The NAMDRC annual meeting will be held March 23-25, 2017, at the Meritage Resort in Napa, California. A variety of excellent speakers and topics of interest to the pulmonary, sleep, and critical care medicine community will be presented, including presentations on the asthma-COPD overlap syndrome, pulmonary hypertension in interstitial lung disease, use of big-data in critical care medicine, cardiovascular risk in obstructive sleep apnea, as well as talks on ICD-10 coding, and updates on practice management and on regulatory topics in pulmonary, critical care, and sleep medicine. Finally, Dr. Mark Kelley, a visiting scholar at the Harvard Business School, will present a special lecture on “What do consumers really value in health care?” Meeting details and a registration form can be found at NAMDRC.org.
Dr. Charles W. Atwood
The costs of starting a pulmonary rehabilitation program are capital intensive and, generally, only hospitals can afford the start-up and ongoing costs, making pulmonary rehabilitation almost always a hospital service. Cost data from CMS demonstrate that the vast majority of billing for pulmonary rehab comes from hospitals and not from physician practices. By stopping the use of hospital-based clinic billing for new or expanded pulmonary rehabilitation services, this has the likely result of severely limiting the development of new pulmonary rehabilitation programs. If the new site of the rehabilitation program is more than 250 yards away, the hospital must bill under the physician fee schedule for reimbursement. No health care enterprise is likely to expand rehabilitation into new venues with such low reimbursement. The real shame in this scenario is that pulmonary rehabilitation is an effective and very low cost intervention for patients with COPD, and its future is largely being threatened by low reimbursement – making it unattractive for hospitals to open new programs in new space they may have purchased.
What is the fix? NAMDRC has discussed this problem with CMS, pointing out the large likely negative impact on pulmonary rehabilitation. We discussed a possible exemption for pulmonary rehabilitation. The final rule does afford an additional comment period, and we anticipate further discussions with CMS. It is also likely that the American Hospital Association, strongly opposed to this new rule, may seek a legislative fix.
A final area of activity is our ongoing discussion with CMS about updating the archaic guidelines created by CMS that govern how patients can be prescribed a bilevel positive airway pressure (PAP) therapy device for different forms of hypoventilation. The guidelines have been so complicated to follow that many clinicians, often at the request of a durable medical equipment company, have obtained home ventilators for patients for whom it was difficult to get a bilevel PAP. To be sure, hypoventilation disorders are complicated. The different patient types have somewhat different equipment pathways but all are overly complicated and are real barriers to getting these patients the necessary ventilatory equipment, which usually can be a bilevel PAP device. The home ventilator pathway has been easier to use to get therapy provided so many physicians have followed it, but it is also a lot more expensive. However, as of October 2015, CMS has effectively shut down the home ventilator pathway unless the patient has an indwelling invasive airway (i.e., a tracheotomy tube). NAMDRC, working with other sister societies, patient organizations, and others, has developed a strategy to oppose this draconian step. We hope to move CMS in a more rational direction regarding ventilator therapy for a variety of patients with hypoventilation. This work is complicated, but we are determined to do our utmost to bring a contemporary approach to this important area of therapy.