FRESNO, Calif. – Sunrise Medical has strengthened its presence in the high-end sports wheelchair market by acquiring RGK Wheelchairs. “The attractive and innovative RGK daily chair lines add an additional facet and choice to Sunrise’s own Quickie and Sopur premium active wheelchair product brands,” the company stated in a press release. The U.K.-based RGK was founded in 1988. It develops, designs, manufactures and distributes high-end, fully tailor made, court-sports and basketball wheelchairs. Sunrise says the acquisition is part of a mid-long term strategy to connect the various active wheelchair and sports product user groups in their social media communities via the company’s social media presence.

U.S. Rehab gets behind outcomes tool

WATERLOO, Iowa – U.S. Rehab has negotiated an exclusive license agreement with the University of Pittsburgh to give its members access to an up-and-coming outcomes tool. Developed by Mark Schmeler and Margo Holm, both professors at UPitt, the Functional Mobility Assessment tool tracks data on the ability of patients to function with their assistive devices like walking aids, prosthetics and wheelchairs. “Eventually, we will be able to track patient outcomes and prove that better equipment provides more patient healthy days, which leads to a better quality of life,” stated Greg Packer, president of U.S. Rehab, a division of The VGM Group, in a press release. “Better equipment will help manage disease states, which will reduce the overall life cost of patients over time.” U.S. Rehab and UPitt are currently conducting a pilot project, but they hope to roll out the tool to U.S. Rehab’s entire membership in 2016. UPitt has already collected preliminary data from other pilot studies, but the agreement with U.S. Rehab will “take this to a large level,” stated Schmeler, Ph.D., OTR/L, ATP.

Verus Healthcare grows 1,000%

NASHVILLE, Tenn. – Verus Healthcare has grown its CPAP business by 1,000% in three years, the company announced this week. Verus, which entered the market in 2012 when it acquired CPAP Care Club, now serves the resupply needs of about 50,000 patients, processing nearly 14,000 new orders per month. “When we bought this company three years ago, the systems and processes weren’t in place to scale,” stated Richardson Roberts, CEO of Verus. “We’ve invested $1.5 million developing our proprietary software called SNAP and built a highly experienced management team. The results have been excellent, but we still have a lot of runway in front of us.” So far, Verus has purchased assets from more than 100 DME companies throughout the U.S. and says, “deal flow continues to be strong” as the industry consolidates.

NSM opens two branches, moves one branch

NASHVILLE – National Seating & Mobility has opened branches in New Redding, Calif., and Cleveland. The New Redding branch, the company’s 14th in California, serves complex rehab patients in the Redding and Chico area. The Cleveland branch, its fourth in Ohio, serves patients in the Columbus, Toledo and Youngstown regions. Additionally, NSM has relocated its Iowa City branch to a larger facility at 4172 Alyssa Court in response to increased business.

Study promotes primary care for sleep apnea patients

LLEIDA, Spain– A new study has found that monitoring patients with obstructive sleep apnea syndrome (OSA) in a primary care setting is equally effective as monitoring them in sleep units.  The study was conducted by Respiratory Research Group and led by Dr. Ferran Barbé, head of respiratory at the University Hospital Arnau de Vilanova (HUAV)in Lleida, Spain. For six months, 101 patients with OSA received primary care management at one of eight primary care centers in Lleida, while 109 patients received sleep unit management atthe University Hospital Arnau de Vilanova. Both groups consisted of predominantly middle-aged obese men with severe OSA. At the end of six months, the mean CPAP compliance for the primary care group was 4.94 hours per night, while the mean CPAP compliance for the sleep unit group was 5.23 hours per night. The study also revealed that primary care monitoring resulted in 60% savings. On average, the total cost per patient in the primary care group was €144 ($162), while the total cost per patient in the sleep unit group was €356 ($401). The cost difference was related to the monitoring performed by specialist nurses in the sleep unit.

Golden maximizes space

LAFLIN, Pa. – Golden Technologies has installed five sets of racks, each 100 feet long, at its primary lift chair distribution center here to improve efficiency. “With our new system of power conveyors, racking and re-organization of the entire floor, movement of product through the building will be much more efficient and faster,” said Dave Leiby, vice president of finance, in a release. Before the renovation, employees walked between 17 to 22 miles a day moving lift chairs from freight trucks to the floor and then loading docks. Now they are able to use a special forklift to select the desired chair. Golden moved into the 100,000-square-feet location a year ago.

NCART, NRRTS, RESNA join forces

ARLINGTON, Va. – NCART, NRRTS and RESNA will co-host a single conference next year, July 12-15 at the Hyatt Regency Crystal City in Arlington, Va. The theme: "Promoting and Protecting Access to Assistive Technology.” “Through our combined efforts, we can offer a unique conference experience that will bring tremendous value to our members” said Michael Brogioli, executive director of RESNA, in a statement. “We will also be able to bring a larger contingent of the assistive technology community to Congress and the administration, and a louder voice on critical issues such as access and funding.” The conference will feature clinical education and poster sessions, professional development and leadership training, instructional courses, exhibit hall, student competitions and visits to Capitol Hill.

Alliqua raises $34.5M

LANGHORNE, Pa. – Alliqua BioMedical, a provider of advanced wound care products, has raised $34.5 million through a public offering. The company, listed on the NASDAQ as ALOA, sold about 6.6 million shares of its common stock at a price of $4.55 per share. Alliqua plans to use the net proceeds from the offering to “fund the commercial expansion of its marketed products, to opportunistically pursue additional product platforms, and for working capital and general corporate purposes,” according to a press release.

Insulet loses ground in first quarter

BILLERICA, Mass. – Insulet, maker of the OmniPod insulin management system, reported revenues of $61.2 million for the first quarter of 2015, an 11% decrease compared to the same period last year. Net loss was $11.8 million vs. $6.1 million. "With our U.S. OmniPod business on track, in spite of some unevenness in our first quarter performance in our other product areas, we remain on track to achieve our originally-stated full-year revenue expectations and we are excited about the promising opportunities ahead of us," stated Patrick Sullivan, president and CEO, in a release. "We recognize that we have work to do, however we are achieving important milestones in executing a strategy to ramp Insulet's sales and marketing efforts, enhance access to our innovative and differentiated technology, and further improve our global footprint. I am confident that we have the right talent to lead Insulet and position the company for sustained accelerated growth over the long-term." Insulet recently appointed a highly experienced CFO and has made other executive appointments across sales, marketing, managed care, customer support and investor relations. For the second quarter, it expects to generate revenues of $67 million to $70 million, and for the full year, it expects to generate revenues of $305 million to $320 million.

