As the Centers for Medicare & Medicaid Services (CMS) prepares to relaunch its Medicare competitive bidding program for home medical equipment, the National Home Infusion Association (NHIA) is reminding stakeholders of the effects of past programs on home enteral nutrition (HEN).
A new NHIA white paper pointed out reductions in both the number of HEN providers serving Medicare patients and Medicare patients accessing HEN care during previous competitive bidding rounds.
The Sept. 30 report — Trends in Home Enteral Nutrition: The Impacts of Competitive Bidding on Access and Quality — also discusses reduced funding levels “for clinical services needed to support patients on home enteral nutrition,” the association said in an accompanying press release.
“An estimated 220,000 individuals in the United States rely on HEN, which demands clinical coordination, specialized equipment, disease-specific nutrition formulas, and a multidisciplinary team to ensure safety, efficacy and quality of life,” the press release said. “But the Medicare competitive bidding program, introduced in 2011, changed reimbursement, resulting in a model that lacks payment for the post-acute clinical services necessary to support positive patient outcomes on HEN.”
Numbers of HEN providers, beneficiaries both decreased
The white paper noted that the numbers of Medicare suppliers providing HEN services and Medicare beneficiaries using HEN both declined in earlier competitive bidding iterations.
“Despite reports that competitive bidding has not negatively impacted access to HEN, a review based on publicly available Medicare DME utilization data shows the number of suppliers billing for HEN kits has decreased by 31% over the past decade, while the number of Medicare beneficiaries accessing HEN
has declined by 27%. NHIA believes this negative trend would not have occurred without the CBP [competitive bidding program].”
The NHIA added that despite the actual downward trend, “HEN utilization would be expected to rise since 2014 based on (1) the growing number of older adults and (2) higher total Medicare enrollment.
“The 65+ population continued to grow rapidly through the 2010s and 2020s, reaching approximately 61.2 million in 2024 (up 3.1% from 2023 to 2024). Aging is tightly linked to conditions that commonly lead to tube feeding (stroke, neurodegenerative disease, cancer treatment sequelae), so a larger older cohort implies higher potential HEN need.”
The inability to find HEN support at home can create a discharge bottleneck when Medicare patients are ready to transition from acute to post-acute care, the white paper noted.
“Hospitals that discharge patients in need of enteral therapy do not have the nutritional support services to continue to manage their needs while on HEN, especially in rural areas,” the report said. “Reimbursement compression for home HEN has caused many Medicare suppliers to cut back on their nutrition support programs, leaving a void for the ongoing clinical management of HEN.”
Competitive bidding’s potentially wider impact
And as usual, there’s the concern that Medicare policy and funding rates could cause other payers to follow suit.
“Competitive bidding may influence other payors’ reimbursement rates, which could jeopardize access to EN [enteral nutrition] care in the home,” the white paper said. “According to reports, one in four EN providers are considering or planning to discontinue providing EN formulas or supplies due to cost pressures.”
The white paper referenced researchers from large health systems in the United States who were interviewed for a different report.
Those researchers “shared their experience with a lack of systemic support for patients discharged from the hospital to their home on EN. They identified that the lack of support for outpatient care was limited due to financial barriers, coordination of care transitions, and the high complexity of care for home EN patients.”
NHIA’s report expressed concern about how competitive bidding could reduce “clinical support intensity, such as patient and caregiver education, delivery, setup and follow-up assessments.”
The association also noted that providers and industry groups worry “that low bids, especially under lead-item pricing, may reduce reimbursement for vital specialized formulas by 15-40%, potentially making high-acuity, medically complex nutrition less sustainable or accessible.”
