Stakeholders seek to make ‘headway’ on enteral nutrition

WASHINGTON – Stakeholders are hoping a new white paper will serve as a tool to educate payers and policymakers on the disconnect between rising costs and stagnating reimbursement specifically for enteral nutrition. 

Everything from shipping to labor to enteral formulas has seen increases in cost, says Vicki Emch, area vice president of clinical operations for Colorado-based Aveanna Healthcare, who was part of the workgroup that developed the paper, “Challenges in Enteral Nutrition Access & Management: Safeguarding Life-Sustaining Enteral Nutrition.” 

“All these costs have gone up and there are times when you lose money on every single patient,” she said. “You can’t stay in business when you are shipping out formula or supplies and it costs $30 and you get reimbursed $20.” 

In addition to providing a market overview, the white paper, which was led by AAHomecare and the Global Enteral Device Supplier Association, makes several recommendations, including reimbursement adjustments, expedited PA processing, formulary reviews and updates, and decreased documentation requirements. 

An ongoing shortage of formula is also driving costs up, says Kristina McIntosh, vice president at California-based Schraders Medical Supply, who chaired the workgroup.  

“It’s a huge challenge – from sourcing it to identifying appropriate products that we need to bring in,” she said. “And we’ve increased our inventory cost quite a bit. We usually keep about a three-week inventory level and now we keep a five- to six-week inventory level to ensure we don’t run out of stock.” 

Those increased costs, along with burdensome documentation and prior auth requirements, are putting pressure on providers who are reconsidering whether they want to stay in the enteral market, according to a 2023 survey by AAHomecare. 

“The strain on enteral suppliers not only impacts their operational viability but also raises significant concerns for patient care,” said Ashley Plauche, senior director of brand marketing for the association. “Suppliers go above and beyond, providing compassionate care within their communities and advocating for policies that ensure continued access to HME, supplies and services. However, unsustainable operational and cost pressures may force suppliers to face the agonizing decision of whether to discontinue offering certain product categories to sustain their operations.” 

Stakeholders like McIntosh are optimistic the white paper will have an impact. 

“I’m hoping that with this paper, with AAHomecare behind us, we can actually make some headway and see positive results,” she said.