Short takes: Roll on Capital Hill, NovaSom, NCPA, Univita, United Spinal Association

Jenny Lieberman, an OT, and Erin Michael, a PT, hope to raise $12,000 to help cover travel costs for a half a dozen disability advocates to attend the United Spinal Association’sRoll on Capital Hill, June 7-10 in Washington, DC. At press time, the team has raised more than $5,000 through Indiegogo, a crowd funding website…NovaSom will be featured in an upcoming episode of Innovations with Ed Begley Jr. During the segment, viewers will learn about the company’s AccuSom home sleep test, which features continuous patient support and next-day test results and interpretation…The National Community Pharmacists Association is partnering with CW Publishing Group on a consumer magazine, Matters of Health. The biannual print and digital magazine will feature topics like coping with chronic conditions, managing heart disease, taking steps to a healthier lifestyle, and managing medications. The first issue will be released this summer…Univita Health has earned accreditation from the Pharmacy Compounding Accreditation Board of the Accreditation Commission for Health Care for sterile compounding of prescriptions. The accreditation is recognized as an independent audit of an organization’s commitment to delivering quality care and services in compliance with nationally recognized (USP) 797 standards…The United Spinal Association has partnered with Myomo to raise awareness of the benefits of the MyoPro myoelectric upper limb orthosis. The orthosis is designed for individuals with spinal cord injury, brachial plexis injury, stroke, MS, ALS and other neuromuscular disorders.

WASHINGTON – Provider Robert Steedley will take the mic at a hearing this week to discuss how the market pricing program is a better alternative to the current bidding system.

“We want to continue to discuss with Congress repairing what we consider to be a flawed program,” said Steedley, who will be speaking as AAHomecare’s chairman of the Board of Directors. Steedley is also president of Barnes Healthcare Services in Valdosta, Ga. “I’ll focus on some of the more problematic areas, such as the lack of binding bids and the size of the MSAs, but then focus how MPP addresses those specific needs.”

The May 19 hearing was called by Rep. Kevin Brady, R-Texas, chairman of the Ways and Means Subcommittee on Health. The hearing, which is not HME-specific, is intended as a general exploration of competition and competitive bidding in health care.

Steedley is testifying on MPP at the behest of Rep. Tom Price, R-Ga., who in the last Congress introduced a bill that would have replaced competitive bidding with MPP.

Whether the congressman plans to drop another bill is uncertain, say stakeholders.

“Price is very much (in favor) of a demo project for MPP,” said Tom Ryan, president and CEO of AAHomecare. “It’s still in the talking stages but I believe that will happen this year and will be a good indicator of whether this program could work.”

But with CMS determined to expand bid rates nationwide in 2016, is it too late for MPP, which has been back-burnered while stakeholders attended to more pressing concerns?

It’s important to keep the discussion going any way we can, says Steedley.

“We know we are not going to see one swift piece of legislation that’s going to fix everything for the industry,” he said. “All we are asking for is to make the improvements along the way and allow providers to stay in business and take care of the customers they’ve been serving for so long.”

Steedley and Ryan both expect momentum from the hearing to carry over into Hill visits later in the week as part of AAHomecare’s Washington Legislative Conference which, is slated for Wednesday and Thursday.

Ryan said about 150 attendees are expected.

“Folks on the Hill are sympathetic to our concerns, so we can’t let up,” he said.

YARMOUTH, Maine – Seventy-two percent of the respondents to a recent HME NewsPoll say their websites are mobile-friendly.

That’s a good thing, because in April, Google tweaked its search algorithm to make mobile-friendly websites rank higher in mobile search results.

It’s also a good thing because 78% of respondents say more of their customers are using mobile devices to find them. 

“During the first quarter of 2015, over 30% of our web traffic was mobile—21% mobile, 10% tablet,” wrote Gary Sheehan, CEO of Sandwich, Mass.-based Cape Medical Supply. 

Overall, 64% of Americans now use smartphones, according to the Pew Research Center.

Like Sheehan, 67% of respondents say they track how their customers find them, a data point that helps them make better business decisions.

“We can tell which type of device and much more from Google Analytics,” wrote Sam Clay, owner of Clay Home Medical in Petersburg, Va., who is in the process of updating his company’s website.

Besides boosting the search rankings of providers, mobile-friendly websites also improve the experience of users, says one respondent. 

“Having a mobile-friendly site allows for better education through the addition of a simple navigation layout,” wrote the respondent. “Computers are not always accessible, so ensuring our patients have instant access to this information was paramount.” 

Not all respondents are concerned about Google’s new ranking system, however.

“Patients are captured via contracts with payers,” wrote James Roache, president and CEO of Advanced Pharmacy Solutions. “Not one has gone to our website.” 

FRESNO, Calif. – Equistone Partners has put Sunrise Medical up for sale, according to Reuters. The European-based investment firm is considering offers from IK Investment Partners and Nordic Capital in a potential $507 million deal, the news agency reports. Equistone Partners, which is owned and managed by the former executives of Barclays Private Equity, is also considering an offer from “a family office,” a vehicle handling the assets of a wealthy family, Reuters reports. Equistone Partners is asking potential buyers to submit final bids by the end of May.

The firm bought Sunrise Medical from New York-based Vestar Capital Partners in 2012.

IK is a European-based private equity advisory group that has raised 7 billion euros in capital and has 21 companies in its current portfolio.

Nordic Capital is a private equity firm in the Nordic region and Germany that formerly owned Permobil, a competitor of Sunrise Medical. It sold Permobil to Investor AB, a Swedish investment firm, in 2013.

New customers boost Liberator’s financial results

STUART, Fla. – Liberator Medical added 5,758 new customers in the first two quarters of fiscal year 2015, the company announced May 11.

“For the remainder of 2015, we intend to build this base through our proven direct response advertising efforts,” stated Mark Libratore, president and CEO, in a press release detailing the company’s financial results for the second quarter ended March 31.

Another emphasis for Liberator: retaining existing customers through “uncompromising” customer service, Libratore says. Existing customers generated $16.9 million in revenues for the second quarter, 86% of total revenues.

Liberator reported net sales of $19.7 million for the second quarter, an 11.7% increase compared to the same period last year. Net income was $1.7 million vs. $1.6 million.

For the first six months of fiscal year 2015, Liberator reported net sales of $39.9 million, a 10% increase compared to the same period last year. Net income was $4.1 million vs. $3.7 million.

ResMed trial fails

SAN DIEGO – ResMed has announced that a phase III trial designed to assess whether treating moderate to severe predominant central sleep apnea with Adaptive Servo-Ventilation (ASV) therapy could reduce mortality and morbidity in patients with chronic heart failure has missed the mark. A preliminary analysis of the data identified a statistically significant 2.5% increased risk of cardiovascular mortality for those patients in the trial who received ASV therapy per year compared to those in the control group. In the study, the cardiovascular mortality rate in the ASV group was 10% per year compared to 7.5% per year in the control group.

