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- 05/23/14--09:47: _Lawmakers voice con...
- 05/23/14--09:40: _In brief: Congressm...
- 05/29/14--10:18: _CMS: PMD spending c...
- 05/30/14--11:30: _Stakeholders say pr...
- 05/30/14--11:26: _Managed care monopoly?
- 05/30/14--11:22: _In brief: PMD spend...
- 06/04/14--09:37: _Government overpays...
- 06/06/14--11:44: _In brief: AAH colle...
- 06/11/14--12:28: _CDC: 9.3% of U.S. p...
- 06/12/14--12:03: _Medicare saves with...
- 06/13/14--11:54: _Bid, audit bills ne...
- 06/13/14--11:52: _Providers debate pr...
- 06/13/14--11:51: _At Heartland, provi...
- 06/13/14--11:45: _In brief: VGM and v...
- 06/19/14--12:41: _SBA to take up indu...
- 06/20/14--11:01: _Audit relief: CGS e...
- 06/20/14--10:59: _CMS dishes on new p...
- 06/20/14--10:54: _In brief: Lawmakers...
- 06/20/14--10:19: _Alabama: Sharp line...
- 06/20/14--10:16: _Surety bond prices ...
- 05/23/14--09:47: Lawmakers voice concerns on audits
- 05/23/14--09:40: In brief: Congressman seeks feedback, Drive expands presence
- 05/29/14--10:18: CMS: PMD spending continues downward slide
- 05/30/14--11:30: Stakeholders say prior auths need to be timely, efficient
- 05/30/14--11:26: Managed care monopoly?
- 05/30/14--11:22: In brief: PMD spending down, F&P earnings up
- 06/04/14--09:37: Government overpays Medicare Advantage plans, report says
- 06/06/14--11:44: In brief: AAH collects funds, Senate green-lights HHS chief
- 06/11/14--12:28: CDC: 9.3% of U.S. population has diabetes
- Another 86 million adults, or one-third of the population, have blood sugar levels high enough to be diagnosed with pre-diabetes;
- More than 200,000 children and teens have diabetes; and
- Diabetes is about twice as common among blacks, Hispanics, American Indian and Alaskan native adults as among whites.
- 06/12/14--12:03: Medicare saves with HME, study says
- 06/13/14--11:54: Bid, audit bills near prime time
- 06/13/14--11:52: Providers debate prior auth proposal
- 06/13/14--11:51: At Heartland, providers learn about game changers
- 06/13/14--11:45: In brief: VGM and van Halem merge, Pride and Navitas partner
- 06/19/14--12:41: SBA to take up industry issues at next hearing
- 06/20/14--11:01: Audit relief: CGS explains denials, excludes certain providers
- 06/20/14--10:59: CMS dishes on new prior auth proposal
- 06/20/14--10:19: Alabama: Sharp line divides providers
- 06/20/14--10:16: Surety bond prices up on Medicare activity
WASHINGTON – Industry stakeholders say a Congressional hearing last week on audits is likely the first of many such hearings on the issue.
“This hearing is part of taking a look at the recovery audit contractor (RAC) audits which the hospitals are fully engaged in,” said Jay Witter, vice president of government affairs for AAHomecare. “Their issues are our issues and they are really boiling up now.”
Officials from the Center for Program Integrity, the Government Accountability Office and the Office of Inspector General testified at the May 20 hearing, held by the House Oversight and Government Reform Subcommittee on Energy Policy, Health Care and Entitlements.
It was clear from lawmakers’ comments during the hearing that they understand the negative impact of audits on HME providers.
“I have some serious concerns that the current system of post payment audits by RACs is resulting in a significant burden on some providers,” said Rep. Michelle Lujan Grisham, D-N.M., at a hearing held by the House Oversight and Government Reform Subcommittee on Energy Policy, Health Care and Entitlements, according to a bulletin from The VGM Group.
With an audit reform bill expected to drop soon—possibly this week—the hearing, as well as the 250 Capitol Hill meetings conducted during the AAHomecare *Legislative Conference May 7–8, should have lawmakers primed to sign on as co-sponsors, say stakeholders.
“It’s a big issue on the Hill, given the administrative law judge situation,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “And it’s not just DME—the entire healthcare industry is up in arms. Billions of dollars are being held up.”
Relief can’t come soon enough for weary providers like Mike Calcaterra.
“All these auditors that are going through with all of these claims and then losing them on appeal and they don’t get money taken back,” said Calcaterra, northern zone vice president for Boise, Idaho-based Norco. “It just amazes me.”
WASHINGTON – Congressman Jim Renacci, R-Ohio, wants to hear from suppliers on the competitive bidding and re-review processes, according to an AAHomecare bulletin. Renacci, a former DME provider who lost in the Round 1 re-bid, will host a roundtable on the bid program and other issues affecting DMEPOS suppliers June 5 in Ohio. AAHomecare is compiling answers to a short online survey and sending them to Renacci. In other competitive bidding news, H.R. 1717 picked up three additional co-sponsors last week bringing the total to 178. They are Reps. Thomas Petri, R-Wis., Bradley Byrne, R-Ala., and Lois Frankel, D-Fla. The bill would repeal competitive bidding and replace it with a market pricing program.
Drive expands presence in Europe
PORT WASHINGTON, N.Y. – Drive Medical has acquired several product lines from Days Healthcare, a U.K.-based manufacturer
The deal will expand Drive’s European presence, says Drive Chairman and CEO Harvey Diamond. “Not only does this acquisition expand our growing presence in the European marketplace and enhance our position as a global manufacturer and distributor of durable medical equipment, it also provides increased manufacturing capacity and more diversified design and technology capabilities in Europe,” he said in a May 19 release. The product lines include homecare and long-term care beds, scooters, wheelchairs, riser recliner products and other items. In October, Drive secured $115 million in financing from GE Capital, Healthcare Financial Services. The loan was obtained with an eye to supporting ongoing capital and growth needs, including acquisitions. Drive also acquired the manufacturing and distribution facility in Bridgend, Wales. Terms of the deal were not disclosed.
ResMed studies target comfort, compliance
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.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.
Bill would add sleep apnea screening to Medicare preventive physicals
DARIEN, Ill. – Under a bill introduced this week, Medicare would screen for obstructive sleep apnea (OSA) during initial preventative physical exams, according to an American Academy of Sleep Medicine release. The bill would add a questionnaire to initial visits performed on or after Jan. 1, 2016, targeting beneficiaries at high risk for the disease. “A sleep apnea screening questionnaire is a simple, validated and cost-effective tool that can be used to identify Medicare patients who are at risk for obstructive sleep apnea,” said Rep. Michael Burgess, R-Texas, founder and co-chair of the Congressional Health Caucus, who introduced the bill. “Diagnosing and treating sleep apnea is essential for effective chronic disease management among seniors.” The American Academy of Sleep Medicine initiated the legislation under its Seniors Sleep program to increase preventive sleep care.
Prepayment review focuses on CPAP
INDIANAPOLIS – National Government Services, the Jurisdiction B DME MAC, plans to target CPAP devices for a widespread prepayment medical review, it announced in a message yesterday. Providers randomly selected for review will receive an additional development request asking for a detailed written order for the CPAP device and any accessory billed on the same claim; medical records documenting a face-to-face clinical evaluation prior to the sleep test detailing symptoms of sleep disorder, their duration, cardiopulmonary and upper airway exam, neck circumference and BMI; a Medicare-covered sleep test; and documentation that the patient or caregiver was instructed on proper use and care of equipment. If the claim is for the fourth or subsequent rental month, providers will be asked to submit documentation of a re-evaluation by the treating physician and documentation verifying the patient used the device four or more hours on 70% of the nights during a period of 30 consecutive days. Refill requests are to include documentation of contact with the patient within a week of dispensing a supply of new accessories, according to the statement.
Numotion expands in Wisconsin, Mobility Plus sells
EAU CLAIRE, Wis., and TULSA, Okla. – Numotion has acquired Eau Claire, Wis.-based Reliant Rehab Service & Supply, a provider of mobility equipment and DME accessories. “Reliant’s locations in Eau Claire and Marshfield will greatly expand our service area, while the Appleton location will strengthen Numotion’s service capabilities throughout the Fox Valley area,” said Tim Havel, Numotion regional vice president. Also this week, Cherokee Nation Businesses has announced its sale of Muskogee, Okla.-based Mobility Plus to Freeland Brown Pharmacy. Mobility Plus offers sales and rentals of rehab technology devices, respiratory products and DME. Freeland Brown Pharmacy offers prescription services, compounding, ostomy, wound care, nutritional supplements, DME and mobility-related supplies.
Provider expands with 101 Mobility franchise
HUNTINGTON, W.Va. – 101 Mobility has awarded West Virginia territory to Bob Murdock, owner of Access & Mobility Products, the company recently announced. "Once we began talking with 101, we were impressed by their vendor relationships and marketing department," said Justin Murdock, Bob Murdock’s son. "It became clear that with 101 corporate handling a large part of the marketing, including web traffic, we would be free to focus on other aspects of our growing business." Access & Mobility will continue offering accessible minivans and other vehicle modifications along with 101 Mobility retail items.
