CHEST-Hosted TEP Meeting to Yield Consensus Paper on Noninvasive Ventilation

FEBRUARY 2021

CHEST-Hosted TEP Meeting to Yield Consensus Paper on Noninvasive Ventilation

As described in the August and October issues of Washington Watchline, a virtual meeting of a Medicare Evidence Development & Coverage Advisory Committee (MEDCAC) panel led to a CHEST-hosted Technical Expert Panel (TEP) on home use of noninvasive positive pressure ventilation in early October.

Central to the message of the MEDCAC meeting was that any comprehensive policy addressing home mechanical ventilation requires additional review to address all the relevant disease states, as well as the appropriate devices to support the affected patients and their caregivers. Encouraged by the proceedings of the MEDCAC, CHEST formed a coalition with the American Academy of Sleep Medicine (AASM), the American Association for Respiratory Care (AARC), and the American Thoracic Society (ATS) to create an external TEP.

Under the leadership of Peter Gay, MD, FCCP, and Robert Owens, MD, the expert panel is now in the process of developing a clinically relevant consensus paper for submission to a peer-reviewed journal, along with an executive summary and an outline of clinical pathways related to this issue. The group’s hope is that through communication of clear, objective clinical practice guidance and participation with CMS in outlining goals of improved patient care, an updated and relevant coverage document can be created in this most important area of patient and clinical need.

TEP Overview

Drs. Gay and Owens led a group of thought leaders in this space during a two-day session in October. The participants were organized and convened to discuss the following five clinical areas:

• Bilevel transition from CPAP - When therapeutic benefit was not achieved
  Chair/Co-chair: Nancy Collop and Susheel Patil
  Committee: Eric Olson, Praveen Vohra, and Alex Chediak
• Hypoventilation syndrome
  Chair/ Co-chair: Babak Mokhlesi and Christine Won
  Committee: Bernardo Selim, Barry Make, and Bernie Sunwoo
• Restrictive thoracic disorders
  Chair/Co-chair: Lisa Wolfe and Josh Benditt
  Committee: Loutfi Aboussouan, John Coleman, and Dean Hess
• Central/complex sleep apnea
  Chair/Co-chair: Tim Morgenthaler and Atul Malhotra
  Committee: Karin Johnson and Marc Raphaelson
• Severe COPD
  Chair/Co-chair: Nick Hill and Jerry Criner
  Committee: Neil MacIntyre, Richard Branson, Bart Celli, and Amen Sergrew

On the first day, the individual panel members presented their initial comments for discussion by the panel as a whole in each of the clinical areas. Edited comments were presented the following day for additional discussion in an attempt to reach a clinical consensus.

External presenters were also allowed to make a formal presentation to the TEP on the first day followed by questions and discussion. Presentations were given by John Cronin, MD, for Philips Healthcare; Louis Libby, MD, for ALS Association; Carlos Urrea, MD, MPH, for Hillrom; Carlos Nunez, MD, for ResMed; Kathy Lester for Council for Quality Respiratory Care, and Thomas Ryan for American Association for Homecare.

In addition to the panel and external presenters, 35 observers joined the virtual meeting. The group included representatives from CMS, the device manufacturing industry, and home medical equipment providers, among others. Several participants were invited by Washington Watchline to share their perspectives about the unique event. Their comments appear in the accompanying callout box.

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