BritKare buys Pillar

AMARILLO, Texas – BritKare Home Medical has acquired Pillar Equipment Services, a diversified DME business based in Lubbock, Texas. The acquisition gives BritKare, which has been serving the Texas Panhandle region since 1995, three locations in Northwest Texas. “The acquisition of Pillar gives us expanded regional capability to continue providing exceptional service to our patients and referral sources in the Texas Panhandle,” stated Josh Britten, president of BritKare, in a press release. BritKare will change Pillar’s name and continue to operate at its existing location. Duckridge Advisors served as the adviser for Pillar Equipment.

Study details important attributes in concentrators

SOMERSET, Pa. – Failure rate is the most important attribute for homecare providers in a 5-liter oxygen concentrator, according to a recent market research study conducted by DeVilbiss Healthcare. Failure rate (36.09%) is followed by price (25.53%), warranty (19.43%), energy savings (11.05%) and maintenance tools (7.9%). “It is clear from our research that more and more providers see the value of a product that is built to last beyond just the acquisition price,” stated Wally Haddick, vice president of sales, Canada and Latin America, for DeVilbiss Healthcare. “When a manufacturer can minimize post-purchase costs, it allows the provider to focus more

efficiently on what they do best—deliver oxygen therapy service.” The research is based on a poll of 29 homecare providers in Canada and Latin America using an analysis questionnaire with the support of Dr. Oded Netzer, associate professor of business at Columbia Business School in New York City.

Coming soon: Prepay reviews for tilt and tilt and recline 

NASHVILLE, Tenn. – The Jurisdiction C DME MAC has announced widespread prepayment reviews for power tilt (E1002) and power tilt and recline (E1007) wheelchairs. If their claims are selected for review, providers will receive a request for additional documentation that must be received within 45 days, or the claims will be denied.

State takes: Illinois, Michigan

Complex rehab providers in Illinois are facing a double-whammy: an unannounced change to the payment methodology announced in April and an across-the-board payment cut of 16.75% announced in May. As a result, two of the largest providers in the state have temporarily stopped providing products and services. Stakeholders are asking providers to call the Department of Health and Family Services and to email state lawmakers to request action reversing the changes…Michigan’s Senate Committee on Regulatory Reform on May 6 approved legislation that would allow certified manufacturers to install residential stair lifts. Currently, lifts are regulated in the same manner as commercial elevators and can be installed only by a licensed elevator contractor. The bills, H.B. 4163 and H.B. 4162, were passed in March by the House and will now be put to a vote in the Senate.

Short takes: VGM, Allstar Medical Supply, Home Care Medical and more

The VGM Heartland Conference has been awarded the 2014 Cedar Valley Tourism Award for “Event of the Year.” The award is given to a hallmark event or festival that creates significant economic impact, attracts substantial out-of-town visitors, generates positive media attention and/or promotes Cedar Valley as a destination. The conference takes place June 15-18…Allstar Medical Supply has won “Best Wellness & Medical Retail Store” in an annual reader poll conducted by the Bay Area News Group, which includes the Oakland Tribune, Contra Costa Times and a number of other newspapers…Home Care Medical will host a grand re-opening event on May 15 at its retail store in West Bend, Wis…BioScrip is offering to exchange up to $200 million of senior notes due in 2021 for an equal amount of its outstanding senior notes due 2021. The notes are in aggregate principal amount of 8.875%. The offer is being made to satisfy BioScrip’s obligations to a registration rights agreement in connection with the old notes…CareTouch Communications is a Friend Sponsor of the Cancer Centers of Colorado at Lutheran Medical Center’s Leaves of Hope run/walk. The company’s “CareTouch in the Community Team” will participate in the June 7 event, which highlights that there is life after cancer, according to a release.

WASHINGTON – The buzz at the AAHomecare Washington Legislative Conference last week was the HME industry’s next moves in the fight against Medicare’s competitive bidding and audit programs.

In the works, but not yet ready: legislation that would phase in or delay the national roll out of competitive bidding planned for Jan. 1, 2016. Another talking point: a market-pricing program to replace the program.

As Sen. John Hoeven, R-N.D., told attendees, “We may not be able to eat the whole apple with one bite.”

The industry scored its first big victory in the fight against competitive bidding recently, when a provision requiring binding bids was passed by Congress as part of a “doc fix” bill. The problem: The provision doesn’t go into effect until 2017 at the earliest, leaving the current Round 2 re-compete, the upcoming Round 1 2017 and the national roll out unaffected.

Hoeven, who sent a letter to CMS last year pressuring the agency to stop the expansion of competitive bidding until the Office of Inspector General completes its investigation of Round 2, spoke of the need for stakeholders to keep picking away at the program.

For example, “we can go back to CMS on the timing (of the national roll out),” he said. “We can tell them, ‘We passed this legislation (requiring binding bids). How about some relief on the timing?’”

Also in the works, but not ready: legislation reforming Medicare’s audit program. Stakeholders had hoped that a bill introduced last year by Rep. Renee Ellmers, R-N.C., would have been re-introduced by now, but they’re getting pushback on a provision reinstating clinical inference. That would allow CMS’s contractors to use “common sense” when, for example, a claim for a prosthetic for a beneficiary who has lost a limb is denied.

“We’re working on it,” said Tom Ryan, president and CEO of AAHomecare. 

WASHINGTON – As HME stakeholders prepared to descend on Capitol Hill on Thursday morning as part of the AAHomecare Washington Legislative Conference, an unexpected item was added to their to-do list.

The House Energy and Commerce Committee announced that morning that the pay-for for the 21st Century Cures Act included reducing Medicaid payments to match Medicare payments for certain HME included in the competitive bidding program, a move it says will bring in $2.8 billion, according to The Hill.

“This is something you need to go to the Hill and talk about,” Jay Witter, senior vice president of public policy at AAHomecare, told attendees the day before, when the pay-for was a threat but not official. “You need to talk about the challenges of the huge cuts to all areas in 2016 and on top of that these cuts to Medicaid.”

The Cures Act, which the committee plans to put to a full vote in the House in June, seeks to streamline the Food and Drug Administration’s approval process for new drugs. Much of the act’s cost comes from $10 billion over five years in new funding for medical research at the National Institutes of Health, the Hill reports.

Witter said AAHomecare met with committee members the week prior to express their concerns, but they largely fell on deaf ears.

“I don’t think they were seeing the light,” he said.

While individual state Medicaid programs have the purview to make adjustments to their payments—and some, like Virginia’s, have already adopted bid rates—this would be a sweeping change.

The idea of applying competitive bidding rates to Medicaid is nothing new. The president often includes such a provision in his annual budget, and the Office of Inspector General has published a number of reports saying state Medicaid programs could have saved money by using bid rates.