Home Care Medical marks 40 years
MILWAUKEE – Home Care Medical will celebrate its 40th anniversary with an open house May 31 at its retail location here. The event will include a cookout and music from a local radio host. In conjunction with the radio remote, one listener will win a restored 1969 Mustang. Attendees at the event can register to win a host of prizes, including Kindles, donated by Jobst-FLA and Sunrise, and gift cards donated by manufacturers including Invacare, Golden, Drive and Comfort Company.
Harmar names new leader
SARASOTA – Harmar has appointed Drew McCartney as its new president and CEO, the company announced May 20. He succeeds Chad Williams, who will remain with Harmar on its board of directors. “His leadership over the last 16 years was critical to Harmar’s growth and we look forward to his continued involvement in the business as a member of the Board of Directors" stated Jeff Lipsitz, managing partner at Cortec Group, Harmar's controlling shareholder. McCartney has previously held CEO positions for portfolio companies of BelHealth Investment Partners and DW Healthcare Partners, and served as CEO of First Circle Medical.
Short takes: Medela, SCA
Medela has completed its acquisition of the enteral feeding assets of Brea, Calif.-based Acacia, which produces neonatal feeding devices… SCA is poised to launch Tena Identifi, a new sensor-based technology for continence care, in the U.S., the manufacturer announced this week. The technology is in the final stages of regulatory clearance, according to a press release. Tena Identifi tracks users’ voiding patterns over a 72-hour time period and converts the data into reports that help acute and long-term care facilities provide more individualized care.
People in the news: Tracy, Zelenko, Cox
Bret Tracy has been named MK Battery’s national sales director. Tracy, an ATP who joined MK Battery in 2012 as associate director of HME business, has worked on federal separate benefit legislation and sits on several industry boards…Tammy Zelenko, president/CEO of AdvaCare Home Services, celebrated her 15th year of owning the company May 20…Laura Cox has joined Shield Healthcare as an ostomy lifestyle expert.
WASHINGTON – Spending on power mobility devices (PMDs) continues to fall nationwide since the September 2012 launch of a demo requiring prior authorizations in seven states, CMS says.
Monthly expenditures for PMD codes dropped from $12 million in September 2012 to $3 million in December 2013 in demo states, and from $20 million to $6 million in non-demo states across the same time period, according to an update.
“While we recognize that multiple factors contributed to the decrease in PMD expenditures, there was also a significant decrease in the number of beneficiaries receiving PMDs in the demonstration states after the start of the demonstration,” CMS wrote. “We believe this decrease is because prior authorization is ensuring that only beneficiaries who meet Medicare requirements receive a PMD.”
CMS had previously reported that expenditures for PMD codes dropped from $12 million in September 2012 to $4 million in September 2013 in demo states and to $9 million across the same time period in non-demo states.
From Sept. 1, 2012, to Dec. 31, 2013, the number of beneficiaries receiving PMDs fell by 75% in demo states and by 66% in non-demo states, CMS says. Of the 36,201 prior authorization requests submitted by Dec. 31, 2013, about half were denied.
Other findings in the update: The DME MACs completed reviews of submissions within 10 business days and of resubmissions within 20 business days, and just 2,537 of 44,030 submissions were sent electronically.
Assuming monthly expenditures on PMDs stayed at $32 million per month, CMS estimates spending has decreased by $202 million since the demo began.
CMS plans to expand the PMD demo to 12 new states.
WASHINGTON – Although industry stakeholders are still combing through a plan to implement a prior authorization (PA) process for certain DME, they think it could be a good thing—with a few caveats.
PAs can provide assurance that the criteria for medical necessity have been met and that the claim will likely stand up under an audits. Both mean the provider is more likely to get paid.
“I think folks generally support it, but it’s got to be done on a timely basis and it’s got to be efficient,” said Cara Bachenheimer, senior vice president of government relations for Invacare.
In a proposed ruled published in the May 28 Federal Register, CMS seeks comments on such a prior authorization process, as well as the criteria to determine what DME is over-utilized and should be included in the process.
Right now, the agency has a “master list” of 134 codes that meet its criteria, mostly L-codes pertaining to lower limb prostheses. Also included: power mobility devices (see related story), negative pressure wound therapy (NPWT), pressure reducing support surfaces and CPAP devices.
“It’s not a huge scope when you look at the list of items,” said Bachenheimer. “Should there be more? Less? We’ll need to look at that and see if there are other items that need to be on there.”
One big question mark: turnaround time. The proposal states that Medicare or its contractor would make a “reasonable effort” to render a decision within 10 days of receiving the initial request, two days for an expedited request, and 20 days for a resubmission.
“There are some challenges when you look at a 10-day window,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “When patients are discharged from hospitals to home, even two days can cause a delay in discharge.”
Brummett is also concerned about applying a prior authorization process to NPWT and CPAP, both of which have ongoing documentation requirements.
“How long would the PA last?” she said. “Would you have to get it twice?”
Despite the unanswered questions, stakeholders are encouraged by the success of a demonstration project implemented in 2012 that requires prior authorizations for power mobility devices. Although there’s no hard data yet on whether the demo has reduced audits, it has certainly streamlined the payment process, say stakeholders.
“When auditors request additional documentation to support the claim, they end up saying, ‘OK, this has gone through the PA process,’” said Seth Johnson, vice president of government affairs for Pride Mobility. “That’s pretty much the end of it.”
Comments on the proposed rule are due July 28.
ORLANDO, Fla. – Industry stakeholders are taking issue with Univita Health’s role as both a third-party administrator (TPA) and HME provider in Florida’s transition to managed care for Medicaid.
Univita has been chosen as the network administrator for 10 of the 14 plans participating in the program, representing roughly 84% of impacted Medicaid recipients. That means it decides which providers are allowed into its network and which get referrals, according to Deanna Rollyson, president of the Florida Alliance of Home Care Services (FAHCS).
“This can be problematic because, as both TPA and a provider, it is directing referrals to itself, thus eliminating competition among Florida’s more than 4,000 independent DME providers and eliminating choice to beneficiaries across the state,” she said.
Univita, which manages and coordinates care for health plans, became an HME provider when it acquired All-Med Services of Florida in 2012.
Even where Univita has gaps in coverage and, therefore, needs to subcontract with other HME providers, it doesn’t negotiate “in good faith,” Rollyson says.
“Univita’s current contracts offer only 50% of the current Florida Medicaid fee schedule as payment, which is unsustainable, and has required a non-compete agreement from every subcontractor,” she said.
Attempts to reach Univita were unsuccessful.
Stakeholders are in a race against the clock to make the program more equitable for HME providers and to ensure access for Medicaid recipients: Florida began the transition to managed care in May and expects to complete the process by October.
FAHCS has focused its efforts on requiring Florida Medicaid to enforce the state’s any willing provider (AWP) provision through the legislative process, Rollyson says.
“A legal process may also be required,” she said. “The two are not mutually exclusive.”
The law firm Munscht Hardt, on behalf of “a couple of provider clients,” is also exploring the legality of the program, on the grounds that its current structure violates anti-trust laws and allows Univita to have a monopoly, says attorney Edward Vishnevetsky. In a white paper for Florida Medicaid, it recommends, among other things, that the state deny “approval of authorized exclusive provider organizations where there is common control or ownership between or among the managed care plans, TPAs and/or providers.”
Both Rollyson and Vishnevetsky warn that this issue is not a Florida issue. Other states are looking to managed care to reduce costs associated with Medicaid, opening the door to increased vertical integration—when different levels of health care are provided by the same company.
“The point isn’t really Univita,” Vishnevetsky said. “It’s this vertical integration model that’s new in the anti-trust world. Typically, you see two providers merge together; this is a new model that could be a significant detriment to health care.”
WASHINGTON – Spending on power mobility devices (PMDs) continues to fall nationwide since the September 2012 launch of a demo requiring prior authorizations in seven states, CMS says. Monthly expenditures for PMD codes dropped from $12 million in September 2012 to $3 million in December 2013 in demo states, and from $20 million to $6 million in non-demo states across the same time period, according to an update. “While we recognize that multiple factors contributed to the decrease in PMD expenditures, there was also a significant decrease in the number of beneficiaries receiving PMDs in the demonstration states after the start of the demonstration,” CMS wrote. “We believe this decrease is because prior authorization is ensuring that only beneficiaries who meet Medicare requirements receive a PMD.” CMS had previously reported that expenditures for PMD codes dropped from $12 million in September 2012 to $4 million in September 2013 in demo states and to $9 million across the same time period in non-demo states. From Sept. 1, 2012, to Dec. 31, 2013, the number of beneficiaries receiving PMDs fell by 75% in demo states and by 66% in non-demo states, CMS says. Of the 36,201 prior authorization requests submitted by Dec. 31, 2013, about half were denied. Other findings in the update: The DME MACs completed reviews of submissions within 10 business days and of resubmissions within 20 business days, and just 2,537 of 44,030 submissions were sent electronically. Assuming monthly expenditures on PMDs stayed at $32 million per month, CMS estimates spending has decreased by $202 million since the demo began.
