The Value of Ventilator Access

April 27, 2020

COVID-19 has made ventilator access a front-page issue. But for patients with chronic respiratory conditions, especially Medicare beneficiaries, the challenge is hardly a new one. 

Just consider noninvasive ventilators, which deliver oxygen through a facial mask to patients with conditions like thoracic restrictive disease, neuromuscular disease, and respiratory failure due to chronic obstructive pulmonary disease. Noninvasive ventilators preserve quality of life by keeping patients in their homes. They can also help keep patients out of the hospital, alleviating pressure on the health care system. People living with ALS, or Lou Gehrig’s disease, are particularly vulnerable due to the degenerative nature of the disease.

But accessing noninvasive ventilators hasn’t been easy. Most recently, seniors faced uncertainty after Medicare officials proposed using a competitive bidding process to obtain noninvasive ventilators starting in 2021. The Centers for Medicare and Medicaid Services envisioned competitive bidding as a way to contain the costs of increased ventilator use. Competitive bidding encourages suppliers to compete with one another for CMS’ business by offering lower prices. 

Patients and advocates raised concerns about competitive bidding for ventilators from the beginning. CMS has never used the competitive bidding for a device like noninvasive ventilators, which require regular upkeep and in-home adjustments by a respiratory therapist. The purchase is not as simple as just acquiring the device and delivering it to a patient’s doorstep. By overlooking the maintenance needed for noninvasive ventilators, CMS’ policy could create potential interruptions to care. Such interruptions can have dire consequences for patients with respiratory illnesses. 

Patients and advocates also worried that the change could have the unintended consequence of threatening patient access. When competitive bidding drives prices too low, businesses may opt not to compete because of low profit potential. If enough suppliers stop providing the device, supply cannot meet demand and patients’ needs may go unmet. It’s a story that respiratory patients know well. In 2010, for example, nearly 41,000 Medicare beneficiaries used portable liquid oxygen. Six years after the introduction of competitive bidding, the number of patients receiving care plummeted to just over 8,000.

There is, for now, good news for respiratory patients who need noninvasive ventilators. The COVID-19 pandemic has prompted CMS to change course. The agency announced earlier this month that it will not move forward with implementing competitive bidding for noninvasive ventilators in 2021.  

It seems to have taken a national pandemic for policymakers to embrace the value of ventilator access.  Patient advocates and clinical support teams are relieved. They also remain hopeful that, after COVID-19 subsides, both the value of access and the unintended consequences of competitive bidding for complex respiratory needs remain on policymakers’ minds.

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