“Congress has talked about including this provision as a pay-for for numerous years,” Witter said.

At least the timing of the committee’s announcement was right, with attendees on the Hill that day to lobby lawmakers on industry issues.

“Happy I’m in D.C. right now,” wrote provider Gary Sheehan on Twitter in response to the news.

WASHINGTON – Robert Steedley handed over the reins to John Letizia during the AAHomecare Washington Legislative Conference this week.

Steedley said one of his goals as chairman of AAHomecare’s board of directors was leaving the association better off than he found it, something he says he feels he accomplished by helping to build a “dynamic staff” and “getting some legislation passed.”

“I’m more committed, more energized now than when I took over two years ago,” said Steedley, president of Barnes Healthcare Services in Valdosta, Ga.

AAHomecare thanked Steedley for his service, including a recent testimony before the House Ways and Means Committee Health Subcommittee, with a crystal mini-Capitol Hill, socks and cuff links.

Steedley’s parting words for the industry: “This association is powerful. Our numbers may be small, but our mission is huge, and we’re poised to be successful.”

Letizia, formerly vice chairman of AAHomecare’s board and chairman of its Complex Rehab & Mobility Council, said one of his goals is to shepherd more providers into being active in the industry and in the association.

“I wasn’t always involved,” said Letizia, president of Laurel Medical Solutions in Ebensburg, Penn., and an ATP. “I always assumed someone was representing our interests. Then one day I realized that person was me.”

Later Letizia, who got his start in an independent pharmacy at the ripe old age of 8, said, “I have an open door to any of you to talk about the association.”

In welcoming Letizia, Tom Ryan, president and CEO of AAHomecare said, “A new boss is now in town.”

Robert Steedley, chairman of AAHomecare’s board of directors, testified during a congressional hearing on May 19 on improving competition in the Medicare program. 

BALTIMORE – CMS will host a Special Open Door Forum on May 27 to discuss eliminating CMNs and durable medical equipment identification forms. The current CMN forms are for oxygen, pneumatic compressions devices, osteogenesis stimulators, TENS devices, seat lift mechanisms, and section C continuation form; the current DIF forms are for external infusion pumps and enteral and parenteral nutrition. Comments on the forms can be emailed to reducingproviderburden@cms.hhs.gov. To participate in the call: 1-866-501-5502, conference ID: 4585862

CVS nabs Omnicare for $12.7B

WOONSOCKET, R.I., and CINCINNATI – CVS Health Corp last week announced plans to acquire Cincinnati-based Omnicare for $12.7 billion in cash. The deal includes $2.3 billion of the pharmacy provider’s debt. “(The acquisition) creates new opportunities for us to extend our high-quality, innovative pharmacy programs to a broader population of seniors and chronic care patients as they transition across the care continuum,” said Larry Merlo, president and CEO of CVS Health, in a release. The deal will allow CVS to expand its presence in the specialty pharmacy business, as well as its ability to dispense prescriptions in assisted living and long-term care facilities. The transaction is subject to approval by Omnicare common stock holders and is expected to close by the end of 2015.

Numotion names new chief strategist

ROCKY HILL, Conn. – Jennie Hanson has been hired as Numotion’s Chief Strategy Officer. Hanson was previously a principal partner at The Physician Leadership Institute and has more than 25 years of experience in executive level profits and loss leadership roles. "Jennie is a dynamic business leader with over two decades of global healthcare leadership experience and extensive strategic expertise," said CEO Mike Swinford in a release. "With her impressive track record of innovative thinking and building businesses, Jennie brings a unique leadership skill set that will ultimately benefit our customers and our business.” 

Roscoe adopts new pricing policy

STRONGSVILLE, Ohio – Roscoe Medical has introduced a minimum advertised price policy for its Viverity line of retail home healthcare products. With a MAP policy, HME providers can be confident that they won’t be underpriced by “bargain basement e-commerce retailers,” according to the company. “The goal with our MAP policy is to maintain margin integrity at the HME storefront level and ensure a level playing field across the board for our provider network,” stated Ryan Moore, vice president of sales, in a press release. Other benefits of the policy, according to the company: protecting the Viverity brand image and maintaining retail value to ensure healthy margins for providers. The policy will go into effect June 1 and apply to all advertising and marketing activities of each provider that purchases any Viverity-brand products.

Itamar expands sleep program to cardiologists

FRANKLIN, Mass. – Itamar Medical will begin offering a comprehensive sleep apnea management service to cardiologists, the medical device company announced May 16. The new offering comes on the heels of growing evidence of the link between cardiovascular disease and obstructive sleep apnea. The Total Sleep Solution program will use Itamar’s cloud-based IT platform to transmit WatchPAT test results directly to physicians and their staff. “The Total Sleep Solution is a growing business opportunity, addressing a significant unmet need in the cardiology space, while contributing to improve the clinical outcomes of cardiovascular procedures,” said CEO Gilad Glick in a release.

HASCO moves, presents at conference

DALLAS – HASCO Medical has relocated its corporate headquarters from Addison, Texas, to Dallas. “With our rapid growth and additions to our HASCO team, we simply reached capacity at our previous headquarters," said CFO Shane Jorgenson in a release. The wheelchair accessible van providersigned a 65-month lease for the 7,150-square-foot space…The company is also slated to give a presentation at the 2015 Marcum MicroCap Conference on May 28 at the Grand Hyatt Hotel in New York City. “I will discuss our success providing solutions for people with limited mobility,” said CEO Hal Compton in a release. The conference showcases companies with less than $500 million in market capitalization.

UK company finds U.S. distributor

EXTON, Pa. – Albert Medical Devices, maker of Melio, has formed a distribution partnership with ABC Medical, the company announced last week.The Liverpool, England-based company introduced Melio, a self-emptying leg bag system for catheters, to the U.S. market at Medtrade in April. “We are delighted to work in partnership with ABC Medical, as this gives more people across the U.S. access to the Melio self-emptying leg bag system through Medicare, Medicaid or private insurers,” said Matt Pearce, CEO of Albert Medical, in a release. “Since launching Melio in the U.S. earlier this year, the customer response has been fantastic.” The Exton, Pa.-based ABC Medical is a urological and continence care supplies provider.

Philips responds to ResMed study

MURRYSVILLE, Pa. – In the wake of a failed study by ResMed, Philips Respironics is recommending that clinicians not use Adaptive Servo-Ventilation (ASV) therapy for treating moderate to severe predominant central sleep apnea for patients with chronic heart failure, due to an increased risk of death in trial patients. ResMed announced May 13 that a phase III trial designed to assess whether treating moderate to severe predominant central sleep apnea with ASV therapy for patients with chronic heart failure found a 10% per year mortality rate of trial patients, vs. 7.5% for the control group. Philips is working with ResMed to better understand study data, according to a release.

