Leading Respiratory Clinician Groups Seek Changes to Ventilator NCD

WASHINGTON, D.C. (April 7, 2016)—Recently, the American Association of Respiratory Care, the American College of Chest Physicians and the National Association for Medical Direction of Respiratory Care submitted a reconsideration of the current Medicare National Coverage Determination for home ventilators, including bi-level devices to CMS.

The request is aimed at 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. 

Their suggested definition of respiratory failure (from page 7 of the report) is the inability of the respiratory system to maintain gas exchange within normal limits:

• Oxygenation failure—inability to maintain PaO2 of 60mmHg or greater on room air
• Ventilatory failure—inability to maintain PaCO2 of 45mmHg or below

The groups submitting the request for reconsideration briefed AAHomecare’s clinical ventilator work group on their proposal last week; early feedback has been positive. 

Julian Husbands, senior vice president, marketing and clinical for Apria Healthcare, said, “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.  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.”

Nick Macmillan, a member of AAHomecare’s HME/RT council, added, “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. Their contention that current reimbursement policy focuses on devices rather than the clinical situation is indeed welcome and refreshing.”

“We appreciate the spirit of collaboration these groups have shown in sharing their perspectives with us,” said AAHomecare’s Tom Ryan. “Respiratory providers and patients alike will benefit if these recommendations help shape future policy.”

Visit aahomecare.org for more information and updates.