WASHINGTON – AAHomecare officials are working to get an audit reform bill introduced in the House of Representatives in time to take it to Capitol Hill during the annual Legislative Conference May 6-8.

“We’re seeking sponsors as we speak,” said Jay Witter, vice president of government affairs for AAHomecare. “At a minimum, we are trying to at least get co-sponsors to say they will champion the bill.”

The bill is part of a multi-pronged campaign to reform Medicare’s audit program. The campaign also includes Save My Medical Supplies, a new initiative aimed at getting consumers more involved in the issue.

In years past, the spotlight at the conference has been on competitive bidding, but with audits reaching a crisis point in recent months, it’s only natural that they will take center stage, say stakeholders.

Still, competitive bidding remains a huge problem, despite CMS’s claims to the contrary. Stakeholders point out that CMS recently awarded new contracts to two local providers in Hawaii, where only 13 of 97 contracts went to local providers, to help alleviate access problems.

“I think this happens more than anybody realizes,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “It’s difficult to keep track. CMS has done a good job of covering up these issues and dealing with them as they come up.”

Other issues that stakeholders expect to talk up during the conference: the face-to-face requirement, the separate benefit for complex rehab, and repair issues.

With the announcement April 22 that Jonathan Blum is stepping down as director and principal deputy administrator at CMS, stakeholders are cautiously optimistic that his replacement, Sean Cavannaugh, will prove easier to work with. Cavannaugh, deputy director for programs and policy in the Center for Medicare and Medicaid Innovations, has had experience working with DME issues in the past and has a background in economics that could be a plus for the HME industry, stakeholders say.

“We are working on (being able to show) our return on investment so we can reach out to him purely from an economic standpoint,” said John Gallagher, vice president of government relations for The VGM Group. “Dollars spent on DME are dollars saved.”

PORT ST. LUCIE, Fla. – Liberty Medical has filed a complaint with the U.S. Bankruptcy Court for the District of Delaware against Medco Health Solutions alleging that Medco engaged in “inequitable conduct” during Liberty management’s buyout of Medco’s then-subsidiary Polymedica, a transaction that included the Liberty business. Liberty’s management alleges, among other things, that it was only after filling for bankruptcy that they learned that more than $42 million listed in accounts receivables were uncollectable, and that the value of Liberty’s property and equipment was overstated by $9 million. Additionally, they allege that Medco refused to pay pre-closing taxes for Polymedica, leaving Liberty on the hook for millions of dollars in taxes. “It is our view that Medco was aware that Liberty would be unable to survive as a stand-alone company should Medco fail to perform as promised in connection with the management buyout,” the company states in a press release. Among other remedies, Liberty seeks damages relating to a series of transactions and over $1 billion in equity redemptions that left Liberty and its subsidiaries insolvent at a time when the businesses were being prepared for sale.

Liberty’s management acquired Polymedica for $30 million in December 2012. Three months later, Liberty filed for Chapter 11 bankruptcy protection.

Ways and Means hearing to examine Medicare waste

WASHINGTON – The House Ways and Means Health Subcommittee will hold a hearing on policies that address Medicare waste, fraud and abuse on April 30 at 2 p.m., according to a bulletin from The VGM Group. The subcommittee is expected to hear from the Office of the Inspector General (OIG), the Government Accountability Office (GAO) and CMS’s Center for Program Integrity about different ways to curb abuses. “It is very clear that problems with Medicare waste, fraud, and abuse persist,” said Chairman Kevin Brady, R-Texas, in a press release from the committee. “The Medicare trust fund is already headed toward insolvency and every dollar of fraud is a dollar not dedicated to providing quality care for our nation’s seniors.” The hearing will take place in room 1100 of the Longworth House Office Building.

Providers enter national stage with merger

WESTMINSTER, Md. – Mobility Rehab Products has joined forces with Cal City Medical Supplies, doing business as Smart Remedies, to develop a national footprint for the delivery of DME. As a result of the merger, the companies will cover 208 competitive bid contracts for general HME and supplies, negative pressure, enteral nutrition, beds, chairs, walkers and support surfaces in 81 areas. “Mobility Rehab Products, with this new merger, will now be able to expand our number of product offerings, services and geographic footprint to offer top quality service to our patients,” stated Randall Watson, CEO of Mobility Rehab Products. Mobility Rehab services a multi-state area encompassing Maryland, Delaware, Florida, Pennsylvania, New Jersey and South Carolina. Its range of products and services includes diabetes testing supplies and footwear; wheelchairs and seating and positioning; orthotics and prosthetics; bathroom safety; respiratory; patient and ambulatory aids; and hot and cold therapy. Smart Remedies focuses on diabetes testing supplies. It does not have a contract to provide supplies as part of the national mail-order program, but it does have contracts for enteral nutrition (1), beds (79), wheelchairs (74), walkers (50) and support surfaces (4) as part of competitive bidding, according to its website. 

Trial closes for 3B Medical, ResMed

LAKE WALES, Fla. – The trial between 3B Medical/BMC Medical and ResMed concluded on April 17, but a final decision is not expected until December, according to a press release. The trial before the International Trade Commission (ITC) was the result of a complaint filed by ResMed in July 2013 alleging infringements on several patients. “It was a long fought and very expensive battle for all companies involved,” stated Alex Lucio, vice president, in the release. “Now that the trial is behind us, we can refocus our efforts to bringing new products and innovative solutions to the sleep disordered breathing market. We are very confident that the ITC will find in our favor.” BMC is also in the process of preparing IPR (Inter Partes Review) applications seeking to invalidate several ResMed patients in the U.S. Patent and Trademark Office to prevent the company from inhibiting future innovations. “We didn’t ask for this fight, but we have no intention of backing down,” stated James Xu, president.

BMC gets ResMed patent revoked in China

LAKE WALES, Fla. – BMC Medical has succeeded in having one of ResMed’s patents revoked in China, according to a press release. BMC initiated invalidity proceedings against five ResMed patents before the Chinese Patent Re-examination Boards (PRB) in October 2013. Oral proceedings for four cases have taken place. On April 22, the PRB revoked one of the patents, for a “cushion for patient interface.” Other cases are still pending. In Germany, BMC has decided not to pursue a patent infringement case brought by ResMed for one of three products, because the patent expires for that product in November. BMC will pursue the case for the remaining products. Hearings are scheduled for the fall.

COPD Foundation challenges GAO report

WASHINGTON – The COPD Foundation “takes great umbrage” with a recent Government Accountability Office (GAO) report, which said that the advocacy groups it interviewed for the report expressed no widespread concern over beneficiary access under the competitive bidding program. “The COPD Foundation has contended for some time that CMS should exempt oxygen from the DME competitive bidding program,” the foundation said in a recent release. “Had the GAO interviewed the COPD Foundation, we would have had the opportunity to express our displeasure and growing concern with this flawed program.” The foundation has been in contact with the CMS Ombudsman regarding access issues, and says the bid program has been a hardship on beneficiaries. 