Team SCA sets sail with senior

PHILADELPHIA – SCA, maker of TENA, has partnered with Wish of a Lifetime to fulfill lifelong wishes of three seniors who have overcome challenges in their daily lives, according to a press release. The first wish was granted May 15 to 90-year-old Shirley Paine, whose wish was to sail with Team SCA, an all-female sailing team. The Kingstown, R.I., resident met with team members, sailed Newport Harbor and watched Team SCA compete in the Pro-Am race. Wish of a Lifetime is a non-profit devoted to fostering respect and appreciation for seniors. After experiencing a wish, 93% of recipients report a 93% quality of life improvement, according to the release.

PFQC launches ‘Faces Behind the Red Tape’

WATERLOO, Iowa – People for Quality Care has launched a new online series called “Faces Behind the Red Tape” to document the impact of audits on Medicare beneficiaries. The first chapter in the series features Sandra, a caregiver struggling to get a wheelchair for her mother. “Sandra was the inspiration for this series,” stated Lalaina Rabary, a communications and marketing specialist for PFQC, a division of The VGM Group. “When I spoke with her, I knew right away that we needed to share her story.” PFQC hopes the series will raise awareness among Medicare beneficiaries that audits are often the reason in takes weeks, if not months, to get the equipment they need. “A lot of beneficiaries we talk to don’t know anything about audits,” stated Kelly Turner, director of advocacy for PFQC.

People in the news: Matthew Monaghan, Harvey Diamond

Elyria, Ohio-based Invacare has announced that its shareholders have elected to the board Matthew Monaghan, the company’s president and CEO, and Clifford Nastas, a director of the Dan T. Moore Company and president of a group of its automotive and advanced materials operating companies. Shareholders have also appointed Monaghan as chairman of the board. The interim chairman, Dr. C. Martin Harris, will return to his role as independent lead director…EY has announced that Harvey Diamond, chairman of the board and CEO of Port Washington, N.Y.-based Drive Medical, is a finalist for the EY Entrepreneur of the Year Award for 2015. The awards program recognizes entrepreneurs who demonstrate excellence and success in areas like innovation, financial performance and personal commitment to their businesses and communities. EY will announce winners at a special gala event at the New York Marriott Marquis on June 16.

WASHINGTON – Rep. Marsha Blackburn, R-Tenn., introduced a bill last week that would require prior authorizations for high-dollar DME.

The bill, H.R. 2437, would also exempt DME that has gone through this prior authorization process from pre- and post-payment audits, according to The VGM Group.

“These pre-approved items could then only be subject to audits for fraud and abuse purposes,” the group stated in a bulletin to members. “The intention of this is to reduce the number of intrusive audits on suppliers.”

The bill has been referred to the House Energy and Commerce and Ways and Means committees for consideration, according to the Library of Congress website. Currently, there is no text for the bill available.

CMS is already running a demo project requiring prior authorizations for power mobility devices. Last year, it also outlined plans to implement prior authorizations for some 134 products that it believes are frequently overutilized, such as CPAP devices.

Blackburn has long been a champion of industry efforts to reform Medicare’s audit program. Last year, she was one of a group of lawmakers to pressure CMS not to retrospectively audit providers for compliance with the face-to-face requirement. The agency has implemented, but still has not started enforcing, the requirement. 

Additionally, two years ago, she was part of a delegation that sent a letter to CMS voicing concerns that it had awarded bids to unlicensed providers as part of Round 2 of competitive bidding.

In 2012, the Association of Tennessee Home Oxygen and Medical Equipment Services chose Blackburn as its Champion for Homecare.

BOSTON – Massachusetts’ proposed Medicaid budget for fiscal year 2016 raises more questions than it answers, say DME stakeholders.

Under the proposal, the state’s Medicaid program, MassHealth, would be allowed to contract with DME manufacturers and distributors, bypassing providers. 

“At this point, the language is fairly vague and it doesn’t have a specific plan in place, which is a concern for providers, because we don’t know where that leaves us,” said Peter Tallas, president and CEO of Pembroke, Mass.-based Charm Medical Supply.

The proposal does not specify which DME products could fall under the provision or what form those contracts would take. It’s also left providers wondering if the state even understands how the DME supply chain works.

“We heard (MassHealth) was thinking about buying diapers in bulk, but where are they going to store it?” said Karyn Estrella, president and CEO of Home Medical Equipment and Services Association of New England. “How are they going to deliver it to the patients? How are they going to qualify people before they deliver the product?”

Cutting out providers could lead to spending increases in unexpected ways, they say.

“We’re the gatekeepers of Massachusetts Medicaid spending,” said Bill Fredericks, president and CEO of Millbury, Mass.-based All Care Medical Supply. “We’re the ones that overlook the prescriptions to see if they’re medically necessary. If that process is taken out, it’s going to be open season.”

The House passed the budget in late April; the Senate was expected to release its own version of the budget in May.

CHICAGO – Based on the attendance figures for HIMSS15 at Chicago’s McCormick Place in April, healthcare IT is a very healthy market.

Organized by the Chicago-based Health Information Management and Systems Society, the four-day event drew more than 40,000 attendees—an 11% increase over last year—while the more than 1,300 exhibitors set a new record.

HIMSS Executive Vice President Carla Smith said the event is “more than just socializing and getting information—it’s an event that equips attendees to return to their care settings to play an active, transformational role for healthcare IT in their communities.”

‘Revolution afoot’

Members of the Open Notes movement are predicting a groundswell of public support for giving patients access to physician notes as part of their medical profiles. Viewing physician notes will help patients understand their diagnoses better, clear up confusion about instructions and catch potential errors in their profiles, advocates say.

Dr. Susan Woods, a general internist with the Veterans Health Administration, told HIMSS15 attendees there is “a revolution afoot” with regard to the public demand to get access to “the rich source of patient information, which is physician notes.”

The value of IT

The 26th Annual HIMSS Leadership Survey of more than 300 participants revealed that 72% of respondents believe patient engagement, satisfaction and quality of care will have a major impact on their organization’s strategic efforts over the next two years.

The strategic value of information technology continues to be top of mind with healthcare leaders, as 81% of respondents indicated IT is considered “a highly strategic tool” at their organizations and 76% noted that their IT plan fully supports their overall business plan. More than two-thirds of respondents (68%) indicated an improvement within the patient health experience, and more than half also felt that IT was reducing the cost of healthcare and improving population health.

WASHINGTON – AAHomecare has resurrected its Legislative Council to pool the industry’s lobbying efforts.

AAHomecare’s Jay Witter points out, for a small industry, quite a few HME companies have lobbyists on the Hill—not only Invacare, Pride Mobility Products and Philips Respironics, but also Hill-Rom, Cardinal Health, Smith & Nephew and others—and a major goal of the council is to get them all in the same room on a regular basis.

