CMS's bull's eye on vents

A few weeks ago, I was in a CPAP frame of mind; this week, it's vents.

First, CMS announced that non-invasive vents would be a new product category in Round 1 2017.

Then the agency announced in an MLN Matters article that providers who furnish vents—not only invasive vents, but also non-invasive vents—“must meet all applicable requirements for accreditation, such as ensuring that frequent and substantial servicing is provided.”

What's the big deal? “Providers need to meet the quality standards for invasive vents, even if they're only providing non-invasive vents,” says Wayne van Halem, president of The van Halem Group.

Products that are categorized as needing “frequent and substantial servicing” may mean visits by respiratory therapists and other high-end services, van Halem says.

In the background to all of this: a widespread prepayment review for non-invasive vents that kicked off last fall.

Because CMS usually takes actions like these when they see a spike in utilization, I leafed through the past few years of our State of the Industry reports to see how much Medicare spends on vents.

We had data on E0463, an invasive vent. Check out these numbers:

2013: $56,613,568

2012: $49,379,924

2011: $41,496,425

2010: $36,164,171

2009: $29,055,186

2008: $23,800,959

In six years, spending on E0463 has increased 138%.

Unfortunately, we don't have data on the other codes in the vents policy group, like E0464, a non-invasive vent.

In our HME Databank, however, we have a list of the top providers for E0464, who may be most affected by all of these changes. The top 5, with the amount Medicare paid them for E0464 in 2013, are:

Ashli Healthcare, $4,505,809

Sleep Management, $4,273,506

DME Tennesse, $3,252,492

Medemporium, $3,015,729

Super Care, $2,567,222

We're on all of this for the HME Newswire on Monday. Managing Editor Theresa will have a story about non-invasive vents being included in Round 1 2017 and I'll have a story about the accreditation requirements for vents.

Stay tuned.