Fisher & Paykel posts record year, plays it safe for 2015
IRVINE, Calif. – Fisher & Paykel Healthcare on May 23 reported a net profit after tax of NZ$97.1 million for the financial year ended March 31, 2014, a 26% increase compared to the previous year. The manufacturer also reported operating revenue of NZ$623.4 million, a 12% increase. “Our record results reflect that hospital clinicians and homecare providers are increasingly using our innovative products to help to improve care and outcomes,” stated CEO Michael Daniell in a press release. By product group, F&P reported revenues of NZ$336.9 million for respiratory and acute care for 2014, a 12% increase over 2013; and NZ$270 million for obstructive sleep apnea, a 15% increase. Within OSA, F&P highlighted a 26% increase in operating revenue in the second half for masks. Looking to 2015, F&P projects net profit to be similar to 2014 and for operating revenue to hit NZ$640 million. “At current exchange rates, we anticipate an operating profit headwind of approximately NZ$32 million in the 2015 financial year from both reduced hedging and less favorable spot rates,” Daniell stated. “Despite the challenge of this large roll-off in hedging, we have momentum in both of our product groups and we believe that we can offset that headwind in the 2015 financial year.”
Brightree, McKesson streamline ordering
ATLANTA – As part of a new integrated electronic purchasing program with McKesson, Brightree users can now view item item availability in real time; perform one-touch drop shipments; and receive automatic confirmations, including delivery notifications. “This enhanced strategic relationship for Integrated ePurchasing will continue to provide common customers significant time and cost savings that come with real-time integration,” stated Jeff Bowman, vice president of homecare sales for McKesson Medical-Surgical, in a press release. “Customers are reporting improved efficiencies, reduced call volume and labor cost reductions.” The companies believe the program decreases shipping and delivery expenses; optimizes inventory by reducing carrying costs; and eliminates re-keying and data entry errors.
CareTouch expands staff
DENVER – CareTouch Communications has more than tripled its live call center staff since February of this year to accommodate an influx of new patient accounts. CareTouch reaches out to patients on behalf of healthcare providers to help them maintain their supplies for sleep apnea, diabetes, incontinence, oxygen and nebulizer treatment. The company combines interactive voice response (IVR) technology with its live, multi-lingual staff.
DME MACs update face-to-face guidelines
WASHINGTON – The DME MACs on May 29 revised a bulletin on the face-to-face requirement to add information clarifying who may perform the in-person visit and the responsibilities of the ordering physician. The face-to-face exam must be performed by a physician (MD, DO or DPM), physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS) within six months of the written order for certain DME. The responsibilities of the ordering physician include: documenting that the beneficiary was evaluated and/or treated for a condition that supports the need for the item; including sufficient medical information in the medical record to demonstrate that applicable coverage criteria are met; and providing a copy of the exam and prescription to the provider before the item can be delivered. The bulletin also notes that the treating practitioner that conducted the face-to-face exam doesn’t need to be the prescriber for the DME, but the prescriber must verify that the visit occurred within the six months prior to the date of his or her prescription and that he or she has documentation the exam was conducted.
OIG report finds jump in redeterminations
WASHINGTON – Medicare contractors processed 2.9 million redeterminations in 2012, an increase of 33% since 2008, according to the Office of Inspector General (OIG) semi-annual report to Congress. As a result, the OIG calls on CMS to use the Medicare Appeals Process to monitor contractor performance, share information and keep an eye on the quality of redeterminations data. Also in the report: the OIG says it expects more than $3.1 billion in recoveries—$295 million from audits and $2.83 from investigations. It cites 465 criminal actions and 266 civil actions, as well as the exclusion of 1,720 individuals from participation in federal health care programs. Additionally, the OIG identified $91.6 million in Part B improper payments to “unlawfully present beneficiaries” from 2009-2011; $33.6 million in uncollected Part A and B improper payments for incarcerated beneficiaries from 2009-2011; and $23 million in improper payments for dead beneficiaries in 2011.
MetroStar obtains government contract
NEW YORK – Metropolitan Home Health Products (MetroStar) has been awarded a Schedule 65 II A medical equipment contract by the General Services Administration (GSA). The GAS establishes long-term, government-wide contracts to streamline the process of obtaining products for the federal government. Contracts are awarded to companies that are evaluated for proficiency and suitability for providing products and/or services to the federal government. The assessment covers a wide selection of a corporation's capabilities, such as customer satisfaction, organizational structure, performance history and other criteria.
CMS updates O&P edits
BALTIMORE – CMS has instructed the DME MACs to update programming edits that deny claims for prosthetics and certain custom orthotics when they are furnished by personnel who are not certified orthotists or prosthetists in states where that is a requirement, according to a MLN Matters article. At the time of the original edit, in 2005, nine states had the requirement. Since then, eight additional states—North Dakota, Iowa, Pennsylvania, Arkansas, Georgia, Kentucky, Mississippi and Tennessee—have implemented the requirement. If a supplier is located in one of the 17 states with the requirement, it must be properly enrolled with the National Supplier Clearinghouse to ensure the correct specialty code(s) is on file. To view the official instruction, go here.
People for Quality Care launches ‘Dear Medicare’ website
WATERLOO, Iowa – People for Quality Care (P4QC) has launched “Dear Medicare,” a website that features the stories of seniors and people with disabilities who are being negatively impacted by healthcare policies. “Our mission with Dear Medicare is to lift up the voices of Medicare beneficiaries and move readers to action through their powerful stories,” stated Kelly Turner, director of advocacy, in a press release. P4QC also has a Medicare Beneficiary Complaint Hotline that has received more than 3,000 calls since launching in June 2013.
Invacare, VGM extend agreement
ELYRIA, Ohio, and WATERLOO, Iowa – Invacare and The VGM Group have signed a new multi-year agreement, the companies announced May 27. Mal Mixon, chairman of the board at Invacare, said, “Supporting providers has always been a top priority for Invacare, and with the challenges that continue to face the HME industry, fighting for the rights of independent providers and the beneficiaries they serve is as important as it’s ever been.” Van Miller, CEO of VGM, said, “Working together makes us stronger and more effective.” No additional details were provided.
Booth space at Medtrade going fast
ATLANTA – Medtrade has already booked most of its booth space for the Oct. 20-23 event in Atlanta, according to show organizers. As of May 29, 93% of space has been booked, and show organizers say they expect the remaining 7% to be sold in the coming months. In other news, show sponsor Emerald Expositions has teamed up with CloserStill Media and LiveMed to provide Medtrade exhibitors with an opportunity to reach new international markets through two new events: Trade Days in Birmingham, England, Oct. 5-6; and ExpoMed in Mexico City June 18-20.
DME MAC releases oxygen, CPAP review data
HINGHAM, Mass. – NHIC found a 44% denial rate for oxygen and oxygen equipment as part of a review of claims filed between Jan. 1, 2014, and March 31, 2014. The Jurisdiction A DME MAC reports responses to additional documentation requests were not received for 59% of the claims. For the same time period, the NHIC found a 64.3% denial rate for CPAP devices. Oxygen claims were most frequently denied for missing documentation; failing to meet written order prior to delivery requirements; and failing to establish medical necessity, according to the statement. CPAP claims were denied primarily for problems with face-to-face documentation, the detailed written order prior to delivery, sleep study documentation, training documentation or deliveries.
Sleep apnea: It’s better managed at home, study says
SAN DIEGO – Testing for obstructive sleep apnea (OSA) and initiating treatment with an APAP device at home vs. in a lab reduces costs and doesn’t negatively impact clinical outcomes, according to a new study. The study, presented at the American Thoracic Society International Conference, May 16-21, in San Diego, enrolled 296 subjects, with roughly half beginning CPAP at home and the other half in a lab. Researchers found the cost of home testing was significantly lower than the cost of lab testing ($4,057 vs. $4,621) over 2.75 years. Additionally, assessment with the Functional Outcomes of Sleep Questionnaire showed no significant difference in outcomes between groups. “While the use of home testing and initiation of CPAP therapy is increasingly common, studies of its cost-effectiveness are scarce,” stated lead author Charles Atwood, associate professor of medicine at the University of Pittsburgh School of Medicine and director of the Sleep Disorders Program of the VA Pittsburgh Healthcare System. “These results support the continued use of home management of these disorders.”
American HomePatient has appointed Barbara Stark senior vice president of business development. Stark has more that 30 years of healthcare sales and leadership experience, including stints at Apria, Gentiva Specialty Pharmacy Services, Coram and, most recently, as senior vice president of sales at Univita Health.
WASHINGTON – The federal government overpaid nearly $70 billion to Medicare Advantage (MA) plans between 2008 and 2013, according to a new report from the Center for Public Integrity (CPI).
CPI found that the risk scores used by providers to charge the government more for sicker patients rose sharply in MA plans in at least 1,000 counties between 2007 and 2011, boosting taxpayer costs by more than $36 billion over the estimated costs for caring for patients in standard Medicare.
“In more than 200 of these counties, the cost of some MA plans was at least 25% higher than the cost of providing standard Medicare coverage,” the report states. “The wide swing in costs was most evident in five states: South Dakota, New Mexico, Colorado, Texas and Arkansas.”
Dominated by private insurers, Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year, according to CPI.
The report is the first in a four part series. CPI is suing CMS to release copies of program audits, billing data and the identities of plans suspected of overcharging the government.
