RE:Communication, communication, communicationMgmt needs to get on with a full blown study of vents vs. BiPaP instead of vents vs no vents. The OIG suggested no compassion have been done but VMD does have a KPMG report that shows vents saved more than RAD.
Throughout its comments Sleep Management contends that the NHV is inherently better than other devices at providing respiratory assistance, but studies have shown that an NHV is not medically necessary in many circumstances. [footnote 45] Medicare requirements obligated our medical reviewer to determine whether the NHV supplied to the beneficiary was reasonable and necessary in each given situation.
We noted that Sleep Management referenced various studies in its comments with findings of mortality reduction, hospitalization reduction, etc., as the result of NHV use. However, the fact that some of these studies were undertaken by vendors, including Sleep Management, should factor into an assessment of their value. Sleep Management cited one study for its finding that “clinical evidence demonstrates that the increased mortality risk following hospital discharge can be ameliorated by the early institution of NHV.” This quotation is from an observational study funded by Sleep Management that compared patients treated with NHV to those not treated with NHV, rather than a comparison of treatments (e.g., a study looking at patients on NHV compared to patients properly titrated on BiPAP). The findings in such a study tend to distract from the evaluation of reasonableness and necessity that pertains to individual claims.