Reality Check: The Risk of Reducing Access to Respiratory Care Devices

America’s critically ill respiratory patients have good reason to be optimistic: Non-invasive ventilation systems can help patients live longer, more independent lives by keeping them out of the hospital and allowing them to enjoy treatment at home. As Medicare moves to include NIV machines in its competitive bidding program, thousands of patients — especially Americans in rural areas — are at serious risk of losing the life-saving devices they need.

As a pulmonologist, I treat thousands of patients with serious lung diseases including chronic obstructive pulmonary disease, emphysema and lung cancer, many of whom require NIV to survive. NIV isn’t just for people with lung diseases — I’ve also seen children and adults with severe neuromuscular conditions like ALS (Lou Gehrig’s disease) who rely on NIV to breathe.

Many of my patients have difficulty performing simple daily tasks such as walking to the mailbox or playing with their grandchildren. Non-invasive ventilation is a game changer that provides patients with moderate to severe COPD and other neuromuscular conditions with the safest, most effective treatment — frequently restoring their quality of life and giving them back these simple tasks we often take for granted.

Multiple studies have shown that NIV reduces hospitalizations, leads to lower mortality rates and helps patients live longer, more independent lives. Not only does home NIV help save taxpayer dollars, as the cost of institutional care is becoming increasingly expensive, it can also be administered in the comfort and privacy of the patient’s home.

Moreover, when patients are treated with NIV, they experience the added advantage of receiving care from respiratory therapists who meet patients where they live. Since my practice covers five counties, it is not uncommon to meet rural patients who drive more than an hour to see me. Fortunately, home NIV helps them stay healthier between visits.

But sadly, patients’ ability to access NIV at home is under threat as Medicare moves to put NIV in its competitive bidding program. My decades of experience have proven to me that competitive bidding often leads to a decrease in the quality of care provided due to the fact that suppliers have been grossly under reimbursed by Medicare.

If non-invasive ventilation is added to the competitive bidding program, I worry that my most critically ill patients — especially those in rural areas — will be vulnerable to disruptions and delays in their care. These changes could be devastating for patients and will actually drive health care costs up for everyone as more respiratory patients become re-institutionalized.

To ensure that Americans with serious respiratory diseases don’t lose access to the home care they need to survive, we must exclude NIV from competitive bidding. The risks of mandating substandard care or allowing NIV providers to shut down are too great for such a vulnerable population of patients.

NIV is a rare win-win-win because it improves patients’ quality of life, keeps them out of the hospital and leads to lower health care costs. The Department of Health and Human Services must remove NIV from Medicare’s competitive bidding program to ensure continued access and affordability for my patients. We need Congress’ help to make that happen.


M Douglas Lee, MD, FCCP, is the division chief of pulmonary medicine at Wilmington Health, a multi-specialty physician practice of over 140 providers, and he has dedicated his career to practicing pulmonary, critical care and sleep medicine at his southeastern North Carolina practice since 1998.

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