WASHINGTON – AAHomecare has kicked off a campaign to raise $250,000 in the next two years to develop and launch HME Audit Key, a tool to track audit activity. “This is a massive, long-term project that will benefit the entire industry and AAHomecare is committed to making sure it is provided with the resources it needs to succeed,” the association stated in a bulletin to members last week. Members of AAHomecare’s executive committee and board of directors, along with The VGM Group and The MED Group, have already committed almost $44,000 to the project in the first two weeks. “Their generous support alone will not be nearly enough,” the association stated. Details about how to make a contribution are available by downloading this overview and contribution form.
Senate green lights Burwell as HHS chief
WASHINGTON – The Senate, in a bipartisan 78-17 vote, has confirmed Sylvia Mathews Burwell to replace Kathleen Sebelius as secretary of the Department of Health and Human Services (HHS), according to news reports. Burwell has been the director of the Office of Management and Budget since April 2013. Prior to that, she was president of the Walmart Foundation and president of the Global Development Program of the Bill and Melinda Gates Foundation, according to reports. Though responsible for 11 agencies that make up HHS, Burwell’s early focus will be continuing to implement the Affordable Care Act. She will likely take over when she is sworn in today, June 9, according to reports.
Government overpays Medicare Advantage plans, report says
WASHINGTON – The federal government overpaid nearly $70 billion to Medicare Advantage (MA) plans between 2008 and 2013, according to a new report from the Center for Public Integrity (CPI). CPI found that the risk scores used by providers to charge the government more for sicker patients rose sharply in MA plans in at least 1,000 counties between 2007 and 2011, boosting taxpayer costs by more than $36 billion over the estimated costs for caring for patients in standard Medicare. “In more than 200 of these counties, the cost of some MA plans was at least 25% higher than the cost of providing standard Medicare coverage,” the report states. “The wide swing in costs was most evident in five states: South Dakota, New Mexico, Colorado, Texas and Arkansas.”Dominated by private insurers, Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year, according to CPI. The report is the first in a four part series. CPI is suing CMS to release copies of program audits, billing data and the identities of plans suspected of overcharging the government.
Judge protects ResMed patent
SAN DIEGO – An International Trade Commission (ITC) judge has ruled that Taiwanese manufacturer Apex infringes a ResMed patent protecting an integrated humidifier used in its CPAP devices. Per the June 4 ruling, Apex can no longer import or sell its XT and iCH CPAP devices with these humidifiers in the U.S. “This ITC victory is validation that our customers should not accept imitations,” stated David Pendarvis, chief administrative officer and global general counsel at ResMed, in a press release. ResMed will ask the ITC to also impose a fine on Apex for any XT and iCH CPAP devices with integrated humidifiers that it has sold in the U.S. to date. The patent fight between ResMed and Apex began in March 2013, when ResMed asserted to the ITC that the XT and iCH CPAP devices infringed on patents. Apex in August agreed to an order prohibiting it from importing and selling the products in the U.S. Apex then redesigned the products and sought a ruling that its new CPAP devices avoided infringing the patents. In the June 4 ruling, the judge held that Apex continues to infringe the patents and stood by the July 2013 order prohibiting the manufacturer from importing and selling those products in the U.S. The judge also ruled, however, that Apex’s redesigned WiZard 220 mask does not infringe on patents. ResMed plans to appeal that decision.
Apex vows to continue legal battle
BREA, Calif. – Apex Medical will appeal an International Trade Commission (ITC) judge’s ruling that the humidifiers in its XT and iCH CPAP devices infringe on a ResMed patent, the company announced today. “We believe that this litigation has always been about something much more important to Apexthan the design of a water chamber,” stated President PJ Hsueh. “Apex offers an affordable yet high quality alternative to the market. Some largercorporations may attempt toeliminategood quality, legitimate competition wherever possible.We, however, believe that a market is only a healthy one whenthere is free and fair competition.”While the ITC didn’t rule in Apex’s favor on the humidifier, it did rule that the company’s Wizard 220 CPAP mask doesn’t infringe on a ResMed patent. Apex also notes that it has requested an Inter Partes Review (IPR) of the humidifier patent and four other patents, and that the U.S. Patent and Trademark Office has begun examining the validity of these patents.
Study: Technology can shape response to CPAP therapy
ANDOVER, Mass. – Users of SleepMapper, a mobile app and web-based solution from Philips Respironics, have a 22% higher adherence rate to PAP therapy than non-users, according to a study that the company released last week at SLEEP 2014. “Study results of SleepMapper demonstrate that technology can shape how patients respond to PAP therapy by improving engagement and motivation, and ultimately leading them to a better course of treatment for their chronic condition,” stated Dr. Mark Aloia, senior director of global clinical research for Philips Respironics, in a press release. SleepMapper provides patients with feedback on their individual adherence and therapy information, and uses empirically tested behavior change therapies to motivate them and keep them interested. To test the effectiveness of SleepMapper, researchers randomly analyzed more than 15,000 patients from the Philips Respironics EncoreAnywhere database and compared adherence and usage rates between those who were provided with SleepMapper upon initial PAP setup and those who were not. Patients in the first group achieved a 78% adherence rate based on CMS guidelines; those in the second group achieved a 56% rate. The study also found, for new patients struggling to manage and accept their therapy, 33% of those who were provided with SleepMapper were able to meet adherence guidelines within 90 days, compared to 11% of those who were not provided with the tool. Finally, the study found patients who were provided with SleepMapper slept an average of 1.4 hours longer on PAP.
NCART revamps websites
EAST AMHERST, N.Y. – NCART has unveiled new and improved websites for www.ncart.us and access2crt.org. “The sites have been completely redesigned to enhance the communication of CRT news, and to better promote CRT education and advocacy on both federal and state levels,” stated Don Clayback, executive director of NCART, in a bulletin to members. Improvements to the sites include: layouts that are easier to navigate; information that’s segregated under federal and state headlines; a tool that helps users conduct and track specific advocacy campaigns; educational materials that are updated regularly; and a blog that provides real-time information. While www.ncart.us is the home of NCART, access2crt.org is a non-denominational website. Originally created to advance efforts to create a separate benefit for complex rehab, access2crt.org has been redesigned to accommodate that and other federal and state issues.
Study shows link between OSA, diabetes
NEW YORK – A new study of more than 8,500 patients in Canada has demonstrated a link between obstructive sleep apnea (OSA) and the development of diabetes, the American Thoracic Society announced June 6. The study included 8,678 adults with suspected OSA without diabetes at baseline who underwent a diagnostic sleep study between 1994-2010. These adults were monitored through May 2011 using health administrative data to examine the occurrence of diabetes. During follow up, 1,017 (11.7%) patients developed diabetes. The American Thoracic Society published the results of the study online and in its American Journal of Respiratory and Critical Care Medicine.
Lawmaker gets 109 responses on bid program
WASHINGTON – Rep. Jim Renacci, R-Ohio, called on those in the HME industry to share their stories and perspectives on the competitive bidding program and 109 responded to his call of action, according to AAHomecare. Renacci used the comments to inform a roundtable discussion on the program that he hosted last week. Since his oxygen business was shut out of the Round 1 re-bid, Renacci has become a “huge champion” for the industry, AAHomecare stated in a bulletin to members this week.
Ackerman replaces Landauer as AAH treasurer
WASHINGTON – Steve Ackerman, president and CEO of Spectrum Medical, has joined AAHomecare’s executive committee as treasurer. He replaces Alan Landauer, chairman of Landauer Metropolitan, who has stepped down from the post but who will remain on the association’s board of directors. Ackerman is a 33-year veteran of the HME industry. He founded Spectrum Medical in 1983 to serve the Washington, D.C., metro area. He has been involved in state and national trade associations, and has been called before Congress and CMS as an expert on industry issues. “The only recommendation I have for the AAHomecare board, and for that matter the membership in general, is for everyone to be actively engaged in the recruitment of new members,” he stated in the bulletin. “There is strength in numbers.”
VGM to host congressional staffers at annual event
WATERLOO, Iowa – The VGM Group and People for Quality Care will host a town hall forum for congressional staffers during the Heartland Conference in June. During “Caring for the Aging and Disabled: How Investing in DME Saves the Government Money and Provides Better Care for Americans,” VGM officials will review the findings of a recent study that shows how the healthcare system and Medicare beneficiaries can save on long-term costs by investing in DME upfront, according to a release. The event, scheduled for Wednesday, June 11, at 1 p.m. CST, will also be broadcast live at www.twitter.com/qualitycare14.
Cape Medical moves resupply online
SANDWICH, Mass. – Cape Medical Supply on June 2 launched a MyResupply web portal, allowing its CPAP customers to reorder their supplies as if they were ordering a book on Amazon. “MyResupply will drastically cut down the time it takes our patients to get the medical supplies they need, helping us get the order processed and on the truck faster than ever before,” the company states in a blog. Cape Medical developed the portal with Brightree, which provides its integrated inventory management software. Because the portal interfaces with insurance providers and Medicare, customers can only reorder when they’re allowed to. “This cuts down on accidental reorders and helps us prevent fraud, while streamlining the billing process for the consumer and completely eliminating their need to interface with their insurance company,” the blog states.
