New NHIA White Paper Published: Trends in Home Enteral Nutrition

HEN Is a critical therapy that spans all demographic groups and health conditions, from acute conditions that only require short-term support, to more chronic conditions such as cancer, neurological disorders and chronic intestinal diseases, like Crohn’s disease. (2,3,4,5) Often times, these complex diseases require HEN for patient survival. Luckily, HEN has been shown to be incredibly safe, efficacious, and improves the patient’s quality of life, while reducing hospital visits when properly supported. To achieve these ideal outcomes, HEN demands strong clinical coordination, specialized equipment and nutrition formulations, and a multidisciplinary team, such as physicians, dietitians, nurses, and pharmacists. (6) However, despite its importance, HEN is often under-recognized and under-supported, particularly within the Medicare system. (7,8)

In this same whitepaper, NHIA highlights how Medicare’s Competitive Bidding Program (CBP) along with the retiring of Enteral and Parenteral Nutrition Therapy National Coverage Determination, has significantly impacted the access and quality of HEN services. (9,10) As an example, the whitepaper found that, according to CMS publicly available data, between 2014 and 2023, the number of Medicare suppliers offering HEN kits dropped by 31%, and the number of beneficiaries receiving HEN decreased by 27%. (11) This trend reflects not only financial strain on providers, but also a growing gap in patient access, as the number of patients relying on HEN has increased over that same period of time.

Additionally, NHIA found that almost 91% of patients rely on pump assisted feeding for their HEN. (12) These pumps, along with other supplies like syringes, bags and tubing, are distributed via home and Durable Medical Equipment (DME) suppliers and infusion pharmacies.  Many of these providers are also facing challenges related to competitive bidding, leading to shortages and limited patient access to critical supplies and formulas.

Due to the issues highlighted in their whitepaper, NHIA calls for urgent reforms to address these critical issues. To that end, NHIA has recommended several strategies which are outlined below:

• HEN services study: A CMS led comprehensive study of HEN services, including the quality of services, provider landscape, patient reported access to services, satisfaction and quality of life, and cost of care.
• Supplier quality standards: Develop supplier quality standards that include clinical support expectations and standardized outcomes to improve patient safety and care continuity.
• Adjust reimbursement models: Explore adding a service code for clinical activities such as performing nutritional assessments, making formula changes, providing education and support, and troubleshooting problems.

These reforms are not only necessary for sustaining HEN services but also for recognizing the clinical and financial value in home nutrition therapy. Without them, patients may continue to face increased barriers to care, and providers may be forced to exit the market, further limiting access to this life-staining therapy. By modernizing reimbursement and support structures, policymakers can ensure that HEN remains a viable and effective therapy for those who depend on it.

To learn more about NHIA’s involvement with Home Enteral Nutrition and other nutrition related topics, and to engage with others in the nutrition community, visit the NHIA Community at https://community.nhia.org/home.

The full white paper can be viewed here: Trends in Home Enteral Nutrition— The Impact of Competitive Bidding on Access and Quality

1.  Proprietary claims data. Magnolia Market Access. 2025.
2. Bering J, DiBaise JK. Home Parenteral and Enteral Nutrition. Nutrients. 2022 Jun 21;14(13):2558.
3. Mundi MS, Pattinson A, McMahon MT, Davidson J, Hurt RT. Prevalence of Home Parenteral and Enteral Nutrition in the United States. Nutr Clin Pract. 2017 Dec;32(6):799-805.
4. Bischoff SC, Austin P, Boeykens K, Chourdakis M, Cuerda C, Jonkers-Schuitema C, Lichota M, Nyulasi I, Schneider SM, Stanga Z, Pironi L. ESPEN guideline on home enteral nutrition. Clin Nutr. 2020 Jan;39(1):5-22.
5. Doley J. (2022). Enteral Nutrition Overview. Nutrients, 14(11), 2180.
6. Bering J, DiBaise JK. Home Parenteral and Enteral Nutrition. Nutrients. 2022 Jun 21;14(13):2558
7. Mundi MS, Pattinson A, McMahon MT, Davidson J, Hurt RT. Prevalence of Home Parenteral and Enteral Nutrition in the United States. Nutr Clin Pract. 2017 Dec;32(6):799-805.
8. Bering J, DiBaise JK. Home Parenteral and Enteral Nutrition. Nutrients. 2022 Jun 21;14(13):2558
9. Parrish CR, Newton AF, Barnadas G. Understanding Medicare Coverage for Home Enteral Nutrition: A Case Based Approach. Practical Gastroenterology, May 2013:10-21.
10. Centers for Medicare and Medicaid Services. Dept. of Health and Human Services, Medicare National Coverage Determinations Manual, Pub. 100-3, Sec. 180.2, Enteral and Parenteral Nutrition Therapy – Retired.
11. CMS. Medicare Durable Medical Equipment, Devices and Supplies Data Sets. Available at https://data.cms.gov/providersummary-by-type-of-service/medicare-durable-medicalequipment-devices-supplies. Accessed September 10, 2025.
12. Proprietary claims data