Marrying Reimbursement with Technology - a Multi-Function Ventilator That Measures Outcomes

Marrying Reimbursement with Technology - A Multi-function Ventilator that Measures Outcomes Miriam Lieber: President, Lieber Consulting Nick Macmillan: Director, Market Access and Strategy, Ventec Life Systems Please Complete Your Evaluation Everyone should have received an evaluation form upon entering the session. Please complete evaluation form and turn in to room monitor as you exit the session. Or, you can complete your evaluation in the mobile app. Locate the session in the app and tap on the clipboard icon to begin the survey. Please help us keep the Medtrade Education sessions the best in the industry by completing an evaluation for every session you attend! Your feedback is very valuable to us and will be used in planning future Medtrade events! Connect with us on Social Media Twitter: @MedtradeConnect Instagram: @MedtradeConnect Facebook: facebook.com/medtrade #Medtrade19 Marrying Reimbursement with Technology - A Multi-function Ventilator that Measures Outcomes Objectives: 1. Learn what a multi-purpose ventilator is and how to utilize a comprehensive E0467 billing checklist to ensure proper payment. 2. Receive detailed instructions for multi-purpose ventilator (E0467) documentation. 3. Track utilization trends and patterns for value-based care and strong communication with stakeholders. Presenters Miriam Lieber • Miriam Lieber is an independent consultant and trainer specializing in homecare reimbursement and operations management. Ms. Lieber’s clientele includes, home health care companies, managed care organizations, hospitals, wholesalers, pharmacists and manufacturers. She is known to have practical approaches to complex reimbursement matters and assists her clients with the nuts and bolts of running a profitable business. Nick Macmillan • Healthcare executive with extensive clinical, managerial, and executive experience in multiple business environments, from start-ups to multi- national organizations. Proficient in hospital and home care services, business operations, product development and management, sales and marketing, and education. Agenda • Multi-Function Ventilator (VOCSN) • PDAC Review • Reimbursement: – Medicaid, Medicare and Commercial Payers • Detailed Documentation and Billing Instructions • FAQs • Value-Based Care and Data Trending • Value Proposition • Summary VOCSN is the first device to integrate five machines into a single unified respiratory system 6 © 2019 Ventec Life Systems Confidential and Proprietary Typical Respiratory Equipment Ventilator patients usually require numerous medical devices 7 Benefits of Integrated Care SIMPLE MOBILE CARE CHANGING • Intuitive touchscreen • Five therapies in one device • Switch between therapies operation • 70% lighter and smaller than with the touch of a button • Single integrated Ventec- five devices • Uninterrupted ventilation One circuit • Up to 9 hours of on-board between therapies • Software enabled updates battery • Designed to reduce the risk of and data capture • 100G impact protection with infection • Quick and easy setup case • Up to 3x quieter device to learn device to transport circuit for all therapies device to clean device to charge touch to operate 1 alarm to silence 1 power supply to carry 1device to monitor VOCSN is Simple, Mobile, and Care Changing 8 © 2019 Ventec Life Systems Confidential and Proprietary Clinical Advantages of E0467 Compliance with prescribed therapies • The seemingly simple act of disconnecting from one device and connecting to another device, as occurs with suctioning or separate cough assist devices, can often be neglected by patients and caregivers due to the time required by the caregiver, anxiety of the patient, and concerns about safety for both. The VOCSN Multi-Function Ventilator permits multiple therapies through the same circuit, mitigating these concerns, and improving compliance with therapies that are critical to my patients’ outcomes. Decreased risk of mistakes • These susceptible patients experience multiple dynamic care needs. This device is designed to reduce a patient’s and/or caregiver’s equipment anxiety, confusion or errors with a single, easy to use operating system. It’s not uncommon for mistakes to lead to unplanned healthcare encounters, adding increased demands on an already burdened healthcare system. Increased patient mobility • Patients and caregivers are often challenged with the challenge of packing and moving multiple medical devices when traveling outside the home, including work, school, and regular healthcare visits. The VOCSN Multi-Function Ventilator with a single battery and power cord greatly facilitates the ability of patients to travel with all physician ordered therapies. Improved patient monitoring and trending data • The VOCSN Multi-Function