CMS to issue comparative billing report for diabetes supplies

WASHINGTON – CMS will issue a comparative billing report (CBR) on diabetes testing supplies in April, it announced in the April 24 MLN Connects newsletter. The CBR, produced by contractor eGlobalTech, will contain data-driven tables and graphs comparing billing and payment patterns on a state and nationwide basis. The goal: to offer a tool that helps providers better understand applicable Medicare billing rules. The report is available only to those who receive them.

Commuter rail eyes sleep apnea screening for engineers

NEW YORK – A new directive would require Metro-North’s 350 engineers to be tested for sleep apnea, according to news reports. The engineer involved in a 2013 derailment that killed four and injured dozens was found to suffer from severe sleep apnea. “Recognizing that an undiagnosed sleep disorder likely was a major contributing factor to the tragic accident, our organization is working with Metro-North to establish a program to help identify engineers who may suffer from the same medical condition,” said Mike Doyle, general chairman of the Officials with the Association of Commuter Rail Employees Union. 

Roche turns around diabetes sales

NEW YORK – Roche Diagnostics saw North American diabetes sales of $112 million for the first quarter of 2014, a 13% increase over the same period a year ago, according to news reports. The company’s sales of glucose monitors decreased 16% in 2013, mainly due to Medicare’s national mail-order program for diabetes supplies, which resulted in a reimbursement cut of, on average, 72%. The program kicked of July 1, 2013. Roche tried unsuccessfully to sell its diabetes division last year.

BOC unites departments, changes leadership

OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) has consolidated its organization certification and accreditation departments, strengthening its product delivery and cross-promotion efficiencies, according to a press release. To facilitate the new direction, BOC has promoted Wendy Miller to chief credentialing officer. Previously, she was director of facility accreditation. She will lead the direction, strategy, policies and day-to-day operations of the credentialing programs. BOC has also promoted Jeff Price to COO. Previously, he was director of operations. He will direct, maintain and support strategic and operational initiatives in the areas of IT, human resources, financial management and marketing.

Short takes

Med-Care Diabetic & Medical Supplies has donated more than 150 refurbished CPAP machines to the American Sleep Apnea Association’s (ASAA) CPAP Assistance Program. Med-Care is a contract supplier for Medicare’s national mail-order program for diabetes supplies…DeVilbiss Healthcare has been named one of five finalists for the 2014 Pennsylvania Governor’s Impact Awards in the Export Impact Category for the Southern Alleghenies Region. This is the second consecutive year that the company has been named a finalist…Team Invacare athlete Ernst van Dyk won the men’s push rim wheelchair division of the Boston Marathon on April 21. The 41-year-old from South Africa broke the tape in an unofficial time of 1 hour, 20 minutes, 36 seconds. Van Dyk has now won the Boston Marathon a record 10 times. His last win was in 2010… ExcelHealth’s new dual-channel electrotherapy TENS device for muscle and joint pain relief is now available without a prescription. The suggested retail price for the iReliev Pain Management System is $69.95. ExcelHealth seeks distribution partners for the device, which is smaller than many cell phones and comes with batteries. The device is already available on eBay, Amazon and HealthOutfitters.com…Integrated Medical Services is now offering Medela’s Invia Liberty negative pressure wound therapy units, and has launched a new online store.

WASHINGTON – AAHomecare has made available for sharing three videos through its Save My Medical Supplies campaign.

The short videos, available at www.savemymedicalsupplies.org, help to educate Medicare beneficiaries, families and caregivers about how Medicare problems can impact them, according to a release.

The first video is an overview of major issues related to Medicare reform. The second: an interview with Thomas Morris, a beneficiary with diabetes and an amputee, that highlights issues related to the national mail-order program for diabetes supplies. The third: an interview with Bert Burns, a Paralympian, that highlights issues with wheelchair repairs.

“These issues aren’t partisan, they’re personal,” said Tom Ryan, president and CEO of AAHomecare in the release. “Please take a moment to share these videos with your personal network.”

Save My Medical Supplies uses email, social media and online resources to reach consumers and make it easier for them to contact Congress to support H.R. 1717, a bill to replace the competitive bidding program with a market-pricing program. Since its April 1 kickoff, more than 3,000 letters have been generated.

WASHINGTON – HME industry stakeholders are seeing their first real sign of relief in the fight against audits.

As a result of discussions with the Jurisdiction D DME Advisory Council (DAC), CMS has reminded its contractors that their “scope of services” includes reopening cases where claims have been denied due to technical reasons. That has opened the door for council members Peggy Walker and Mary Stoner to get more than 70% of the denied claims they submitted for reopening overturned.

“This is huge,” said Walker, a billing and reimbursement advisor for The VGM Group’s U.S. Rehab, who continues to collect documentation from providers to submit to contractors for reopening.

Traditionally, when providers contact contractors such as C2C Solutions, which handles the second level of appeals, to reopen cases, they’re told to take it up with the contractor at the next level of appeals.

But with mounting pressure from the industry and CMS, and a high-profile forum* in February on the huge backlog at the administrative law judge level (ALJ), the third level of appeals, these contractors are now more willing to take a second look at claims denied due to technical reasons.

“Providers need to be more aware of their options,” Walker said. “Mistakes happen and they can be corrected before they get to the ALJ.”

Of course, not all denied claims are overturned. First of all, the denial has to be for a technical reason, such as not including pricing on a detailed product description, something that hasn’t been required since 2011. It can’t be for lack of medical necessity, Walker and Stoner say.

“You have to know what the rules are when you put your documentation in,” said Stoner, chairwoman of the Jurisdiction D DAC and president of Electronic Billing Services. “The contractor can’t fix if it if you didn’t provide proper documentation.”

Members of the Jurisdiction D DAC aren’t stopping at audits, either. They’re also discussing with their contacts at CMS issues with PECOS and the face-to-face requirement.

“They’re not just this big cloud hovering over us throwing down lightning rods,” Stoner said. “They’re people and they’re willing to engage with us.”

http://hmenews.com/article/audits-we-are-crisis-stakeholders-say

WASHINGTON – In an April 30 proposed rule that sets hospital and long-term care inpatient payment rates and rules for 2015, CMS acknowledged it plans to implement ICD-10 on Oct. 1, 2015. Congress forced the agency’s hand when both the House of Representatives and the Senate passed “doc fix” bills that included a one-year delay in the transition to the new coding system. CMS “expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015,” according to a statement from the agency published in Modern Healthcare. “The rule will also require HIPAA-covered entities to continue to use ICD-9-CM through Sept. 30, 2015.” In the proposed rule, CMS also seeks comments on how “if at all, we should adjust performance scoring under the Hospital VBP Program to accommodate quality data coded under ICD-10-CM/PCS, or otherwise ensure fair and accurate comparisons under the Hospital VBP Program once the transition date has passed.” Industry stakeholders have urged HME providers to prepare for the transition to ICD-10 for some time.

