Last week, several leading respiratory clinician groups submitted a reconsideration of the current Medicare National Coverage Determination for home ventilators, including bi-level devices, to CMS, the American Association for Homecare reports.
The request from the American Association of Respiratory Care, the American College of Chest Physicians and the National Association for Medical Direction of Respiratory Care calls for establishing specific definitions of chronic respiratory failure, as well as for mechanical ventilators/ventilation and ensuring that objective, consistent and clinically beneficial criteria is used in providing these products for patients.
Specifically, the groups’ suggested definition of respiratory failure (is the inability of the respiratory system to maintain gas exchange within normal limits. For oxygen failure, this would be the inability to maintain PaO2 of 60mmHg or greater on room air. For ventilatory failure, this would be the inability to maintain PaCO2 of 45mmHg or below.
AAHomecare reports that the groups submitting the request for reconsideration briefed its clinical ventilator work group on their proposal last week; early feedback has been positive.
“We are pleased with the engagement of pre-eminent pulmonologists to help direct ventilation policy changes in a way that are in alignment with appropriate care of these patients and will help facilitate optimal utilization of this therapy,” noted Julian Husbands, senior vice president of marketing and clinical for Apria Healthcare. “We are moving in the right direction with these groups to have a clear medical policy to ensure that patients qualify versus the current environment of not knowing whether or not you will be paid for a critical therapy.”
“These leading respiratory and pulmonary groups have prepared an exceptionally thorough position statement addressing a pressing issue affecting patients and clinicians alike, employing sound peer-reviewed clinical evidence and ‘real world’ experience,” Nick Macmillan, a member of AAHomecare’s HME/RT council, had this to add. “Their contention that ‘Current reimbursement policy focuses on devices rather than the clinical situation’ is indeed welcomed and refreshing.”
“We appreciate the spirit of collaboration these groups have shown in sharing their perspectives with us,” added AAHomecare President and CEO Tom Ryan. “Respiratory providers and patients alike will benefit if these recommendations help shape future policy.”