Moneyline: ResMed, Liberator Medical, Aeroflow, Stable Step
ResMed Director Christopher Roberts has sold 25,000 shares of the company’s stock in a transaction on May 29. The stock was sold at an average price of $49.73 for a total value of about $1.2 million. Roberts now owns 101,988 shares in the company for a total value of about $5 million. A few days later, COO Robert Douglas sold 8,000 shares in a transaction on June 2 (total value of about $400,000) and Chief Administrative Officer and Global General Counsel David Pendarvis sold 5,000 shares in a transaction on June 3 (total value $248,800)…The board of directors at Liberator Medical Holdings approved on May 30 a cash dividend of $0.03 per common share to its shareholders. This is the sixth quarterly cash dividend to be paid by the company. It will be paid on July 10, 2014, to all shareholders of record as of the close of business on June 26, 2014. Liberator began trading on the New York Stock Exchange in November…Aeroflow Healthcare has seen 14% growth since January, the company announced in a May 29 press release. Buoying that growth: In January, the company acquired Air-Care Home Health in South Carolina. Aeroflow’s strategy includes buying existing HME companies to leverage the contracts it won as part of Medicare’s competitive bidding program. “Our goal is to bring Aeroflow’s unprecedented care and low costs to existing companies, while continually growing our patient base,” said Josh Hill, director of business development, in the release…Stable Step has acquired Archmolds. The acquisition will improve Stable Step’s orthotics offerings to include Archmolds’ full line of heat moldable insoles.
‘Enjoy Life’ program kicks off
ATLANTA – Sports n’ Spokes, the sports and recreation magazine of the Paralyzed Veterans of America, has teamed up with Life After Spinal Cord Injury, a nonprofit program of UroMed, and Wheel:Life, an online community, to encourage people with disabilities to “Get Out & Enjoy Life This Summer.” Now in its fourth year, the program kicks off with a photo contest with prize giveaways. This year’s theme is running free and the slogan is ROAM. The program will spotlight activities like adaptive sports, accessible amusement parts, inclusive vacation spots and other unique outings. The contest ends June 27.
Kevin Cooper, a respiratory therapist who works in sales for a medical supply company, has decided to open a storefront. “I’ve got a website where I’ve sold a lot of medical equipment online for the past four or five years, but this is going to be the first retail store,” he told the local newspaper. Cooper Medical Supply will offer a full line of equipment, ranging from wheelchairs to walkers to beds, in West Rome, Ga…Advanced Brain Monitoring announced last week that the U.S. Food and Drug Administration (FDA) has granted 510(k) clearance for Night Shift, a therapy for positional obstructive sleep apnea. Worn on the back of the neck, Night Shift begins to vibrate when users sleep on their back and slowly increases intensity until they change their position…A recent donation of mobility equipment by Ottobock will soon be on its way to Matagalpa, Nicaragua. The support is being given through Familias Especiales (Special Families), a nonprofit agency that helps families attain basic needs and services for handicapped children.
Pride Mobility Products has named Rick Michael as national sales manager, retail mobility, it announced June 3. Michael has 15 years of experience in the mobility industry, according to a release. Michael, along with Pride’s retail mobility team, will support providers in a variety of areas, from point-of-purchase displays to planning and financing. “Retail mobility is a winning strategy in today’s mobility marketplace,” said Andrew Pyrih, senior vice president of domestic sales, in the release…Ottobock has promoted Darrell Burnette to regional sales manager for the East region of the company’s Mobility Solutions sales team. Brunette joined Ottobock in 2011 as a territory sales representative covering Maryland, Virginia, West Virginia and Washington, D.C.
WASHINGTON – The Centers for Disease Control and Prevention (CDC) released the National Diabetes Statistics Report 2014 this week and it’s not pretty.
The CDC now believes 29.1 million people, or 9.3% of the U.S. population, had diabetes in 2012, up from 26 million in 2010. It believes 21 million were diagnosed and 8.1 million were undiagnosed.
The CDC estimates the total costs of diabetes were $245 billion in 2012, up from $174 billion in 2010. Of that, $176 billion were direct costs (after adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than people without diabetes) and $69 billion were indirect costs (disability, work loss, premature death).
Other findings from the report:
WATERLOO, Iowa – Medicare sees significant cost savings when it preserves spending on home medical equipment, according to a new study unveiled at The VGM Group’s Heartland Conference this week.
The study, conducted by Brian Leitten of Leitten Consulting, found, for example, that for every $1 that Medicare pays for mobility equipment, it saves $16.78 in treatment for avoided falls.
“The message is clear: HME does save Medicare money and helps beneficiaries live where they want to be—at home,” said John Gallagher, vice president of government relations for VGM, in a press release.
Other examples from the study: For every $1 Medicare spends on supplemental oxygen therapy, it saves $9.62 in treatment for COPD-caused medical complications; and for every $1 Medicare spends on CPAP therapy, it saves $6.73 for the treatment of OSA-related complications.
The study is an update to a similar study in 2011.
WASHINGTON – Industry stakeholders expect Reps. Pat Tiberi, R-Ohio, and John Larson, D-Conn., to lead a group of lawmakers in introducing a bill this week that would require HME providers to obtain bid bonds as part of the competitive bidding program.
If a provider receives and accepts a contract from CMS, the bid bond would turn into a performance bond. If a provider receives a contract offer but does not accept it and its bid is at or below the bid price, the government can collect on the bond, explains Cara Bachenheimer, senior vice president of government relations for Invacare.
“That’s the beauty of it,” she said. “We believe the bill will be at least budget neutral because of this possibility of collecting on the bonds.”
The bill would also require providers to prove that they meet licensure requirements before they submit bids. A similar provision was included in the Senate Finance Committee’s version of the “doc fix” bill earlier this year.
Because the process for obtaining a bid bond would be similar to a surety bond, it shouldn’t be much of a burden for providers. An added bonus: In addition to CMS, the surety bond company would perform a financial assessment, stakeholders say.
“It’s a two-fold checks and balance,” said Jay Witter, senior vice president of public policy at AAHomecare.
The bill signals a shift in strategy for the industry. While a bill that would replace the competitive bidding program with a market-pricing program (MPP) already includes a provision requiring binding binds, it also includes a number of other provisions, which may be weighing it down, stakeholders say.
“Out of the gargantuan MPP bill, everyone understands binding bids,” Bachenheimer said. “This is non-controversial.”
The industry’s goal is to get the bill passed, on its own or as part of a larger bill, before the next round of bidding is set to take place in 2015, stakeholders say.
“This is something that Tiberi has talked about with the chairs of the relevant committees,” Witter said. “He’s run all the traps on this.”
Stakeholders are also making ground on another bill, this one to reform the audit program. It was announced at AAHomecare’s Washington Legislative Conference in May that Rep. Renee Ellmers, R-N.C., planned to introduce such a bill. Since then, she has been fine-tuning language to make sure that, like with the bid bill, it has legs, stakeholders say.
“Every time you do something like this, you want to fix all the problems, but her goal is not to fix all 100 problems,” said Beth Bowen, executive director of the North Carolina Association for Medical Equipment Services, which will host Ellmers at its summer meeting on June 27. “She wants a bill with teeth but that will pass.”
The industry continues to build its case against both the audit and competitive bidding programs. Just last week at the Heartland Conference, The VGM Group released a study that shows Medicare saves money by investing in HME. For every $1 that Medicare spends on mobility equipment, for example, it saves $16.78 in treatment for avoided falls, according to the study, conducted by Brian Leitten of Leitten Consulting.
“You always hear the drum beat from CMS about all the savings,” said John Gallagher, vice president of government relations for VGM. “We need to be able to say, ‘No, you’re losing money.’ You’re gutting the very entity that’s saving you money.”
YARMOUTH, Maine – A majority of HME providers welcome the idea of prior authorizations for certain DME, but they say Medicare’s proposed timeline for returning decisions is unreasonable.
Sixty-nine percent of the 160 respondents to a recent HME Newspoll think CMS’s proposal to implement a prior authorization process for certain DME is a good idea. Eighty-four percent say they already go through a similar process with other payers, anyway.
“It would save so much time and money because it should reduce the amount of audits,” said Stan Grilliot of Hutchinson, Kansas-based Health-E-Quip.
But as always, the devil is in the details. In a proposed rule published in the May 28 Federal Register, CMS says it will make a “reasonable effort” to issue decisions on prior authorizations within 10 days.
Sixty percent of poll respondents say that’s not fast enough.
“This is yet another example of the disconnect between CMS and the real world,” said one respondent. “Medicare beneficiaries who meet the coverage criteria need the equipment now, not 10-plus days from now.”
Other providers think adding a prior authorization process is overkill.
“Current mandates, such as the face-to-face and detailed written order requirements, provide the oversight that focuses on working together to provide appropriate health care,” said Cindy Marvin of Canton, Ohio-based Aultman Home Medical Supply. “This would add an additional layer of unnecessary work on an industry already struggling with providing services to a challenging population.”
But if prior authorizations provide some protection from audits, the extra steps would be worth it, say many providers.
“I’d rather have my documents reviewed before I release the product to the patient any time,” said Lori Sears of Active Home Medical Supply in Lapeer, Mich. “I simply can’t afford to lose an audit so I support any plan that reduces that risk.”