“It’s a good way to get all of the D.C. assets together, trade intel, share contacts and strategize,” said Witter, senior vice president of public policy at AAHomecare, who will serve as the staff liaison for the council. “It’s a tremendous resource.”

The council, which was dissolved before Witter’s time at AAHomecare, had its first meeting in April. It joins seven other councils at the association with focuses ranging from medical gases to DME MACs.

Where most councils are tasked with helping AAHomecare’s Executive Committee set policies on issues, the Legislative Council is tasked with helping the association “get things done” on the Hill, Witter says.

“What’s the best route for a piece of legislation?” he asked. “Who are the key members of Congress who need to be influenced?”

WASHINGTON – Orbit Medical and its partial successor, Rehab Medical, have agreed to pay $7.5 million to settle allegations that it altered and forged physician prescriptions and supporting documentation for power wheelchairs and accessories, the U.S. Department of Justice announced today.

Orbit Medical says it fully cooperated and offered full transparency during the DOJ’s four-year investigation.

“We are relieved to close this chapter and move forward growing our business,” the company said in a statement to HME News.

A False Claims Act lawsuit alleged that Orbit Medical sales reps changed or added dates to physician prescriptions and chart notes to falsely document that physicians examined beneficiaries within 45 days of the face-to-face exam; changed prescriptions to falsely establish medical necessity; created or altered chart notes and other documents to falsely establish medical necessity; and forged physician signatures on prescriptions and chart notes and added facsimile stamps to supporting documentation.

“The resolution of this case helps to restore funds taken from the Medicare trust fund through the use of falsified records and billings,” said Carlie Christensen, U.S. attorney of the District of Utah.

The lawsuit was filed by former Orbit employees, Dustin Clyde and Tyler Jackson. Under the False Claims Act, a private party can sue for false claims on behalf of the government and share in any recovery. Both employees will receive $1.5 million of the settlement.

BALTIMORE – CMNs/DIFs are a burden HME stakeholders would like to see eliminated, they told CMS officials during an Open Door Forum last week.

“There was a time and place for CMNs,” said Ronda Buhrmester, a reimbursement specialist for The VGM Group, during the forum. “Providers already have to gather that info in the progress notes and it is redundant. It’s time to eliminate CMNs.”

Currently, CMNs are required for oxygen, pneumatic compression devices, osteogenesis stimulators, TENS devices, seat lift mechanisms, and section C continuation forms. DIFS are required for external infusion pumps and enteral and parenteral nutrition. CMNs were eliminated several years ago for power mobility devices and hospital beds.

During the forum, CMS officials wanted to hear from HME providers about eliminating them altogether.

“CMNs were developed to provide evidence of medical necessity and we’ve found that CMN information often conflicts with the medical record itself,” said an official from the CMS Provider Compliance Group. “What is the impact (on providers) of eliminating the forms?”

Overwhelmingly, callers to the forum were in favor of dumping CMNs/DIFs, citing them as time-consuming and frustrating for both providers and physicians.

“The CMN is really a huge chore to get the physician to even fill it out,” said provider Lori Corey. “The amount of time we spend trying to get the CMN right does us no good in the end if our documentation was not in a row to begin with.”

However, callers were also quick to say that CMNs do offer objective criteria to establish medical need. Could the criteria be incorporated into the written order prior to delivery? Or, could the CMN be replaced with an electronic template, they asked?

“The concept of an electronic template has some logic built in,” said one caller. “It could make a world of difference in terms of being more meaningful and timely.”

In fact, CMS is considering electronic templates for PMDs, oxygen concentrators and lower limb prostheses, said Melanie Combs-Dyer, director of the Provider Compliance Group.

“There are more templates that we would like to develop in the future,” she said. “We are working to begin pilot testing some of those e-clinical templates.”

WASHINGTON – HME stakeholders have accomplished the first of two goals in their bid to reform Medicare’s audit program.

Rep. Marsha Blackburn, R-Tenn., introduced a bill on May 19 that would require prior authorizations for certain high-cost DME, including oxygen. The bill would also exempt DME that has gone through that process from pre- and post-payment audits.

“There are two components to reform: one is prior authorization, and the other is clinical inference,” said John Gallagher, vice president of government relations for The VGM Group.

Stakeholders are also working with Rep. Renee Ellmers, R-N.C., to introduce a bill that would reinstate clinical inference to the audit program. Ellmers, along with Rep. John Barrow, D-Ga., introduced a similar bill last year.

Elements of Blackburn’s bill, H.R. 2437, include aligning the prior authorization process with best practices from commercial managed care and Medicare Advantage plans, which already have such processes in place; providing emergency review for certain items, including oxygen; and ensuring stakeholder input.

“Stakeholder input is huge,” said Jay Witter, senior vice president of public policy at AAHomecare. “When they first developed (the current demonstration project requiring prior authorizations for power mobility devices), it was a nightmare. It turned around when they started working with us. Now our folks love it.”

H.R. 2437 was necessary, stakeholders say, because, although CMS currently has a PMD demo in place in certain states, it expires* in August. Additionally, the agency published a proposed rule in May 2014 outlining its plans to require prior authorizations for 134 DME codes, but it doesn’t plan to take the next step, publishing a final rule, until 2017.

“Hopefully the bill will spur them to do something more quickly,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Relief can’t come fast enough for providers like Thom Harvill, co-owner of Riverside Medical in Savannah, Tenn., who worked with the staffs of Blackburn and Sen. Lamar Alexander, R-Tenn., on the bill for more than a year.

“With Medicare HMOs, all we do is fax everything in to their utilization department and within 24 hours we have a reply, ‘Yes, this patient does meet qualifications; here’s your authorization; it’s good through 2099,’” he said. “The more I thought about it the more I thought, ‘Why can’t CMS do this.’”

If CMS continues to drag its feet, stakeholders say a prior authorization process for a broader spectrum of DME has bi-partisan support in Congress, including from Rep. Kevin Brady, R-Texas, who sits on the Ways and Means Subcommittee on Health, and Sen. Ron Wyden, D-Ore., who sits on the Finance Committee.

“From what we’re gathering, some kind of prior authorization package could be included in the hospital improvement program they’re working on,” Gallagher said.

WASHINGTON – AAHomecare has successfully lobbied the House Energy and Commerce Committee to delay the start date for a provision reducing Medicaid payments to 2020 instead of 2016.

The committee has included the provision, which would limit the federal portion of state Medicaid fee-for-service rates for HME to the Medicare competitive bidding rates, as a “pay-for” in its 21st Century Cures Act.

“AAHomecare will continue to defend against the inclusion of these cuts to Medicaid HME rates in any future iterations of this bill,” the association stated in a bulletin.