Ventilator is the first system to trend data for all five therapies providing a more complete and holistic view of the patient. This data can improve my ability to proactively address exacerbations, reduce complications, prevent hospital readmissions and other unplanned healthcare encounters, and decrease overall costs. Less regulatory and administrative burden • A significant amount of time is exhausted through documenting and substantiating the therapies provided by multiple respiratory devices, each with differing criteria and forms. By combining devices, the Multi-Function Ventilator not only decreases front-line administrative burdens on physicians but may also result in cost savings for payers by decreasing the number of prescribed devices, duplicative claim submissions and the costs of processing those claims. 9 © 2019 Ventec Life Systems Confidential and Proprietary Provider Advantages of E0467 Streamlined Payer and DME Billing • By combining devices the payer and DME communities may recognize cost savings by decreasing payer processing load and costs by decreasing the number of claim submissions and claim submission errors Greater access to all five therapies • One of the key challenges to National Competitive Bidding (NCB) is that multiple DME suppliers could win varying bids, i.e. one supplier wins oxygen while another receives suction and nebulizers. This creates an enormous coordination of care burden. • Because the multi-function ventilator in not competitively bid AND it combines the most common therapies required for the ventilate patient, access and care coordination challenges are mitigated. Higher reimbursement rate, uncapped • The fee schedule amounts for code E0467 are established using the Medicare fee schedule amounts for ventilators and the average cost of the additional functions performed by multi-function ventilators. • Consequently, reimbursement is higher for E0467 in all Medicare jurisdictions and in many Medicaid jurisdictions when compared to ventilation alone. Single ownership schedule • VOCSN integrates five separate devices including a ventilator, oxygen concentrator, cough assist, suction, and nebulizer into one unified respiratory system. • That takes inventory management, service contracts, and warranty management burdens from five to one. • And once one rental episode is complete, the DME can furnish the equipment to other beneficiaries for separate rental periods. Not part of competitive bidding • E0467 is not part of the competitive bidding process nor does Ventec support any ventilator being included in the competitive bidding program. 10 © 2019 Ventec Life Systems Confidential and Proprietary Prior to 2019 No reimbursement mechanism for integrated devices • Centers for Medicare & Medicaid Services (CMS) has not provided a mechanism for devices that integrate multiple types of Durable Medical Equipment (DME) into one device, to receive reimbursement using a single Healthcare Common Procedure Coding System (HCPCS) reimbursement code. Consequently, that would mean that under traditional rules, VOCSN would only be allowed to be billed according to the ventilator. VOCSN would not be eligible for additional reimbursement for the oxygen, cough, suction or nebulizer therapies without a new rule from CMS. [Ventec participated in numerous meetings to educate CMS policy makers on the need for a single code and the benefits of integrated care] Jan 1, 2019 New billing code (E0467) established to pay for VOCSN under Medicare • CMS released the final 2019 payment rule announcing a new Medicare Part B reimbursement policy for multi- function ventilators, while at the same time the PDAC established a new billing code, HCPCS code E0467, effective January 1, 2019. Present Medicaid and Commercial Payers are adopting E0467 • Several states and commercial payers are in varying states of adoption, including full adoption and payment, product review and scheduled face to face meetings with Ventec • Dialogue is ongoing with CMS to clarify E0467 “same and similar” guidelines 11 © 2019 Ventec Life Systems Confidential and Proprietary Reimbursement • Medicare – November 2018: CMS finalized and approved official coverage of multi-function ventilators: Effective January 1, 2019 – Medicare reimbursement for the E0467 is based on an average of all five functions, regardless of how many functions are utilized – Check reimbursement for your state here. • Medicaid – Thirty states covering, 5 more pending • Commercial Payers Current Medicare Coverage Alaska Alabama Arizona Arkansas California Colorado Connecticut Delaware Florida Georgia E0465/66 $899.78 $934.17 $1,099.02 $934.17 $934.17 $934.17 $1,099.02 $1,099.02 $1,099.02 $1,099.02 E0467 $1,156.50 $1,105.15 $1,267.29 $1,260.15 $1,116.35 $1,106.78 $1,287.06 $1,277.35

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