WATERLOO, Iowa – Reimbursement may be shrinking, but the HME industry is standing on the cusp of explosive growth, The VGM Group’s Mike Mallaro told attendees at the Heartland Conference last week.
“Other industries would kill for the demand curve we are on,” said Mallaro, CFO, during his session, “HME Success: Building Your Business for the Next Five Years.” “You hear about the baby boomers and you get numb to it, but it’s a massive game changer.”
Heartland took place June 9-12. Now in its 13th year, the event drew more than 900 people, according to VGM.
While attendance was down slightly from last year, there was an increase in the number of VGM member companies that had never attended before.
“Nearly 50 new companies attended this year, which represented more than 80 individuals,” said Christa Miehe, vice president of strategic projects for VGM.
Bend the curve
The number of people age 65 and older is projected to grow 80% by 2030, said Mallaro. Unlike previous generations, they have money: In 1960, 40% of seniors were poor; today, only 8% are poor.
That’s good, because the trend of payers paying less is going to continue, Mallaro said.
“We’re not at the end of shrinking reimbursement, but you’ll have the chance to sell dramatically more units,” he said. “Patients are going to pay a bigger portion going forward and that opens the door to new products and services.”
For providers to succeed in this new normal, however, they must make changes to their business models, Mallaro said. That means expanding, increasing efficiencies, improving customer service, obtaining contracts and gathering data.
“Know your numbers,” he said. “To ignore data is to ignore opportunity.”
Get an alignment
A major opportunity for providers can be found in helping hospitals reduce 30-day readmission rates, Bob Messenger of Invacare told attendees during his session, “The Future of Hospital Oxygen Referrals: The Changing Paradigm.” During any given year, roughly half of all hospitals will be penalized, he said.
“There are $17 billion a year in costs associated with readmissions,” he said. “Don’t you think it would be wise on the part of hospitals to align themselves with those outside the hospital where the patients are?”
Keep your eye on the prize
No matter what the future brings, the reason providers keep on keeping on hasn’t changed, as keynote speaker David Wagner, author of “Living Life as a Daymaker” and a cancer survivor, told attendees.
"Know that what you do matters,” he said. “There's dramatic change in your industry. We understand that and we appreciate it. Don't take your eye off of what you do even though there is a lot of static in the way."
WATERLOO, Iowa – The VGM Group and The van Halem Group have merged, allowing the member services organization to offer “an array of mission-critical professional services” related to audits. “They are the recognized leader in the audit defense field and our members will benefit greatly from this association,” stated Van Miller, CEO and founder of VGM, in a press release. The van Halem Group is now a division of VGM. Its headquarters will remain in Atlanta, and Wayne van Halem will continue on as president. With investment from VGM, The van Halem Group will be able to expand its capabilities, according to the release. “Together, The van Halem Group and VGM will make sure that our clients have the support that they need so they can continue providing quality care to their patients while maintaining compliance with complex regulatory issues,” van Halem stated. In addition to van Halem, the leadership team at The van Halem Group includes Carrie Nienberg, manager of clinical operations; Laura Wilson, operations manager; Kenneth Nelson, medical adviser; and Kelly Grahovac, senior consultant.
Pride Mobility, Navitas offer financing program
EXETER, Pa. – Pride Mobility Products has partnered with Navitas Lease Corp. to offer providers a new financing program. Features of the program include a simple one-page application, competitive rates, financing terms from 12 to 36 months, and credit decisions within hours. “Pride is focused on supplying our providers with the tools to grow their business and manage their cash flow,” said Andrew Pyrih, senior vice president of domestic sales for Pride Mobility, in a press release. “The program, which covers both Pride and Quantum products, offers affordable payment options to help providers best serve their clients’ mobility needs.” Ponte Vedra Beach, Fla.-based Navitas provides equipment financing to small- and medium-sized businesses nationally through referral programs with equipment vendors and through lease brokers in its RLC Funding division.
Roll up buys Care Medical Partners
LOS ANGELES – Patient Home Monitoring (PHM), a company focused on rolling up annuity-based healthcare service companies in the U.S. and Canada, has acquired Care Medical Partners, a Georgia-based HME provider, for about $5.5 million, according to a press release. Under the terms of the deal, PHM will acquire 100% of Care Medical in exchange for $144,243 in cash and 5,655,476 in shares of PHM at $0.26 per share. As part of the deal, PHM will acquire $3.15 million in medical equipment placed with patients. Care Medical, which generated more than $13.1 million in revenue from March 31, 2013, to March 31, 2014, joins other recent acquisitions by PHM in Georgia, as well as South Carolina and Florida. “We are solidifying PHM’s regional presence in the southeastern United States, while at the same time providing significant expansion opportunities for our California-based cardiology service business unit,” stated Michael Dalsin, chairman and CEO of PHM, in the release. There’s more to come: “Our M&A team is nearing the LOI stage with two additional acquisition targets and I expect to have the next deal lined up shortly,” Dalsin stated.
CDC: 9.3% of U.S. population has diabetes
WASHINGTON – The Centers for Disease Control and Prevention (CDC) released the National Diabetes Statistics Report 2014 last week and it’s not pretty. The CDC now believes 29.1 million people, or 9.3% of the U.S. population, had diabetes in 2012, up from 26 million in 2010. It believes 21 million were diagnosed and 8.1 million were undiagnosed. The CDC estimates the total costs of diabetes were $245 billion in 2012, up from $174 billion in 2010. Of that, $176 billion were direct costs (after adjusting for population age and sex differences, average medical expenditures among people with diagnosed diabetes were 2.3 times higher than people without diabetes) and $69 billion were indirect costs (disability, work loss, premature death).
‘Dear Colleague’ letter calls for review of bid program
WASHINGTON – A “Dear Colleague” letter circulating through Congress calls on the Office of Inspector General to review the competitive bidding program before its 2016 expansion, according to a VGM bulletin. The letter, spearheaded by Rep. Tom Price, R-Ga., Rep. Bruce Braley, D-Iowa, Rep. Tom Reed, R-N.Y., and Rep. Tammy Duckworth, D-Ill., calls for a study of how competitive bidding and the national mail-order program for diabetic testing supplies are affecting senior health. Members of Congress have until June 30 to sign on.
Medtrade registration opens June 16
ATLANTA – Registration for Medtrade will open June 16. The show will take place Oct. 20-23 at the Georgia World Congress Center in Atlanta. Early rates of $25 for the expo and $99 for the conference are in effect until mid-September, according to a press release.
Special forum to address prior auth expansion
WASHINGTON – CMS will host a Special Open Door Forum on June 17 to discuss its plans to expand prior authorizations for PMDs to 12 additional states and to implement prior authorizations for certain DME nationwide. The forum will take place 2 p.m. to 3 p.m. EST. To participate, call 800-837-1935 and use the ID 41801913.
Van Miller named Entrepreneur of the Year
WATERLOO, Iowa – Van Miller, CEO and founder of The VGM Group, has been chosen as one of nine EY Entrepreneurs of the Year for the Upper Midwest. “I owe it all to the associates,” Miller said of VGM’s 630-plus employees, who own the company through an ESOP. The entrepreneurs, who are chosen by an independent judging panel, are eligible for national recognition in November. While Miller is quick to credit his associates, he deserves kudos, too, says Jim Walsh, president and general counsel of VGM, and one of its original investors. “His consummate skill in managing talent and making hard decisions is evident to all who know him,” he said.
Univita sells division, names new CEO
EDEN PRAIRIE, Minn. – Univita Health has signed an agreement to sell its Insurance Administration Services division to Stone Point Capital, a private equity firm. “The sale of the division will allow Univita to continue to expand its proven integrated home care delivery model as the single source solution for the post-acute care continuum,” the company states in a press release. “With the post-acute market size estimated at over $60 billion, there is a recognized need for expertise integrating across the care continuum.” Univita has also named Michael Muchnicki as CEO, replacing Jean Haynes. Muchnicki has 25 years of experience in health care delivery and managed care, including management positions at United Health Group and Cigna Healthcare.
AMA addresses coverage, payment for telemedicine
CHICAGO – The American Medical Association (AMA) voted last week at its annual meeting to approve a list of guiding principles to ensure the appropriate coverage and payment for telemedicine services. “The principles aim to help foster innovation in the use of telemedicine, protect the patient-physician relationships and promote improved care coordination and communication with medical homes,” according to a press release. The principles stem from a policy report developed by the AMA’s Council on Medical Service to address coverage and payment for telemedicine. “Telemedicine can improve access to receive care remotely, as medically appropriate, including treatment for chronic conditions, which are proven ways to improve health outcomes and reduce healthcare costs,” stated Dr. Robert Wah, president-elect of the AMA, in the release.
United Spinal sets date for Roll on Capitol Hill
NEW YORK – The United Spinal Association and advocates from its membership division, National Spinal Cord Injury Association, will gather in Washington, D.C., June 22-25 for Roll on Capitol Hill. The goal of United Spinal’s signature event: to shape policies that impact the health, independence and quality of life of people living with spinal cord injuries and disorders. “Roll on Capitol Hill presents a unique forum for our members and chapter leaders to constructively address disability issues that are impacting their lives, for good or bad, face to face with their representatives,” stated Joe Gaskins, president and CEO of United Spinal, in a press release. Those issues include ensuring increased access to needed DME, medical supplies and related services, prescription drugs and outpatient therapies; and expanding home- and community-based services and supports.