The change in the start date reduces the value of the “pay-for” to $2.8 million instead of $2.8 billion.

As part of negotiations, the committee asked AAHomecare for a budget neutral proposal that would improve the HME benefit.

“A nationwide prior authorization process would help address audit problems, and AAHomecare is working to have prior authorization language added to the Cures Act before it reaches the House floor,” the association stated.

Earlier this month, Rep. Marsha Blackburn, R-Tenn., introduced a bill that would require prior authorizations for high-dollar DME. H.R. 2437 would also exempt DME that has gone through this process from pre- and post-payment audits.

The full House is expected to vote on the Cures Act in June. If it makes it through the House, it’s unlikely it will make it through the Senate, according to AAHomecare.

“The Senate’s never going to pass a bill this big,” Rep. Fred Upton, chairman of the committee, told the association.

Upton expects the Senate to pass something broader, according to AAHomecare.

Orbit agrees to $7.5 million settlement

WASHINGTON – Orbit Medical and its partial successor, Rehab Medical, have agreed to pay $7.5 million to settle allegations that it altered and forged physician prescriptions and supporting documentation for power wheelchairs and accessories, the U.S. Department of Justice announced last week.

Orbit Medical says it fully cooperated and offered full transparency during the DOJ’s four-year investigation.

“We are relieved to close this chapter and move forward growing our business,” the company said in a statement to HME News.

A False Claims Act lawsuit alleged that Orbit Medical sales reps changed or added dates to physician prescriptions and chart notes to falsely document that physicians examined beneficiaries within 45 days of the face-to-face exam; changed prescriptions to falsely establish medical necessity; created or altered chart notes and other documents to falsely establish medical necessity; and forged physician signatures on prescriptions and chart notes and added facsimile stamps to supporting documentation.

“The resolution of this case helps to restore funds taken from the Medicare trust fund through the use of falsified records and billings,” said Carlie Christensen, U.S. attorney of the District of Utah.

The lawsuit was filed by former Orbit employees, Dustin Clyde and Tyler Jackson. Under the False Claims Act, a private party can sue for false claims on behalf of the government and share in any recovery. Both employees will receive $1.5 million of the settlement.

Mi-Med Supply expands on West coast

DALLAS – Mi-Med Supply has acquired Spokane, Wash.-based Peaks & Plains, according to Generational Equity, a mergers and acquisition firm that advised Peaks & Plains. Peaks & Plains offers diabetes supplies, compression hosiery, ostomy, urology and wound care products. “As a family company with longstanding roots in the Pacific Northwest, Peaks & Plains Medical was the perfect platform for Mi-Med Supply to expand their retail offering on the West coast," said Andres Ochoa, an affiliate with Generational Equity, in a release. Founded in 1999 and based in Vista, Calif., Mi-Med Supply offers urology, incontinence, ostomy and wound care supplies. The deal closed April 30.

A/R Allegiance adds billing services

OVERLAND PARK, Kan. – A/R Allegiance Group has expanded its services to include medical billing, positioning the company to offer full revenue cycle management. The company’s CollectPlus helps providers recover private pay collections and now ClaimCollect can do the same for insurance reimbursement. A/R Allegiance has packaged its services into a five-step revenue cycle management process to help providers grow and thrive: pre-billing documentation audits, billing all types of payers, collections, ongoing support, comprehensive reporting and additional services like process consulting.

PFQC recruits for cause

WASHINGTON – People for Quality Care is recruiting patients for the COPD Foundation’s new COPD Patient-Powered Research Network. The network’s purpose is to give COPD patients a place to share how the disease has impacted their lives and to support each other. Information from the network, which is stored in a secure database, will be used for research purposes and to better understand the disease. “As someone living with COPD, I consider the COPD PPRN a huge step forward in terms of the level of research that is needed to refine testing and diagnosis, improvements and find a cure,” said John Walsh, president and co-founder of the COPD Foundation in a release. To enroll, click here.

Quantum Rehab launches website

EXETER, Pa. – Quantum Rehab has launched a dedicated website featuring its iLevel power seat elevation technology. The website offers users information on how the technology improves health, safety, functionality and independence, according to a press release. “We realized through the users’ eyes the life-changing characteristics of iLevel, and sought a website and content that conveys the extraordinary impact,” said Megan Kutch, director of marketing at Quantum Rehab. Quantum Rehab released iLevel in February.

Groups host contest

ATLANTA – People with disabilities are being encouraged to “Get Out & Enjoy Life” this summer. The five-year-old event is sponsored by UroMed’s nonprofit program Life After Spinal Cord Injury, At Home Medical’s iPush Foundation, Sports ‘N Spokes Magazine and online community Wheel:Life. All four groups will feature daily listings of accessible vacation spots, outdoor programs and other events. The event kicks off June 1 with a photo contest. Contest details and official rules viewable at: http://pvamag.com/sns/article/6923/2015_goel_rules

Short takes: HOMES, Comfort Medical, BioCorrect, Sizewise

HOMES elected its new board of directors at its recent annual meeting. Gary Sheehan of Cape Medical Supply is chairman, Peter Tallas of Charm Medical Supply is vice chairman, Jason Morin of Home Care Specialists is treasurer and Chris Henry of The Medical Store is secretary…Comfort Medical Supply has opened in Fredericksburg, Va. Owners and RTs Larry Filkowski and Sean Magill told a local newspaper that they opened the upscale retail store because the equipment and supplies recommended by insurance companies don’t meet the needs of their patients…Agility Health’s subsidiary BioCorrect, an orthotics provider, has been accredited by the American Board of Certification of Orthotics, Prosthetics and Pedorthics…Yankee Alliance, a healthcare group purchasing organization, has a contract with Sizewise Worldwide, a global manufacturer, to provide long-term care equipment like therapeutic support surfaces, beds, wheelchairs and other mobility items for its provider members.

WASHINGTON – AAHomecare has successfully lobbied the House Energy and Commerce Committee to delay the start date for a provision reducing Medicaid payments to 2020 instead of 2016.

The committee has included the provision, which would limit the federal portion of state Medicaid fee-for-service rates for HME to the Medicare competitive bidding rates, as a “pay-for” in its 21st Century Cures Act.

“AAHomecare will continue to defend against the inclusion of these cuts to Medicaid HME rates in any future iterations of this bill,” the association stated in a bulletin.

The change in the start date reduces the value of the “pay-for” to $2.8 million instead of $2.8 billion.

As part of negotiations, the committee asked AAHomecare for a budget neutral proposal that would improve the HME benefit.

“A nationwide prior authorization process would help address audit problems, and AAHomecare is working to have prior authorization language added to the Cures Act before it reaches the House floor,” the association stated.