AAHomecare adds videos to campaign toolbox

WASHINGTON – AAHomecare has made available for sharing three videos through its Save My Medical Supplies campaign. The short videos, available at www.savemymedicalsupplies.org, help to educate Medicare beneficiaries, families and caregivers about how Medicare problems can impact them, according to a release. The first video is an overview of major issues related to Medicare reform. The second: an interview with Thomas Morris, a beneficiary with diabetes and an amputee, that highlights issues related to the national mail-order program for diabetes supplies. The third: an interview with Bert Burns, a Paralympian, that highlights issues with wheelchair repairs. “These issues aren’t partisan, they’re personal,” said Tom Ryan, president and CEO of AAHomecare, in the release. “Please take a moment to share these videos with your personal network.” Save My Medical Supplies uses email, social media and online resources to reach consumers and make it easier for them to contact Congress to support H.R. 1717, a bill to replace the competitive bidding program with a market-pricing program. Since its April 1 kickoff, the campaign has generated more than 3,000 letters.

VGM doubles up on retail

WATERLOO, Iowa – The VGM Group has boosted its retail offerings by acquiring Minneapolis-based Simply Shops. VGM will merge Simply Shops, a healthcare retail consultant primarily to hospitals, with VGM Retail Services. Simply Shops is known for its “Retail Science” concept—offering a blend of gift/floral, convenience, health and wellness, and logo wear to support patients, families, staff, visitors and the overall community in the hospital environment, according to a press release. “Blending these business practices with what has been considered traditional HME retail will open up new opportunities for VGM member business,” the release states. Together, VGM Retail and Simply Shops will offer a wider range of business consultation and implementation offerings, including merchandising plans for various health needs/space requirements, business plans and operational service options.

Price raises bidding issues at hearing

WASHINGTON – During an April 30 Ways and Means Health Subcommittee hearing on waste, fraud and abuse, Rep. Tom Price, R-Ga., pressed Kathleen King, director of the Government Accountability Office (GAO), to explain CMS’s conclusion that the competitive bidding program has had no negative impact on beneficiaries. The GAO released a report on the program April 18 that drew its conclusions largely on information provided by CMS. During his questioning, Price learned that CMS had not conducted clinical data reviews and that the agency only tracked patient progress for 120 days, according to a bulletin from The VGM Group. “He also talked about the COPD foundation release, and wanted more information about patient care,” said Jay Witter, vice president of government affairs for AAHomecare, which had a representative at the meeting. To view Price at the hearing, click here.

Study highlights clinical, economic benefits of CPAP therapy

SAN DIEGO – CPAP therapy lowers blood pressure in obstructive sleep apnea patients with Type 2 diabetes and helps to control their diabetes, according to a new study sponsored by ResMed. What’s more: it’s cost effective. The study used a case-control design, during which 300 patients with OSA and Type 2 diabetes were randomly selected from a nationally representative database of patients in the U.K. Researchers then analyzed the total National Health Service (NHS) cost and outcomes of patient management over a five-year span in the 150 patients who underwent CPAP therapy, compared to the remaining 150 patients who did not. Researchers found that using CPAP therapy was associated with significantly lower blood pressure at five years, and increasingly lower HbA1c levels over five consecutive years, compared with untreated OSA patients. At five years, the HbA1c level in the CPAP-treated group was 8.2% versus 12.1% in the control group. The study also demonstrated that use of CPAP led to an increase in health status by 0.27 quality-adjusted life years (QALYs) per patient over five years, and only increased NHS management costs by £4,141 per patient over that same five-year period. The NHS uses QALYs to measure how much a patient’s life is improved by a therapy. If a treatment costs more than £20,000 per QALY gained, it is not considered cost-effective by NHS standards. Researchers found that the cost per QALY gained with CPAP was £15,337, suggesting that initiating treatment with CPAP in OSA patients with Type 2 diabetes is a cost-effective use of resources.

GAO supports delay in RAC fees

WASHINGTON – The Government Accountability Office (GAO) last week signed off on Medicare’s plan to pay RACs for audits of hospitals only if a second-level appeals judge upholds their findings, according to news reports. The change is one of several that CMS plans to put in place as part of signing on a new group of RACs in 2014. “At this point, I do not think that the change will impact how much the RACs get paid, since appeals to the first and second levels are almost always decided in favor of the RAC/CMS,” Emily Evans, a partner and analyst at Obsidian Research Group, told Modern Healthcare. RACs receive between 9% and 13% of payment amounts flagged as inappropriate.

PHS expands infusion pharmacy

ST. PAUL, Minn. – Pediatric Home Service (PHS) has expanded its infusion pharmacy to meet the demands of its growing population of medically complex pediatric patients, according to a release. The expansion will also enable PHS to increase efficiencies in workflow, better use space and enhance staff communication. “Thanks to our additional capabilities and a rise in infusion therapies that can be delivered in the home, we’re able to continue providing this unique service to a growing patient population at the highest level of care,” said Jill Liebers, pharmacy manager, in the release. PHS, which was founded in 1990, also provides respiratory, specialty pharmacy and private duty nursing services to pediatric patients.

Golden expands operations with new distribution center

OLD FORGE, Pa. – Golden Technologies has doubled the capacity of its Pennsylvania Lift Chair Distribution Center by opening a new warehouse in Laflin, Pa. The warehouse has 10,000 square feet of storage and distribution space, and features energy efficient lighting, railroad ramp access and truck loading docks. In addition to the larger distribution center, Golden’s long-term plan includes increasing its manufacturing capabilities by adding new production lines. That’s exactly what the company will do at its former distribution center in Old Forge. “Now that we’ve emptied out that building, we can begin the process of installing manufacturing lines, creating an additional 50,000 square feet of manufacturing space,” stated Richard Golden, CEO, in a release. “This will allow us to maintain and improve our entire quality systems for lift chair manufacturing.”

Home Care Medical gets in with health network

NEW BERLIN, Wis. – Home Care Medical has reached an agreement with Sheboygan Employer’s Health Network (SEHN) to be an in-network provider for area health insurance members. SEHN offers health insurance to the employees and their families of six major self-funded employers located in Sheboygan County. The agreement allows SEHN members to access products and services from all five of Home Care Medical’s lines of business: infusion and enteral therapy; high-tech rehab equipment; respiratory care; HME and supplies; and bracing and compression garments. Home Care Medical also has a retail showroom conveniently located in Sheboygan.

Short takes

Reps. Tim Walberg, R-Mich., and Mark Amodei, R-Nev., have thrown their support behind H.R. 1717, the “Medicare DMEPOS Market Pricing Program Act of 2013.” The bill, which would replace the current competitive bidding program with an industry supported market-pricing program, now has 173 co-sponsors. The bill was sponsored by Rep. Tom Price, R-Ga., on April 24, 2013….Ewing, N.J.-based Goodwill Home Medical Equipment now offers refurbished power wheelchairs from Hoveround, Pride Mobility Products, Invacare and Golden Technologies. “All chairs are refurbished to like-new condition upon donation,” states a press release...Online medical supplies provider Disposable Medical Express (DME) has revamped its website to make it easier for customers to navigate. The new site divides products into categories and brands for easier shopping, and includes a pricing schedule of shipping and tax rates for all items that cost more than $25.