VGM, Brightree extend agreement
WATERLOO, Iowa, and ATLANTA – The VGM Group will continue its exclusive relationship with Brightree for business and financial management solutions for its members per a new multi-year agreement. “Effective use of modern business software solutions is vital to the success of independent HME providers,” stated Van Miller, CEO and founder of VGM, in a release. “We are excited to sign this new agreement so that our members have the opportunity to adopt a best-in-class, cloud-based solution to improve margins and optimize their businesses.” To date, more than 1,000 VGM members have converted to Brightree’s solution, according to the release.
It’s official: Gaskins becomes CEO of United Spinal
EAST ELMHURST, N.Y. – The United Spinal Association has named Joseph Gaskins its permanent president and CEO. Gaskins is an experienced Washington, D.C., lobbyist, accomplished executive in the wireless industry and wheelchair user from Seattle. Gaskins became interim CEO in December, when Paul Tobin resigned. He has been a member of United Spinal’s board of directors since April 2014. Gaskins says he looks forward to using his skills and experience to improve disability rights and help other wheelchair users achieve greater independence.
AAHomecare welcomed two new staffers in June: Melissa Perry as administrative & meeting associate, and Jess Hammett as communications associate. Perry will focus on meeting planning, and Hammett on membership and event communications.
WASHINGTON – The Small Business Administration (SBA) will discuss the impact of competitive bidding and audits at its National Regulatory Fairness Hearing on June 25.
The meeting is an opportunity for business organizations, trade associations, chambers of commerce and related groups that serve small businesses to report unfair or excessive federal regulatory enforcement affecting their members, according to a notice from the SBA.
Several members of the HME industry are scheduled to testify, including Peggy Walker of U.S. Rehab and seven HME providers.
The hearing will take place 9:30 a.m. to 1 p.m. at the Environmental Protection Agency, William Jefferson Clinton East Building. It’s open to the public, but advance registration is required.
The SBA last took up competitive bidding a year ago.
NASHVILLE, Tenn. – CGS Administrators has agreed to make two concessions that should make audits less hair-raising for HME providers in Jurisdiction C.
The first: In a June 3 bulletin, the DME MAC detailed its plans to start sending providers detailed written letters explaining why their claims were denied as part of prepayment or complex medical reviews.
“We’re encouraged that they’re taking our feedback and that we’re finding those areas where collaboration is possible,” said Andrea Stark, a reimbursement consultant for MiraVista and chairwoman of the Jurisdiction C Council.
CGS started sending the letters on May 30, but only to providers that bill for oxygen and diabetes supplies. It will expand to other providers throughout the year. In addition to the reasons for denials, the letters also contain claim-specific information, such as dates of service and submitted charges.
Typically, providers that want more information about denials have to log in to myCGS, but they say the web portal doesn’t always have what they need.
“We still find ourselves calling a lot and that’s very time consuming,” said Sylvia King, general manager of Thrift Home Care, a member of the council, and vice president of the Mississippi Association of Medical Equipment Suppliers. “Anything that will save us time getting paid, especially with reimbursement cuts, is so valuable.”
With a written record of the reasons for denials, providers will also be better positioned to train not only their staff but also their referral sources, King says.
“We can tell our referral sources, ‘This is what Medicare is telling us,’ and it’s on their letterhead,” she said. “That will be more real to them.”
Stark puts it this way: “It triggers a more direct response and intervention.”
The second concession: CGS has also started excluding providers with low error rates from service-specific audits.
“Exclusion from the edit is not forever, but it’s long enough to catch your breath, pat yourself on the back and celebrate your success,” wrote Robert Hoover, the medical director for Jurisdiction C, in a letter.
While CGS doesn’t specify what it considers a low error rate, Stark says 20% or less is a good goal for providers to have.
“That’s a good place to start and fine tune from there,” she said. “Very few providers have 0% error rates. There are going to be things that happen.”
The two initiatives together should go a long way toward empowering providers to “get in front of what’s impeding their reimbursement,” Stark says.
“A lot of times, I think providers have a high error rate because of the difficulty they have in tracking this process from start to finish,” she said. “Getting these letters is really going to allow providers to start managing this in a different way.”
As for whether or not other jurisdictions will follow suit: “I haven’t heard any talk,” Stark said.
WASHINGTON – CMS officials last week acknowledged that some providers feel “angst” about prior authorizations (PAs), but they say, given a chance, the process will prove beneficial.
“We know there is some level of angst out there about this new process,” said Connie Leonard, acting deputy director of the Provider Compliance Group, during a Special Open Door Forum June 17. “That’s understandable.”
CMS scheduled the call to provide information “on all of the prior authorization initiatives.” In the May 28 Federal Register, the agency outlined its plans to implement a PA process for certain DME.
During the call, however, officials didn’t provide any specific information on DME. They did, however, try to address some common questions, including whether there would be a form (no) and whether claims with a PA attached would be subject to audits (unlikely).
“It goes for most, if not all of the PA affirmations, that a claim that has the PA decision isn’t typically reviewed again,” said Leonard. “That’s some peace of mind for the supplier that, three years later, Medicare is not going to come looking for the claim.”
CMS officials also discussed the PMD demo project, which it will expand to an additional 12 states. They said the agency remains committed to its continued success.
“We do have frequent meetings with the MACs to be sure things are running smoothly,” said one official. “We do spot checks to make sure everything is appropriate.”
It’s the success of that project that’s pushing CMS to implement PAs for other equipment, Leonard said.
“Some of you may remember that you did not want this and thought it was the worst thing that ever happened to Medicare,” she said. “Today, CMS believes that, for the most part, most suppliers actually like the demonstration or would like to be part of it.”
CMS is accepting comments on the proposed rule until July 28.
WASHINGTON – Reps. Pat Tiberi, R-Ohio, and John Larson, D-Conn., have introduced a bill that would require providers to obtain bid bonds as part of future rounds of competitive bidding. H.R. 4920, the Medicare DMEPOS Competitive Bidding Improvement Act of 2014, would also require providers to prove they meet licensure requirements before they submit bids. “AAHomecare is putting the full weight of the industry behind this practical piece of legislation,” stated Tom Ryan, president and CEO of the association, in a press release. “All providers and manufacturers should immediately ask their elected officials to support H.R. 4920.” Per the new bill, if a provider receives and accepts a contract from CMS, the bid bond would turn into a performance bond. If a provider receives a contract offer but does not accept it and its bid is at or below the bid price, CMS has the option to collect on the bond. AAHomecare believes the bill will “incentivize more responsible bids.” “When bids don’t have to be honored, the whole process becomes hollow,” stated Robert Steedley, president of Barnes Healthcare Services and chairman of the association’s board of directors.
SBA to take up industry issues at next hearing
WASHINGTON – The Small Business Administration (SBA) will discuss the impact of competitive bidding and audits at its National Regulatory Fairness Hearing on June 25. The meeting is an opportunity for business organizations, trade associations, chambers of commerce and related groups that serve small businesses to report unfair or excessive federal regulatory enforcement affecting their members, according to a notice from the SBA. Several members of the HME industry are scheduled to testify, including Tom Ryan of AAHomecare, Peggy Walker of U.S. Rehab and seven HME providers. The hearing will take place 9:30 a.m. to 1 p.m. at the Environmental Protection Agency, William Jefferson Clinton East Building. It’s open to the public, but advance registration is required. The SBA last took up competitive bidding a year ago.
Medtronic buys Covidien
MINNEAPOLIS and DUBLIN – Medtronic has agreed to buy Covidien in a cash-and-stock transaction valued at about $42.9 billion, the companies announced June 15. The combined company will have a comprehensive product portfolio, a diversified growth profile and broad geographic reach, with 87,000 employees in more than 150 countries, according to a press release. “We are excited to reach this agreement with Covidien, which further advances our mission to alleviate pain, restore health and extend life for patients around the world,” stated Omar Ishrak, chairman and CEO of Medtronic, in the release. The boards of directors of both companies have approved the transaction. After the transaction is completed, Medtronic and Covidien will be combined under a new entity called Medtronic plc. It will have principal offices in Ireland, where Covidien’s current headquarters reside and where both companies have a longstanding presence. Medtronic plc will be led by Ishrak and will continue to have operational headquarters in Minneapolis, where Medtronic currently employs more than 8,000. Per the transaction, each outstanding share of Covidien will be converted into the right to receive $35.19 in cash and 0.956 of an ordinary share of Medtronic plc. The per-share consideration represents a premium of 29% to Covidien’s closing stock price on June 13, the last trading day prior to the announcement. The transaction will allow Medtronic to enhance its existing portfolio, offer greater breadth across clinical areas and create entry points into new therapies. It will also allow the company to better package complementary therapies and solutions to drive value and efficiencies in healthcare systems. Finally, it will boost its capabilities in emerging market R&D and manufacturing.
