Outpatient Management of Chronic Respiratory Failure

Doctor’s Corner #2

Presented by: Doug Kane M.D. FACCP (RRT)
Chief Medical Officer
Director of Program Development
Encore HealthCare
Aside from fulltime ventilator patients in the home setting, utilization, management, and payment have been problematic. As a pulmonary physician I have felt that patients with Stage IV COPD or those with chronic respiratory failure would benefit from home use of NIV/BIPAP. Patients not meeting the definition of chronic respiratory failure including desaturation on 02 would not be covered for BIPAP. This is counterintuitive since oxygenation does not determine the need for ventilation. Over the years when we would order BIPAP for patients that we felt would benefit even though they did not meet the specified criteria, insurers would insist on a sleep study which often was not indicated. True NIV machines for home and transport use are relatively new. Invasive ventilators are reimbursed at a higher rate since historically they are needed 24/7 for life support and the patient care needs are extensive. Since the non-invasive ventilators are considered true ventilators they are reimbursed at the higher rate. Read the Full Article