CHEST Guidelines-Executive-Summary_2021

Executive-Summary_2021_chest
Pdf Summary
The Optimal NIV Medicare Access Promotion (ONMAP), a collaborative effort by the American College of Chest Physicians and other respiratory and sleep associations, addressed the outdated national coverage determinations (NCDs) from 1998 for noninvasive ventilation (NIV). The current policies are no longer aligned with modern technology, research, and expert consensus. The initiative aimed to update these NCDs to optimize patient care for thoracic restrictive disorders, COPD, hypoventilation syndromes, OSA, and central sleep apnea.<br /><br />The Technical Expert Panel (TEP) met in October 2020 and identified barriers to optimal NIV care. They suggested policy changes based on recent scientific evidence and clinical guidelines to ensure patients receive appropriate devices at the right time. This included addressing inconsistencies in the existing criteria and incorporating modern diagnostic and therapeutic technologies.<br /><br />Among the key areas identified:<br />1. Thoracic Restrictive Disorders: The panel suggested simpler initiation criteria and advocated for home mechanical ventilator support for severe cases.<br />2. COPD: The panel recommended focusing on treating persistent hypercapnia with BPAP or HMV without redundant nocturnal oximetry requirements.<br />3. Central Sleep Apnea: Proposed wider coverage for BPAP and PAP devices with backup rates, aligning with AASM guidelines.<br />4. Hypoventilation Syndromes: Emphasized the inclusion of various hypoventilation causes and easing diagnostic processes to facilitate timely NIV therapy.<br />5. OSA: Recommended expanding symptom criteria for device coverage and improving access to BPAP for CPAP-intolerant patients.<br /><br />The report calls for a simplified regulatory framework to remove treatment barriers and ensure coverage aligns with contemporary clinical practice. This revision aims to improve the delivery of evidence-based respiratory care, supporting patient access to necessary devices and ongoing support services.
Keywords
ONMAP
noninvasive ventilation
NCDs
thoracic restrictive disorders
COPD
hypoventilation syndromes
OSA
central sleep apnea
BPAP
AASM guidelines