Carlos Nunez, MD: Clinicians Speaking up on COPD Costs, Access

Reimbursement policies can add an unnecessary hurdle to an at-need chronic obstructive pulmonary disease (COPD) patient’s pursuit of therapy. But clinicians aren’t without a network or set of resources to resolve these issues.

In an interview with MD Magazine®, Carlos Nunez, chief medical officer of ResMed, provided suggestions for a primary care or specialist doctor looking to resolve their COPD patients’ therapy access.

MD Mag: How can clinicians make COPD patients issues with treatment access and costs better known?

Nunez: It's probably 3 things that they can do.

So, they should become active: talk to either their representatives, talk to the different academic societies that they belong to—whether its primary care or respiratory care physician like here at the ATS Meeting in Dallas. They do a lot of advocacy on behalf of patients, and by contacting them, there are a few things that they can talk about.

They can target these budget neutrality measures that, unfortunately in this case make the reimbursement even lower in some rural areas, so patients in rural areas—underserved populations—are probably the ones who are hit the most because the reimbursements gotten so low. So these budget neutrality measures probably need to be looked at and addressed. That's one of the things that they can they can ask for.

The second thing is to look at the individual therapies within this oxygen category. There are a variety of different therapies, and there needs to be a reimbursement for each type of therapy that is rational and makes sense, so that the only thing stopping a patient from getting the treatment and the therapy they deserve is the discussion between them and their health care provider.

It shouldn't be whether or not it's reimbursed, or whether or not a DME is going to be able to about break-even in 3 or 4 years. It should be that there's reasonable, fair, and equitable reimbursement for all the different therapies. And when you and your doctor or your healthcare provider decide what's most optimal for you, it's available to you, regardless of whether you're a Medicare beneficiary or you use some other access to healthcare.

The third thing that they can do is also talk with their legislators to help influence CMS, and others who look at rates of readmission as a proxy for the efficacy of therapy and the efficacy of payment policy. So right now, they mostly look at things like all-cause readmission—which doesn't single out readmission based on respiratory diseases and respiratory complications—to really understand the ramifications of payment policy and the effect it has on the population and the beneficiaries.

We really need to be able to see how many patients are being readmitted with complications from diseases like COPD, not just all-cause readmissions. These patients tend to be elderly, they tend to have multiple comorbidities, and we need to be able to understand how the therapy that they're on, the way the policy decisions influence that therapy, lead to the clinical outcomes that are driving these reimbursement decisions.

If you're saying they're being readmitted for all different causes and you don't single out the respiratory causes, it's hard to understand how your policy has ramifications for these patients down the road.

So those are the things that I would suggest both primary care and respiratory care physicians talk to their representatives, talk to their public policy and advocacy groups within their specialty associations about.