People in the news

Mervyn Watkins, the founder of Convaid, has been named one of the 15 Most Influential Business Leaders in Torrance, Calif., by the Torrance Chamber of Commerce. He was recognized for his commitment and leadership in support of growing the local economy. Watkins served as Convaid’s CEO until 2008 and maintains an active role on the company’s board of directors…Ottobock has promoted Kathy Schuerman to vice president of finance for North America. She joined the company in 2006 as controller and has been serving as executive director of finance since 2012.

In memoriam

Provider Lynn Giglione, a leader in home medical equipment and home infusion, died April 30, according to an announcement from the National Home Infusion Association (NHIA). Giglione joined the NHIA’s board of directors in 2005 and became the association’s first female board chairwoman in 2009. During her tenure at the association, Giglione helped establish the NHIA Standards for Ethical Practice and the NHIA Industry-Wide Data Initiative. During her career, Giglione held positions at Keystone Medical Equipment, Critical Care America and Apria, before joining Chartwell Pennsylvania in 1998. In 2011, she was named president.

WASHINGTON – A new clock has started ticking on ICD-10.

In an April 30 proposed rule that sets hospital and long-term care inpatient payment rates and rules for 2015, CMS acknowledged that it now plans to implement the new coding system on Oct. 1, 2015.

Congress forced the agency’s hand when both the House of Representatives and the Senate passed “doc fix” bills that included a one-year delay in the transition from ICD-9 to ICD-10.

CMS “expects to release an interim final rule in the near future that will include a new compliance date that would require the use of ICD-10 beginning Oct. 1, 2015,” according to a statement from the agency published in Modern Healthcare. “The rule will also require HIPAA-covered entities to continue to use ICD-9-CM through Sept. 30, 2015.”

In the proposed rule, CMS also seeks comments on how “if at all, we should adjust performance scoring under the Hospital VBP Program to accommodate quality data coded under ICD-10-CM/PCS, or otherwise ensure fair and accurate comparisons under the Hospital VBP Program once the transition date has passed.”

Industry stakeholders have urged HME providers to prepare for the transition to ICD-10 for some time.

WASHINGTON – Average annual growth in per capita personal healthcare spending for the elderly was 4.1% from 2002 to 2010, the lowest among any other age groups studied, according to a report by the CMS Office of the Actuary released May 5 and published in the journal Health Affairs.

Overall, authors of the report found that growth in spending among groups over this time period varied, especially during the recession. For example, in 2008-10, the largest difference in average spending growth between males and females was for the working-age group (19-64). In this period, per capita spending growth for this group was 4% for males but 2.6% for females.

However, authors found the impact on the elderly was less clear. Per capita spending growth for this group in 2008-10 averaged just 2.4% annually, which was lower than the growth rate for the other age groups. Contributing factors: slower Medicare spending, and continued slow growth in spending for nursing care facilities and continuing care retirement communities.

Additionally, private health insurance spending per enrollee for those ages 65 plus grew slowly, at 3% annually in 2008-10—the slowest growth rate of private health insurance among the major age groups. Out-of-pocket spending per person for the elderly declined 0.4% annually over this same period, according to the report.

Despite the lower rate of growth among the elderly, per capita spending by the elderly in 2010 ($18,424) continued to be about three times more than the average for working adults ($6,125) and five times more than children ($3,628).

Authors considered personal healthcare costs all the medical goods and services used to treat or prevent a specific disease or condition in a specific person. As such, the estimates of health spending by age and gender reflect the types of goods and services delivered, including hospital care, physician and clinical services, retail prescription drugs, and the program and payers for that care, such as private health insurance, Medicare and Medicaid.

WASHINGTON – Rep. Renee Ellmers, R-N.C., plans to sponsor legislation to fix Medicare’s broken audit system, AAHomecare and the North Carolina Association for Medical Equipment Services (NCAMES) announced today.

“Congresswoman Ellmers has recognized an intensifying problem in the homecare industry,” stated Robert Steedley, president of Barnes Healthcare Services and chairman of AAHomecare’s board of directors, in a release. “We look forward to working with her to move this legislation forward.”

The announcement came on the first day of AAHomecare’s Washington Legislative Conference, May 7-8 in Washington, D.C.

While AAHomecare has yet to detail the legislation, officials at Medtrade Spring in March said it would pull from a list of recommendations to the administration and CMS. Those recommendations include conducting independent reviews of contractors, implementing interest penalties when claims are overturned, limiting the number of audits a provider can receive during a given period, and reinstating “clinical inference.”

“AAHomecare has been raising the alarm and we have worked for a number of years on policy solutions to address this emerging issue,” stated Tom Ryan, president and CEO of AAHomecare, in the release.

Once the bill is introduced, AAHomecare urges members of Congress to support the legislation.

WASHINGTON – AAHomecare plans to build a system to track the Medicare audits that are devastating HME providers, the association announced during its Washington Legislative Conference this week.

“Good data informs good decisions,” said Tom Ryan, president and CEO of the association, in a release. “We’re ready to work on behalf of the industry to collect and quantify the impacts of audits and present compelling facts that policymakers cannot ignore.”

AAHomecare worked with the American Hospital Association on its audit-tracking tool, called RACTRAC, and has met with the company that built the tool, Provider Consulting Solutions.

The association will use lessons learned to develop a tool that collects “hard facts that will demonstrate the impact of audits on the industry,” according to the release.

“Anecdotal stories and self-reported data are not credible and not persuasive with policymakers,” said Kim Brummett, vice president of regulatory affairs for the association, in the release. “The new audit tracking system will help the industry track a more complete picture of audit activity and its impact.”

WASHINGTON – Expect a trio of HME-related bills to drop in the next few weeks as, slowly but surely, industry stakeholders make headway in their efforts to improve the competitive bidding program and the audit system.

“We’re here to close a lot of issues,” AAHomecare President and CEO Tom Ryan told attendees at the annual Washington Legislative Conference last week. “We can’t do it without your help.”

The big news going into the conference: Rep. Renee Ellmers, R-N.C., plans to introduce the Audit and Improvement Act. Although the language is still being fine-tuned, the bill would seek to, among other things, increase education and outreach about improper payment, reduce error rates, and require timely filing limits on claims subject to audits.

Ryan described the bill as “passable.”

“We’ve worked very hard on getting the points we needed in there, and the points the committees are comfortable with,” said Ryan. “It’s got the substance to be more than a message bill.”

Other bills in the works: Sen. Lamar Alexander, R-Tenn., has drafted language that would expand prior authorizations to include certain high-cost home medical equipment; and Reps. John Larson, D-Conn., and Pat Tiberi, R-Ohio, are working on a bill that seeks to require binding bids in future rounds of competitive bidding.

Also putting a bounce in attendee footsteps was a *Senate sign-on letter being circulated by Sens. John Hune, R-S.D., Robert Casey, D-Pa., and John Hoeven, R-N.D. The letter comes in the wake of CMS publishing an advanced notice of proposed rulemaking seeking input on expanding bid prices nationwide in 2016.

