Reporter's notebook: Vents, vents and more vents

Friday, January 22, 2016

Providers had plenty to vent about in 2015 as CMS twisted the ventilator product category this way and that in response to a spike in utilization. 

That’s according to the most read specialty provider stories of the year, where four of the five most read stories dealt with ventilators. 

In a saga that stems from 2014, when the use of non-invasive ventilation to treat sleep apnea skyrocketed, CMS proposed numerous changes (“CMS overhauls vent product category”) that have kept providers and stakeholders alike hopping to keep up. 

Those changes included attempting to clarify coverage criteria for Bi-level devices vs. vents (“CMS further distinguishes vents”). This, in turn, created a coverage gap for COPD patients who failed the CPAP or Bi-level therapy but didn’t meet the standards for ventilation, and resulted in a struggle for providers to get paid (“Some claims in limbo as Medicare clamps down on vents”).

CMS also announced—and then eventually withdrew—vents from Round 1 2017 of competitive bidding (“Challenging product put out to bid”).

Finally, in November, the agency announced, despite widespread opposition from basically everyone, that it would move ahead with plans to consolidate vents into two codes and lower their reimbursement (“CMS steamrolls ahead with vent overhaul”).

With legislation to address reimbursement cuts to vents in the draft stages, and providers clamoring for clear coverage guidelines, this story will continue to develop in the coming year.

While vents may have been the hot topic of 2015, the most read specialty provider story of the year actually dealt with diabetes supplies.

In January, Med-Care Diabetic became the latest provider to receive a visit from federal law enforcement officials (“Feds raid Med-Care Diabetic”). The company, which said it had nothing to hide, cooperated as agents seized property. A year later, we have heard of no new developments, but the provider remains listed as a Medicare contract supplier of diabetes supplies.