More education, communication needed between COPD patients, physicians
WASHINGTON – More than half of COPD patients don’t fully understand their disease or how to manage it, according to a new survey from the COPD Foundation. The two-part Chronic Obstructive Pulmonary Experience (COPE) surveyed both patients and physicians. Nearly 62% of patients said they don’t know much about COPD exacerbations—a leading cause of hospitalization in the United States. Another 16% said they don’t know what an exacerbation is at all, and 60% said they don’t have a plan for dealing with an exacerbation. By contrast, 98% of physicians said they discuss exacerbations with patients and 92% said they develop action plans with them. The survey also found that many patients aren’t being diagnosed early enough. On this, patients and physicians appear to agree. Patients said they experience symptoms of COPD for two years and nine months, on average, before diagnosis; physicians said that 39% of their patients had reached a “severe” or “very severe” disease state by diagnosis. “COPD can be treated—but it’s crucial for doctors to diagnose it early and for patients to follow the appropriate therapeutic strategies to improve symptoms, increase activity, and reduce the chances of exacerbations,” said MeiLan Han, M.D., M.S., associate professor of Medicine in the Division of Pulmonary and Critical Care at the University of Michigan.
Does mail-order program meet requirement?
WASHINGTON – CMS may want to consider whether subsequent rounds of its national mail-order program for diabetes supplies meet a 50% requirement outlined in the Medicare Improvements for Patients and Providers Act (MIPPA). The Office of Inspector General (OIG) says 22 suppliers submitted at least 43 types of test strips for the three-month period from July to September 2013. Two types of test strips accounted for about 45% of the Medicare mail-order market share, three types accounted for 59% and 10 types accounted for 90%. The 50% requirement prohibits CMS from awarding competitive bidding contracts for diabetes supplies to suppliers that don’t demonstrate that their bid covers at least 50%, by volume, of all types of test strips. The OIG’s report is based on a sample of 1,210 claims drawn from a population of about 505,000 claims for test strips provided to beneficiaries during this period.
ResMed CEO sells 3,200 shares
NEW YORK – ResMed CEO Michael Farrell sold 3,200 shares of company stock on the open market June 16. Farrell sold the shares at an average price of $53.20 for a total of $170,240. He now directly owns 106,655 shares valued at approximately $5.7 million. Farrell is one of a number of execs at the company who has sold shares in May and June.
ASP: Brovana sees another increase
BALTIMORE – Payment increased for brand-name drug Brovana (J7605) in the third quarter of 2014 to $6.39 per dose, up 25 cents from the previous quarter, according to average sales price (ASP) figures released June 17. By contrast, Perforomist (J7606) saw payment decrease 29 cents to $6.62 per dose. Payment for budesonide (J7626) decreased 20 cents to $4.90 per dose. Payment for albuterol (J7613) stayed relatively flat at just over 13 cents per dose, and payment for ipratropium (J7644) was unchanged at just under 12 cents per dose.
Senior Medicare Patrol saves $9 million
WASHINGTON – Medicare/Medicaid recoveries attributed to Senior Medicare Patrol (SMP) projects increased 50%, to $9.1 million from 2012 to 2013, according to a report from the Office of Inspector General (OIG). However, total savings to beneficiaries decreased from $133,971 to $41,718. As part of SMP projects, 5,406 active volunteers conducted 148,235 one-on-one counseling sessions and held 14,924 group education sessions in 2013. SMP trains retired professionals and other seniors to recognize and report patterns of healthcare fraud.
HME provider faces prison time, fines
BATON ROUGE, La. – A federal court jury has found Ahaoma Boniface Ohia, owner of All-Star Medical Supplies, guilty of wire fraud, it was announced June 12. Ohia was accused of billing Medicare for durable medical equipment that was less expensive than what was provided or that wasn’t provided at all, according to a press release. Ohia, who was taken into custody after the verdict, faces up to 140 years in prison, fines of up to $1.75 million, and restitution to victims.
Wheelchair team gets replacement chairs
CEDAR RAPIDS, Iowa – It’s a happy ending for the wheelchair basketball team Iowa Chairiots. On June 14, the team received 20 new wheelchairs to replace wheelchairs that were stolen back in December. Tim Barrett, program director, told a local news outlet that the theft was actually a “blessing.” “Our equipment was outdated and unsafe, and now we have brand new equipment,” he said. In April, police arrested Rick Smith in the theft. Smith had many of the stolen wheelchairs in his home, but most of them were destroyed. The new wheelchairs have a value of about $30,000 and were paid for by donations, including a $12,000 donation from The VGM Group.
Performance Health buys TheraPearl
AKRON, Ohio – Performance Health, the manufacturer behind TheraBand, Biofreeze, Perform, Cramer, Bon Vital and Hygenic branded products, has acquired TheraPearl, a creator of hot and cold therapy products. The acquisition brings strength and scale to Performance Health’s emerging retail business, the company states in a press release. TheraPearl’s products use a proprietary Pearl Technology that allows them to be chilled or heated. They conform to the body and can be used for 20 minutes of hot/cold therapy. The products are available at most retailers throughout the U.S. and Canada, including Walmart, Rite Aid, Dick’s Sporting Goods and Target. In March, they became available in Europe at the pharmacy chain Boots. TheraPearl will continue to operate from its headquarters in Maryland.
Aeroflow updates website
ASHEVILLE, N.C. – Aeroflow has launched a new website that makes it easier for customers to find information on products and services. The website features the following new tools: patient/parent education resources; a cost savings calculator to help customers make informed decisions about whether to get equipment through insurance or buy online; a search function; a blog; a medical equipment look-up tool by zip code; and forms that make qualifying online easier. “We realized Aeroflow’s website is a first-impression to many seeking medical equipment or cost-assistance through insurance,” stated Maria Eilers, online marketing manager, in a press release. “The new website does a better job reflecting our mission to provide quality care by offering more for the convenience of those we serve.”
New Berlin, Wis.-based Home Care Medical has received reaccreditation from the Joint Commission, the provider announced June 18. Home Care Medical says it was the first accredited provider in the state in 1990.
BIRMINGHAM, Ala. – The ink was barely dry on a new law making a brick-and-mortar location a requirement for licensure in Alabama when providers in neighboring states found themselves on the wrong side of the divide.
“I have a location in Columbus, Ga., that is separated from Phoenix City, Ala., by the Chattahoochee River—it’s 1.6 miles from the state line,” said Tyler Riddle, president of MRS Homecare. “Now the state of Alabama tells me I can no longer get an Alabama license, which I have had for years.”
The law, which is slated to take effect Aug. 1, allows no exceptions, confirms provider Peter Czapla, who worked on the legislation and said it is similar to a law in Tennessee.
“There’s nothing that anybody can do as far as exemptions for bordering counties,” said Czapla, co-owner of Quality Home Health Care in Wetumpka, Ala., and chairman of the State of Alabama Board of Home Medical Equipment, which issues licenses. “If there’s an exemption for 10 miles, what about suppliers that are 11 miles away?”
Provider Carter Fuller has a location in Chattanooga, Tenn., which is also on the border with Alabama, and services patients in the state.
“If you’re not opening a location in the state of Alabama, don’t even think about it,” said Fuller, vice president of business development for Professional Medical & Respiratory. “Sometimes these things are overkill and you end up hurting patients because you exclude companies like us.”
Czapla says patient protection was top priority.
“We tried to create the best law to protect patients,” he said.
Riddle says he “wholeheartedly” supports licensure as a way to protect local providers from out-of-state bidders but says he’s caught in an unintended consequence of the new law.
“I can’t even service my patients,” he said.
Colorado also recently passed a law requiring a physical location, but it allows any provider within 50 miles of the border to be licensed in the state. There are not many providers in that radius, though, says Doug Coleman, president of the Colorado Association for Medical Equipment Suppliers (CAMES).
“It’s not a big deal in Colorado,” he said. “Other states—it could be huge.”
YOUNGSTOWN, Ohio – The price of surety bonds is rising on increased Medicare activity and drops in credit scores, insurance brokers say.
“From what I’ve heard from customers that have shopped for surety bonds with us, they have noticed everything from a little to a pretty decent price increase from the carrier they’re currently with,” said Bill McMahon, account executive at Cailor Fleming Insurance, which has not increased its bond prices.
Medicare began requiring that HME providers carry surety bonds—glorified, secured lines of credit, McMahon said—of at least $50,000 in 2009.
Increased claim activity from Medicare is the main driver behind the price increases, said McMahon.
“With that $50,000 guarantee, basically Medicare goes in and whether they suspect fraud or overpayment, in some cases, they’re going straight to the surety instead of to the carrier,” he said.
In some instances, the increase in claim activity is compounded by tighter credit requirements—the result of the growing number of bankruptcies nationwide—or by changes in the credit scores of the business owners buying the bonds, McMahon said.
All of these factors have resulted in not only higher rates but also increased scrutiny by insurers, said Michelle Newman, senior bond associate at VGM Insurance.
“We’re seeing surety companies doing more detailed underwriting—just looking at everything a little closer than we would have a few years ago due to that increased risk,” she said.
This new environment seems to be sending some providers shopping around. Cailor Fleming receives, on average, five calls a day from people looking for a better price on surety bonds or trying to consolidate where they buy their insurance products, McMahon said.