It’s the first time Senators have spoken out on bid expansion.

“The Senate needs to send a message not to move forward with these prices,” Rep. James Renacci, R-Ohio, told attendees. “Every senator has rural areas that are going to be impacted.”

Renacci, a former HME provider, has firsthand knowledge of the impact of competitive bidding. He encouraged providers to send lawmakers his way if they needed to learn more about the flawed program.

“I’ve lived through it,” he said.

Although attendance at this year’s event was down sharply—150 attendees vs. about 260 the previous year—enthusiasm was high and many compared positive notes from the more than 250 meetings conducted on Capitol Hill.

“It’s been a long fight and the troops are weary,” said Karyn Estrella, executive director of the Home Medical Equipment and Services Association of New England. “But, I really feel like things are changing and starting to come together. I feel really positive.”

In addition to the anticipated bills, stakeholders are looking ahead to a pair of reports, possibly coming in June, from both the Senate Finance Committee and the Government Accountability Office (GAO) on audit issues.

“We’ll be taking a hard look at auditors, how many audits there are, appeal rates, CMS oversight, duplication,” said Kim Brandt, chief investigative counsel for the Senate Finance Committee told attendees. “Then we’ll work with the chairman to have a hearing after July 24.”

WASHINGTON – AAHomecare plans to build a system to track the Medicare audits that are devastating HME providers, the association announced during its Washington Legislative Conference last week. “Good data informs good decisions,” said Tom Ryan, president and CEO of the association, in a release. “We’re ready to work on behalf of the industry to collect and quantify the impacts of audits and present compelling facts that policymakers cannot ignore.” AAHomecare worked with the American Hospital Association on its audit-tracking tool, called RACTRAC, and has met with the company that built the tool, Provider Consulting Solutions. The association will use lessons learned to develop a tool that collects “hard facts that will demonstrate the impact of audits on the industry,” according to the release. “Anecdotal stories and self-reported data are not credible and not persuasive with policymakers,” said Kim Brummett, vice president of regulatory affairs for the association, in the release. “The new audit tracking system will help the industry track a more complete picture of audit activity and its impact.”

BioScrip reports double-digit increases

ELMSFORD, N.Y. – BioScrip reports revenue from continuing operations was $239.6 million in the first quarter of 2014, an increase of 32.3% over the same period last year. In the Infusion Services segment, revenue grew to $221.4 million, an increase of 43.4%, driven primarily by BioScrip’s acquisitions of HomeChoice and CarePoint, along with organic growth. Consolidated gross profit was 27.2% higher for the first quarter of this year compared to the same period last year. Adding to BioScrip’s earnings picture: In March, the company sold Deaconess HomeCare for $60 million and used the proceeds to pay down a portion of outstanding debt.

Untreated cases drive sleep market, report says

NEW YORK – Undiagnosed cases and new devices will drive growth in the global sleep apnea device market, a new Kalorma report says. In the U.S., 18 million are affected by sleep apnea in any given year, the report says, while another 10 million are undiagnosed. “Sleep apnea is very common,” said study author Mary Ann Crandall. “Yet because of the lack of awareness by the public and healthcare professionals, the vast majority remain undiagnosed and therefore untreated.” The report predicts an influx of device alternatives in the future as large companies expand their offerings through acquisitions. For example, ResMed acquired Narval SA, which makes a mandibular repositioning device, and Philips Respironics purchased Aspire Medical, which makes an implant to treat sleep apnea. The market grew from $3.6 billion in 2011 to $4.2 billion in 2013, according to the report.

Software companies ready for Medtrade

ATLANTA – More than a dozen software companies have already signed on to exhibit their wares at Medtrade, Oct. 20-23 at the Georgia World Congress Center in Atlanta, according to a release. The companies have a focus on efficient operations and smoother billing processes. “It’s no secret that revenue is down for many HME providers, but demand is steadily growing,” says Kevin Gaffney, group show director. “While these two forces are at work, it makes sense that software companies that truly lower costs can help providers’ bottom lines.” 

Home Care Medical snags HMO contract

NEW BERLIN, Wis. – Home Care Medical has reached an agreement with Trilogy Health Plan to be an in-network provider for its new Medicaid HMO health insurance members in southeastern Wisconsin. Trilogy provides service to all Medicaid HMO members in Milwaukee, Ozaukee, Racine and Waukesha counties. Per the agreement, members now have access to products and services from Home Care Medical’s five lines of business: infusion and enteral therapy; high-tech rehab equipment; respiratory care; HME and supplies; and bracing and compression garments. Home Care Medical also became an in-network provider with Sheboygan Employer’s Health Network in April.

ResMed execs unload stock

SAN DIEGO – Peter Farrell, the former CEO of ResMed and a current director, sold 25,000 shares of company stock on the open market in a transaction dated May 1. The stock was sold at $49.80 for a total value of $1.245 million. Farrell still owns 304,990 shares in the company valued at $15.188 million. Brett Sandercock, CFO, sold 4,290 shares in a transaction dated May 6. The stock was sold at $50 for a total value of $214,500. Sandercock sill owns 71,423 shares in the company valued at $3.57 million.

Alliqua buys Choice Therapeutics

LANGHORNE, Pa. – Alliqua, a provider of advanced wound care products, has acquired Choice Therapeutics for $4 million in stock and cash. The agreement, effective May 5, provides for an additional contingency payment of up to $5 million in stock or cash if stated revenue thresholds are reached over the next three years ending April 30, 2017. Alliqua has acquired Choice’s wound care portfolio, its technology platform, and its sales and marketing team. The portfolio includes a TheraBond Antimicrobial Barrier Systems technology that’s in wide use at key burn centers nationwide.

Short takes

Invacare was the proud sponsor of the Paralyzed Veterans of America Buckeye Wheelchair Games at the Spire Institute in Geneva, Ohio, May 2-3. More than 40 veterans from Ohio and Pennsylvania competed in the games, which included archery, bowling, billiards, weightlifting, table tennis, and track and field. Stuart Cohen, a national account manager for Invacare, worked a booth at the event…StateServ Medical, a provider of DME, DME software and DME benefit management for the hospice industry, is celebrating 10 years in business, according to a release. “In 2010, we launched our Network Services to contract with DME companies across the country,” said Paul DiCosmo, CEO.

People news

Megan Delperdang, community relations coordinator for Convaid, has been elected meeting and education chairwoman for the Greater Texas Rehab Providers’ Council (TXRPC). In this role, Delperdang will identify key educational opportunities and needs, and coordinate council activities on educational programs and meetings.

WASHINGTON – The Medicare Fraud Strike Force has charged 90 individuals with $260 million in false billings, according to a May 13 release from the Department of Justice. 

Those charged include physicians, nurses and other medical professionals.

“The crimes charged represent the face of health care fraud today—doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing numbers of patients,” said Acting Assistant Attorney General David O’Neil. “The fraud was rampant, it was brazen, and it permeated every part of the Medicare system.” 

