served.”

At that point, there was really only one response left: legislation. Rep. Griffith and Rep. Welch were joined by Reps. John Larson (D-Conn), Darren Soto (D-Fla.) and Gus Bilirakis (R-Fla.) to launch The Safeguarding Medicare Access to Respiratory Therapy (SMART) Act, a House bill that would delay the inclusion of all types of ventilators in competitive bidding by five years.

Now it’s time for everyone in the industry to advocate on behalf of this bill. Contact your Representative and urge that he or she co-sponsor this critical legislation. The stakes are too high.

This article originally appeared in the Nov/Dec 2019 issue of HME Business.