Date : 26 Sep 2003

Many people have been confused by the different terminology used to refer to equipment that assists ventilation either noninvasively or invasively.

Actually a ventilator is a piece of equipment that assists your ventilation; it can be noninvasive or invasive. This includes the older negative pressure ventilators such as the iron lung and the shell (cuirass), and the bilevel ventilators such as the BiPAP S/T, VPAP II S/T, KnightStar 330, and the Pulmonetics LTV. The small portable volume ventilators can be used either for noninvasive or tracheostomy (invasive) long-term ventilation. The FDA must approve equipment in order for it to be sold in the USA; the FDA approved bilevel noninvasive equipment as ventilators, but many bilevels do not have enough safety features to allow them to be approved for 24 hour use.

The CMS (Centers for Medicare and Medicaid Services), which was formerly HCFA, decided to use a new terminology for Medicare reimbursement. Medicare calls noninvasive bilevel ventilators "Respiratory Assist Devices" (RADS) and is trying to cut back on the level of reimbursement for those with back-up capability -- the "S/T" models that should be used by people with neuromuscular diseases. Any device called a ventilator should have continued reimbursement with "frequent and substantial servicing" (FSS) by the home medical equipment company (HME); -- and the reimbursement is meant to cover this higher level of service, without a limitation as to how long it is used. CMS (Medicare) is now proposing to "cap" the reimbursement to only 13-15 months and stop paying at the higher level for FSS. This is an attempt to save money, but the ventilator users will receive less than adequate service from HME companies, and only for 13-15 months. Anyone concerned about this should review the information on the IVUN

With all best wishes,

Edward Anthony Oppenheimer, MD, FCCP

Pulmonary Medicine

Los Angeles, California