The defendants are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes and money laundering. The charges stem from alleged fraud schemes involving various medical treatments and services, including home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy.

More than half of those charged were part of an alleged fraud scheme involving false billing for home health care and mental health services and pharmacy fraud in Miami.

Since 2007, the Strike Force has charged nearly 1,900 individuals with approximately $6 billion in fraud, according to the release.

PHOENIX – The 9th U.S. Circuit Court of Appeals has voided a cost-saving bid by Arizona’s Medicaid program to deny incontinence briefs to adults who need them.

The Arizona Health Care Cost Containment System (AHCCCS) contended that briefs are only medically necessary when prescribed to treat skin breakdown or infections due to incontinence and that doctors were preemptively prescribing them before any medical problems arose, the Arizona Daily Star reported.

The ruling by the three-judge panel leaned on AHCCCS’s own rules, which state that products are medically necessary when a doctor prescribes them “to prevent disease, disability, or other adverse health conditions or their progression,” the newspaper reported.

The judges also pointed out that CMS approved AHCCCS’s definition of medical necessity, but not an amendment carving out incontinence briefs, the Daily Star reported.

YARMOUTH, Maine – HME providers say they’ve had some luck getting Medicare contractors to reopen and overturn denials, but it’s not always easy.

The vast majority (96%) of the 49 respondents to a recent HME Newspoll said they have made attempts to get Medicare contractors to reopen claims denied for technical reasons. Sixty percent said they succeeded and, of those, 80% said their denials were, ultimately, overturned. 

“We have had as many as 16 claims processed incorrectly as recent as April,” said one poll respondent. “These all have to go to a level 2 rep and they have them reopened and reprocessed correctly, but it takes time. This should not be happening nine months after. Fix the glitch and get it right.”

As a result of discussions with the Jurisdiction D DME Advisory Council, CMS has reminded its contractors that their “scope of services” includes reopening cases where claims have been denied due to technical reasons.

Providers who have had some success say you must approach the process methodically.

“I educated the contractor by sending them the written rules (LCD) and then highlighted the areas they were obviously wrong in and showed how our documentation lined up to the letter of the rules,” said one poll respondent.

Despite more responsive and reasonable contractors, the system still has its glitches, as one provider found out while attempting to reverse a claim denied as same/similar.

“To get the same/similar denial processed, we had to go to redetermination,” said the poll respondent. “Well, we had to wait for the refund process before we could appeal the denied item and by that time the initial denial went beyond 120 days. So now they are dismissing our redetermination as past timely filing.”

Going forward, 98% of poll respondents say that, now that they’ve seen others succeed in reopening and overturning claims denied for technical reasons, they’ll try the strategy in the future.

“This whole system is beyond broken,” said Erin Duke, CFO at Duke Medical Equipment in Baytown, Texas. “This shouldn’t be legal to keep providers’ money while the patient keeps equipment and take this long, all over a claim that never should have been denied.”

WASHINGTON – Thirty-one senators, as of press time on Friday, had signed a letter to CMS Administrator Marilyn Tavenner asking her not to expand the competitive bidding program until the Office of Inspector General completes an investigation of Round 2.

“We are seeing results,” said Jay Witter, vice president of government affairs for AAHomecare.

CMS in February published an advance notice of proposed rulemaking seeking comments on developing a methodology to apply bid rates to non-bid areas; and bundling payments for certain DME. The agency received 185 comments, mostly critical of the proposal.

In the letter, Sens. John Hune, R-S.D., Robert Casey, D-Pa., and John Hoeven, R-N.D., express particular concern with the impact of competitive bidding prices on rural areas.

“DMEPOS are especially vital and necessary to resident beneficiaries, ad we question whether an apples-to-apples comparison with urban areas is the best approach, especially since there are some concerns with the bidding process in Round 1 and Round 2,” the letter states.

It’s the first time senators have taken a stance on competitive bidding, possibly paving the way for future progress, stakeholders say.

“We are getting emails from Senate staff asking all these questions about competitive bidding, so it’s an opportunity to educate and update them on the issue,” said Witter.

Education is key if the industry wants to get any help from lawmakers, says Doug Coleman, president of the Colorado Association for Medical Equipment Suppliers (CAMES). He secured the support of two senators from Colorado and Wyoming during the *AAHomecare Legislative Conference earlier this month.

“I do think that continuing to have a presence at those fly-ins is important,” he said. “You’ve established the relationship and when you have an ask, you’ve laid the groundwork with the education.”

Correction

In “AAHomecare closes in on key issues” in the May 12 HME Newswire, the quote from Kim Brandt should have read: “Then we’ll work with the chairman to have a hearing after July 4.”

PHOENIX – The 9th U.S. Circuit Court of Appeals has voided a cost-saving bid by Arizona’s Medicaid program to deny incontinence briefs to adults who need them. The Arizona Health Care Cost Containment System (AHCCCS) contended that briefs are only medically necessary when prescribed to treat skin breakdown or infections due to incontinence and that doctors were preemptively prescribing them before any medical problems arose, the Arizona Daily Star reported. The ruling by the three-judge panel leaned on AHCCCS’s own rules, which state that products are medically necessary when a doctor prescribes them “to prevent disease, disability, or other adverse health conditions or their progression,” the newspaper reported. The judges also pointed out that CMS approved AHCCCS’s definition of medical necessity, but not an amendment carving out incontinence briefs, the Daily Star reported.

Quantum Rehab buys Stealth Products

EXETER, Pa. – Quantum Rehab, a Pride Mobility Products company, has acquired Stealth Products, a Burnet, Texas-based manufacturer of complex rehab technology components and accessories. Per the deal, Stealth Products’ management team, including President Lorenzo Romero, and its employees will continue to operate independently. “By aligning the two companies within the larger complex rehab technology industry, we’re able to expedite developing and delivering the needed technologies to help those with disabilities lead the most independent, enriched lives,” stated Scott Meuser, chairman and CEO of Pride Mobility, in a press release. Stealth Products manufactures specialty drive controls, head and body positioning components, specialty mounting hardware, and pediatric mobility solutions. This is only the most recent move made by Quantum Rehab and Pride Mobility to strengthen their position in the market. The companies already have a partnership with Comfort Company to ramp up sales of Quantum and Pride manual wheelchairs, and they have a strategic alliance with Active Controls to offer products like the JoyBar on their power wheelchairs.

Gov’t cracks down on ‘brazen’ fraud

WASHINGTON – The Medicare Fraud Strike Force has charged 90 individuals with $260 million in false billings, according to a May 13 release from the Department of Justice. Those charged include physicians, nurses and other medical professionals. “The crimes charged represent the face of health care fraud today—doctors billing for services that were never rendered, supply companies providing motorized wheelchairs that were never needed, recruiters paying kickbacks to get Medicare billing numbers of patients,” said Acting Assistant Attorney General David O’Neil. “The fraud was rampant, it was brazen, and it permeated every part of the Medicare system.” The defendants are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes and money laundering. The charges stem from alleged fraud schemes involving various medical treatments and services, including home health care, mental health services, psychotherapy, physical and occupational therapy, durable medical equipment and pharmacy. More than half of those charged were part of an alleged fraud scheme involving false billing for home health care and mental health services and pharmacy fraud in Miami. Since 2007, the Strike Force has charged nearly 1,900 individuals with approximately $6 billion in fraud, according to the release.

