Competitive Bidding Impacts Home Enteral Nutrition Access

ALEXANDRIA, Virginia—The National Home Infusion Association (NHIA) released a new white paper, “Trends in Home Enteral Nutrition—The Impacts of Competitive Bidding on Access and Quality,” which documents the declining payment structure for clinical services needed to support patients on home enteral nutrition. 

“An estimated 220,000 individuals in the United States rely on home enteral nutrition (HEN), which demands clinical coordination, specialized equipment, disease-specific nutrition formulas and a multidisciplinary team to ensure safety, efficacy and quality of life,” the organization said. 

In the paper, the NHIA said 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. The program has gone through several bidding and implementation phases, as well as pauses, and the organization said it is now in a temporary “gap period” awaiting a formal public notice and comment rulemaking process to make changes to the program.

“Although government reports indicate that competitive bidding has not negatively impacted access to HEN, NHIA reviewed publicly available Medicare [durable medical equipment] utilization data and found 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 said. “The market conditions created by competitive bidding may influence other payor policies as well. According to reports, one in four HEN providers are considering or planning to discontinue providing HEN formulas or supplies due to cost pressures.”

NHIA said it believes that certain reforms would improve outcomes and the quality of life in HEN patients, while lowering the total cost of care. It continued that the Centers for Medicare and Medicaid Services should perform a comprehensive study of HEN services, patient access and impacts on overall costs of care; newly developed supplier standards should reflect clinical support expectations and standardized outcomes; and a new service code should be added for clinical activities such as performing nutritional assessments, monitoring nutritional status, making formula changes, troubleshooting problems and providing nutrition education and support.