By Bill Guidetti
July 24, 2020 at 5:00 am ET
The coronavirus pandemic has vindicated the old adage that during times of crisis, history is put on fast-forward.
Since COVID-19 came to America’s shores, changes once thought years in the making have occurred in the span of weeks. While it will take time to fully comprehend the scope and scale of these changes – one area that has seen a positive impact is the transition of patient respiratory care out of hospitals and into the home setting.
Before the coronavirus, home respiratory care suppliers were too often undervalued in our nation’s care delivery continuum. But, since early March, the narrative has shifted quite dramatically. Hospitals, eager to avoid occupancy surges and reduce rates of viral infection among vulnerable patients, have found a pillar of support in home respiratory care suppliers.
As the division president of the East for Apria Healthcare, which services hot spots in both New York and New Jersey, I’ve witnessed how our sector has stepped in to provide continued support to beleaguered health care systems. Home respiratory therapies, including noninvasive ventilators and oxygen concentrators, are lifelines for patients with serious respiratory illnesses because they improve health outcomes and help patients avoid the need for institutionalized care in either a hospital or nursing home. Recent data even suggests that patients suffering from chronic obstructive pulmonary disease who are treated at home have lower hospital readmission rates – demonstrating how our services keep patients out of hospitals.
In the midst of the pandemic, we see our work as part of a broader humanitarian effort. Respiratory care suppliers have seen a dramatic increase in the number of patients served. As more hot spots emerge across the country, we will maximize our efforts to address the needs not only of those suffering from chronic illnesses, but also patients with acute care needs brought on by COVID-19.
While these efforts are critical, the sector also needs the support and cooperation of lawmakers and federal officials. The immediate future of the pandemic is still relatively unclear, but what is certain is that America’s home respiratory care needs will only continue to surge in 2020 and beyond. With a vaccine not likely until 2021 at the earliest, our sector’s supply infrastructure will find itself under unprecedented strain as patient demand steadily grows.
To meet this need, Washington must take decisive action to reduce regulatory red tape. In the past weeks, the Centers for Medicare & Medicaid Services – the agency responsible for overseeing the Medicare program – has already spearheaded positive policy changes that will allow patients with acute respiratory conditions including COVID-19 to receive care in their homes. But these efforts must go further to fortify respiratory care supply, starting with the suspension of programs that threaten the availability of home respiratory care during a public health emergency.
The CMS competitive bidding program restricts patients’ access to care by requiring them to obtain medical equipment from suppliers who are awarded Medicare contracts, while basing rates on the patient need for equipment, supplies, and services and the suppliers’ bid amounts that must be based on verifiable costs. CMS is set to release the contracts to the winning bidders for the next round of competitive bidding this summer, even though the patient need and costs used to determine which suppliers can and cannot remain in the markets were set using pre-pandemic data.
If implemented in this way, the program risks hot spot areas not having enough suppliers to meet patient need. It also would result in rates that do not account for supply chain disruptions, increased labor and supply costs, and other increases resulting from the pandemic. In addition, these rates will also be used to set the rates in rural areas, which are now seeing growing numbers of COVID-19 positive patients.
Because the underlying estimates that guide the program were informed by data gathered before the pandemic, these policies no longer reflect the reality of what is occurring on the ground. Continuing to include critical home respiratory care supplies in this program could force many suppliers to leave markets and communities in desperate need of equipment and clinical services – an inherently dangerous proposition given the present health emergency.
To create stability in the home respiratory care supply chain, Medicare should push the whole bid process back and begin rebidding for critical respiratory care supplies and services after the pandemic subsides. Doing so will bolster a critical part of America’s health care response to COVID-19 and would dovetail with other positive actions the agency has taken to support home respiratory care over the last few months.
Vulnerable patients deserve access to the best respiratory care our sector can provide in the comfort of their home. It’s time for federal officials to recognize this reality and remove unnecessary barriers to care.
Bill Guidetti serves as the Division President of the East for Apria Healthcare, which provides home respiratory care to communities throughout New York and New Jersey.
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