VGM to roll out Audit Task Force

WATERLOO, Iowa – The VGM Group’s U.S. Rehab will roll out an Audit Task Force at its Heartland Conference, June 9 through June 12, said U.S. Rehab President Greg Packer. Task force members Peggy Walker, Ronda Buhrmester and Dan Fedor will offer billing and reimbursement advice; review claims and audits providers feel were incorrectly denied; answer questions on National Supplier Clearinghouse issues; and offer ongoing educational opportunities for members of VGM and U.S. Rehab.

Liberator Medical holds on

STUART, Fla. – Liberator Medical’s reported a sales of $17.6 million for its second fiscal quarter ended March 31, 2014, a 5.3% increase compared to the same period in 2013, the company announced May 15. Net income for the quarter was $1.6 million. Cash on-hand was nearly $9.6 million compared with $12.4 million for the quarter ended Sept. 30, 2013. "In the second quarter we encountered our normal seasonal sales weakness associated with the renewal of calendar year deductibles, continued delayed payments due to Medicare's industry wide auditing of medical supply claims and a significant increase in income tax payments,” said Mark Libratore, president/CEO. Liberator began trading on the New York Stock Exchange in November.

Sleep apnea market to grow 7.8%

YARMOUTH, Maine – The global sleep apnea market for diagnostic and therapeutic equipment is expected to increase 7.8% from $3.8 billion in 2012 to $6.43 billion by 2019, according to a report released May 12 by Transparency Market Research. While polysomnography devices comprised the largest share of the market in 2012 (28.35%), technological advances in devices like actigraphy systems and pulse oximeters are expected to drive future growth. North America accounted for the largest market share in 2012 due to high levels of sleep apnea awareness, the rising prevalence of obesity and the presence of well-equipped sleep labs.

VMI offers financing through Bank of America

PHOENIX – Vantage Mobility International (VMI) customers may now apply directly for financing from Bank of America using a link from VMI’s website under a new agreement announced May 15. Decisions are usually made within 15 minutes, according to the release, and approved customers receive phone calls within an hour. “Our goal was to help VMI streamline the credit application process for those who need wheelchair accessible transportation,” said John Hyatt, president of Bank of America Dealer Financial Services. “We share VMI’s commitment to make it easier for these customers to pursue financing options for vehicles that can help transform their lives.” Loans can be used to purchase new or used wheelchair accessible vans at any VMI dealership in the U.S.

Error rate for glucose test strips tops out

INDIANAPOLIS - A prepayment review of glucose test strips resulted in a claim error rate of 99.2%, according to National Government Services. The Jurisdiction B DME MAC reviewed 8,758 claims filed between Jan. 1 and March 31. The top four reasons for denial: lack of medical necessity, documentation not returned within the requested time frame, billing more than the standard allowed quantity, and incorrect modifier submitted. Claims denied due to lack of medically necessity were missing progress notes, proof that the testing frequency was medically necessary or the quantity of supplies remaining for the refill requests; were already billed or paid to the same or a different supplier or same or similar dates of service; were billed with the KS modifier instead of the KX modifier to indicate the beneficiary used insulin; included a written order without the quantity to be dispensed; or included a proof of delivery record that lacked sufficiently detailed descriptions to identify the items delivered.

Allegro Medical survey links incontinence, depression

BOLINGBROOK, Ill. – People purchasing incontinence products look at comfort, capacity and cost, a new survey by Allegro Medical has found. The survey found 95% use incontinence products themselves or for a spouse or parent; 90% say their condition keeps them from participating in favorite activities; and more than 85% say they suffer from depression. “A growing number of people who are experiencing incontinence will usually wear some sort of protective layer so that accidents will be discreet and easy to clean,” said Craig Hood, executive vice president. “With the right products, a person can usually live an active lifestyle.” The survey also found that the leading causes of incontinence are prostate issues and physical trauma for men, and obesity and diabetes for women.

Review results in 87.7% error rate for power wheelchairs

INDIANAPOLIS – The claim error rate for Group 2 power wheelchairs without power seating options was 87.7% between Jan. 1 and March 31, according to National Government Services (NGS), the Jurisdiction B DME MAC. Of 389 claims filed, 48 were paid in full, with the rest fully or partially denied. The most common reasons for denials: face-to-face documentation failed to prove a manual wheelchair wouldn’t meet the beneficiary’s needs in the home, the beneficiary had a significant mobility limitation requiring a power wheelchair, or why a power-operated vehicle wouldn’t meet the beneficiary’s needs in the home; and coverage criteria did not show the beneficiary lacks upper extremity strength to propel a manual wheelchair in the home or that a cane or walker were unsuitable alternatives. NGS reminded providers they are required to respond to requests for additional documentation.

National Sleep Therapy makes buy

NORWOOD, Mass., & WALLINGFORD, Conn. – National Sleep Therapy (NST) has acquired Gaylord Sleep Medicine Equipment. Gaylord, a division of Gaylord Hospital, operates four sleep labs. “Gaylord Sleep and National Sleep Therapy have been working collaboratively during the past year to develop a sleep equipment program that is one of the best in the U.S.,” said Joseph Zangrilli, vice president of operations for NST. “We believe the new combination will result in a great patient experience and result in better outcomes.” NST, which accepted several contracts for CPAP in Round 2 of competitive bidding, acquired Rest Ensured Medical in 2012.

3B/BMC scores patent victory

LAKE WALES, Fla. – 3B/BMC Medical has successfully invalidated a ResMed patent on a “cushion for patient interface” in China, it announced today. BMC in October initiated proceedings before the Chinese Patent Re-examination Board against five ResMed patents. BMC is also in the process of preparing IPR (Inter Partes Review) applications seeking to invalidate several ResMed patents in the U.S. Patent and Trademark Office. In April, the two companies concluded a trial before the International Trade Commission that was the result of a complaint filed by ResMed alleging infringement on several patents. A final decision is expected in December.

Truefit CPAP supplies hit walmart.com

BOSTON – PBM Capital has announced that its Truefit CPAP supplies and accessories are now available nationwide through Walmart.com. The Truefit line of products includes filters for more than 60 popular CPAP machines; replacement hoses and tubing; and a full line of accessories, such as chin straps, headgear, cleaning solutions, gel pads and hose wraps, according to a press release. “Until now, CPAP supplies have been sold exclusively through medical supply stores making them expensive and inconvenient for consumers to access,” the release states. “Truefit is the first full line of CPAP supplies sold through Walmart.” The release echoes a recent brochure touting the availability of the Truefit line of supplies and accessories at Walmart.