Earlier this month, Rep. Marsha Blackburn, R-Tenn., introduced a bill that would require prior authorizations for high-dollar DME. H.R. 2437 would also exempt DME that has gone through this process from pre- and post-payment audits.

The full House is expected to vote on the Cures Act in June. If it makes it through the House, it’s unlikely it will make it through the Senate, according to AAHomecare.

“The Senate’s never going to pass a bill this big,” Rep. Fred Upton, chairman of the committee, told the association.

Upton expects the Senate to pass something broader, according to AAHomecare.

WASHINGTON – The Senate Finance Committee on Wednesday will mark up a proposed bill to improve the Medicare audit and appeals process.

The bill, the “Audit and Appeal Fairness, Integrity and Reforms in Medicare Act” or AFIRM Act, was co-authored by Sen. Orrin Hatch, R-Utah, chairman of the committee, and Sen. Ron Wyden, D-Ore., ranking member.

“Increased Medicare payment appeals from a range of Medicare providers and suppliers has resulted in a substantial backlog, causing financial and administrative problems that sometimes last years,” Hatch and Wyden stated in a press release. “This legislation is designed to improve the appeals process at HHS while upholding the integrity of the audit process so that providers and beneficiaries are not indefinitely left in limbo.”

Hatch and Wyden said they expect a “constructive mark up” on the bi-partisan bill.

The AFIRM Act seeks to strengthen the current process in the following ways:

·      Improve oversight capabilities for HHS and CMS that increase the integrity of the Medicare auditors and claims appeals process.

·      Coordinate efforts between auditors and CMS to ensure that all parties receive transparent data regarding audit practices, improved methodologies over time, and new incentives/disincentives to improve audit accuracy. CMS would create in independent ombudsman for Medicare reviews and appeals to assist in resolving complaints by appellants and those considering appeal. This ombudsman would further increase the transparency of the appeal process by publishing data regarding the number of determinations appealed, each appeal’s outcomes, and aggregate appeal statistics for each contractor and provider type.

·      Establish a voluntary alternate dispute resolution process to allow for multiple pending claims with similar issues of law or fact to be settled as a unit, rather than as individual appeals.

·      Raise the amount in controversy for review by an ALJ to match the amount for review by district court to ensure timely and high quality reviews. For cases with lower costs, a new Medicare magistrate program would be created to allow senior attorneys with expertise in Medicare law and policies to adjudicate cases in the same way as the ALJs. This would allow more complex cases to retain the full focus of the ALJs.

·      Allow for use of sampling and extrapolation, with the appellant’s consent, to expedite the appeals process.

Industry stakeholders are also working with Rep. Renee Ellmers, R-N.C., to introduce a bill in the House of Representatives that would, among other things, reinstate clinical inference as part of the audit process.

WASHINGTON – The Senate Finance Committee on Wednesday passed a bill to improve the Medicare audit and appeals process.

The bill, the “Audit and Appeal Fairness, Integrity and Reforms in Medicare Act” or AFIRM Act, was co-authored by Sen. Orrin Hatch, R-Utah, chairman of the committee, and Sen. Ron Wyden, D-Ore., ranking member.

“This is a common sense bill that will help untangle the web of red tape that ensnares the current audit and appeals process and guarantee Medicare patients continue to have access to high-quality care,” Hatch stated in a press release. “I look forward to continuing to work with my colleagues on both sides of the aisle to move this bill forward.”

The AFIRM Act seeks to strengthen the current process in the following ways:

·      Improve oversight capabilities for HHS and CMS that increase the integrity of the Medicare auditors and claims appeals process.

·      Coordinate efforts between auditors and CMS to ensure that all parties receive transparent data regarding audit practices, improved methodologies over time, and new incentives/disincentives to improve audit accuracy. CMS would create in independent ombudsman for Medicare reviews and appeals to assist in resolving complaints by appellants and those considering appeal. This ombudsman would further increase the transparency of the appeal process by publishing data regarding the number of determinations appealed, each appeal’s outcomes, and aggregate appeal statistics for each contractor and provider type.

·      Establish a voluntary alternate dispute resolution process to allow for multiple pending claims with similar issues of law or fact to be settled as a unit, rather than as individual appeals.

·      Raise the amount in controversy for review by an ALJ to match the amount for review by district court to ensure timely and high quality reviews. For cases with lower costs, a new Medicare magistrate program would be created to allow senior attorneys with expertise in Medicare law and policies to adjudicate cases in the same way as the ALJs. This would allow more complex cases to retain the full focus of the ALJs.

·      Allow for use of sampling and extrapolation, with the appellant’s consent, to expedite the appeals process.

Industry stakeholders are also working with Rep. Renee Ellmers, R-N.C., to introduce a bill in the House of Representatives that would, among other things, reinstate clinical inference as part of the audit process.

WASHINGTON – It may be broad, but there’s a lot for HME providers to feel good about in the audit bill that cleared the Senate Finance Committee last week, says AAHomecare’s Kim Brummett.

First, there’s what’s not in the bill, namely a fee structure for filing appeals, something that was in the original version, says Brummett, vice president of regulatory affairs.

“The initial conversations on that revolved around deterring those providers who just appeal everything, but obviously we oppose a fee,” she said. “We already feel that we’re in the appeals process to begin with because we feel an error has been made.”

The bill, co-authored by Sens. Orrin Hatch, R-Utah, chairman of the committee, and Ron Wyden, D-Ore., the ranking member, seeks to reform the Medicare audit and appeals process by, among other things, improving CMS’s oversight capabilities of auditors, better coordinating efforts between CMS and auditors to ensure all parties receive transparent data regarding audit practices, establishing a voluntary alternate dispute resolution process, and allowing for the use of sampling and extrapolation to expedite the appeals process.

The devil is in the details for many provisions in the bill, including one to establish a magistrate program within the Office of Medicare Hearings and Appeals for cases with lower costs, $150 to $1,460, Brummett says.

“We do see the value in segmenting out smaller dollar claims,” she said. “When you look at oxygen claims, rendering a decision on that is better than a $100,000 hospital re-admission. But what is the program—an ALJ wannabe? What’s the difference between the two?”

Since the bill is far from final, AAHomecare officials plan to continue working with Kim Brandt, chief healthcare investigative counsel for the minority staff of the committee, to try and further shape the Senate’s efforts. One point they want to hammer home: the ways in which HME providers are different than hospitals and need special concessions.

“A hospital encounter is a one-time hit; for us, it’s the same patient, the same equipment, but different dates of service,” Brummett said. “We’ve had conversations with Kim about how it would be nice to have specific DME language that spoke to related claims and ongoing decisions.”

Next steps for the bill include finalizing the language and submitting it for a score from the Congressional Budget Office.

“It’s high priority, but they haven’t indicated when the legislation will hit the floor,” said Jay Witter, senior vice president of public policy for AAHomecare.