Bills get boost from complex rehab conference

WASHINGTON – Lobbying visits conducted during the recent CRT Leadership & Advocacy Conference are paying off. NCART reported this week that 13 new lawmakers have signed on to a bill in the House of Representatives to create a separate benefit for complex rehab. One additional lawmaker has signed on to a similar bill in the Senate. H.R. 942 and S. 948 now have 122 and 13 co-sponsors, respectively.

People in the news

Todd Tyson received the 2014 Legislative Advocate Award at the AAHomecare Washington Legislative Conference earlier this month. AAHomecare recognized Tyson for his contributions of time, effort and leadership to advance the association’s government affairs efforts…Michael Merriman has been elected to Invacare’s board of directors. He is currently an operating advisor for Resilience Capital Partners, a private equity firm focused on principal investing in lower middle market underperforming and turnaround situations…Gary Cox, CEO of PMDRX, is running for a state Senate seat in Arizona. Cox, who has also owned two DME companies, seeks to represent District 30. Part of his platform: introduce legislation to fix loopholes in the state Medicaid program that allow “Medicaid contracted payers to reap millions of dollars in profits at the expense of patient providers,” he says…Ali Bauerlein, Brenton Taylor and Byron Myers, the trio who founded Inogen in 2001, have received the Venky Narayanamurti Entrepreneurial Leadership Award, also known as “The Venky.” The award, given by UC Santa Barbara’s College of Engineering, honors leadership and success in the high technology entrepreneurial community in the region…Van Miller, founder of The VGM Group, is one of three Iowa-based finalists for the Ernst & Young Entrepreneur of the Year award for the Upper Midwest. He travelled to Minneapolis last week for interviews with a panel of judges. The winner will be announced June 11.

SAN DIEGO – A study presented this week at the American Thoracic Society 2014 International Conference shows a new algorithm can make APAP therapy more comfortable for women. 

“The overlooked gender differences of sleep apnea can make treatment uncomfortable and less effective for women,” said Jeff Armistead, vice president of medical affairs at ResMed, which funded the study.

Researchers say the treatment algorithm addresses symptoms common to women: shorter respiratory events, apneas that occur mostly during the REM phase of sleep, and that air flow is frequently restricted but not blocked in female patients.

Researchers found that the proportion of flow-limited breaths was significantly lower with the new algorithm than with standard APAP, and mean mask pressure tended to be less.

Also this week, ResMed announced the results of another study, which found that its U-Sleep compliance management solution led to a 59% reduction in labor associated with coaching patients on CPAP therapy. U-Sleep monitors usage and helps providers coach and manage patients. It sends automated text messages and emails to patients when data shows they aren’t using their CPAP devices.

BIRMINGHAM, Ala. – HME providers here in March hailed the passage of a bill that they say will protect Medicare beneficiaries from shoddy service.

The bill, H.B. 225, contains a provision that makes a physical presence in the state a requirement of licensure for most HME providers. Signed into law March 19, it is slated to take effect Aug. 1.

“We had people shipping oxygen concentrators and power mobility devices with absolutely no one within 1,000 miles to look after the patients,” said Michael Hamilton, executive director of the Alabama Durable Medical Equipment Association.

Alabama saw many Round 2 contracts awarded to companies that were, in some cases, located several hundred to more than 1,000 miles from the Birmingham competitive bidding area. In the event of another round of bidding, out-of-state providers would have to open a local location.

Alabama’s HME licensure board will spend the next several months hammering out regulations to ensure all providers meet the new requirement, says Peter Czapla, co-owner of Quality Home Health Care in Wetumpka and chairman of the state’s licensure board.

“If (out-of-state) providers intend to provide good quality service in our state, we welcome them,” he said. “They have to be able to take care of the patients and give them the service they need. It’s that simple.”

The law won’t impact providers of diabetes testing supplies, nebulizer medications, and other products that can be more easily delivered by mail order, or providers who live just outside state borders, according to Hamilton. 

As to any potential impact on existing out-of-state contract suppliers, Hamilton predicts it won’t be a problem for most.

“The people who were out of state that won bids have bought companies here so they have a local presence,” he said.

HONOLULU – With patients waiting weeks or months for equipment, Hawaiian healthcare providers have convinced CMS to award two additional competitive bidding contracts to island-based HME providers.

Just 13 of 97 contracts awarded in the Honolulu CBA in Round 2 of the program went to local providers. With no same day or overnight delivery options, mainland suppliers can’t get equipment or parts to Hawaii faster than two to four days, and beneficiaries on the island wait an average of four to eight weeks for hospital beds or wheelchairs. 

“This resulted in patients being left in beds when they were ready to go home,” said George Greene, president of the Healthcare Association of Hawaii (HAH). “Hospitals actually spent operational funds to pay for the equipment these patients needed because they needed the beds and patients no longer needed to be in those beds.”

Hospitals have also had to loan their own equipment to Medicare beneficiaries just to get them discharged.

Complicating matters: The one-size-fits-all bidding program just doesn’t work in Hawaii, where the cost of business is higher, said Greene. That not only put local providers at a disadvantage during the bidding phase, but also meant that contract suppliers couldn’t find subcontractors.

It’s having a ripple effect, with many local providers shutting their doors.

“These are small shops, mom-and-pop shops with local employees working for them,” said Greene. “It’s not lucrative in any way, shape or form from my perspective. They do it because they’re invested in helping the healthcare community take care of patients.”

The two additional local contracts aren’t enough to change the landscape in Hawaii, said Greene, but they’re a step in the right direction.

“We hope that, as we continue to dialogue with them and as we don’t see the impact of competitive bidding being mitigated by those two additional awards, that they will award more,” he said.

BALTIMORE – CMS may implement prior authorizations for certain durable equipment, it announced May 22.

Through a proposed rule to be published in the May 28 Federal Register, the agency will seek comments on the prior authorization process, as well as criteria for establishing a list of DME that is frequently overutilized. The agency has a “master list” of 134 codes that meet the criteria and that could be subject to prior authorization. It includes lower limb prostheses, negative pressure wound therapy, pressure reducing support surfaces and CPAP.

The proposed rule is projected to reduce Medicare spending by $100 million to $740 million over the next 10 years.

“With prior authorization, Medicare beneficiaries will have greater confidence that their medical items and services are covered before services and supplies are rendered,” stated CMS Administrator Marilyn Tavenner in a release. “This will improve access to services and quality of care.”

CMS also announced that it will expand its demonstration project for power mobility devices to 12 additional states: Pennsylvania, Ohio, Louisiana, Missouri, Maryland, New Jersey, Indiana, Kentucky, Georgia, Tennessee, Washington and Arizona, bringing the total number of states to 19.

The PMD demo has reduced spending from $11 million in September 2010 to $5 million in June 2013.

PMD stakeholders are largely supportive of prior authorizations. At the request of the Senate Finance Committee, the industry has drafted language that would expand the demo to all 50 states and would expand it to include all power mobility devices, including Group 3 wheelchairs.