NEW YORK – The lead plaintiff in a class action lawsuit against Invacare has reached a proposed settlement of $11 million in cash, according to a statement from lead counsel Bernstein Litowitz Berger & Grossman.

A hearing for Government of Guam Retirement Fund et al vs. Invacare will be held Nov. 9 before Christopher Boyko in the U.S. District Court, Northern District of Ohio, Eastern Division in Cleveland.

Boyko will determine whether the proposed settlement should be approved as fair, reasonable and adequate; whether the action should be dismissed with prejudice against defendants and the releases specified and described in the stipulation and agreement of settlement should be granted; whether the proposed plan of allocation should be approved as fair and reasonable; and whether the application for an award of attorneys’ fees and reimbursement of litigation expenses to be filed on behalf of lead counsel Bernstein Litowitz Berger & Grossman and local counsel Climaco, Wilcox, Peca, Tarantino & Garofoli should be approved.

The lead plaintiff in the lawsuit alleges that the defendant made false and misleading statements about violations of FDA regulations and current Good Manufacturing Practices.

United Health dominates Medicare Advantage market

NEW YORK – There is little or no competition in the Medicare Advantage market in 97% of U.S. counties, according to a new study from the Commonwealth Fund.

Among the nation’s 2,933 counties, only one—Riverside, Calif.—qualified as a competitive market and only 80 qualified as moderately competitive.

“Allowing private health insurers to play a larger role in Medicare is often suggested as a way to control Medicare costs and improve quality of care,” said Stuart Guterman, senior scholar in residence at AcademyHealth and coauthor of the study, in a press release. “The idea is if there are more insurers, they’ll fight for customers by lowering premiums and improving quality. For that to happen, however, we need to have enough insurers in a given market—and this study shows that, overwhelmingly, that isn’t the case.”

The Commonwealth Fund found that six insurers dominate the markets in the 100 counties with the most Medicare beneficiaries. United Health had the greatest number of Medicare Advantage enrollees in 38 counties, while Blue Cross affiliates had the greatest enrollment in 13 counties and Humana in 12 counties.

While both urban and rural markets lack competition, rural markets are the least competitive, the Commonwealth Fund found.

The Commonwealth Fund is a private foundation that aims to promote a high-performing healthcare system that achieves better access, improved quality and greater efficiency, particularly for society’s most vulnerable, including low-income people, the uninsured, minority Americans, young children and elderly adults.

Cardinal Health bets on post-acute management services

DUBLIN, Ohio – Cardinal Health will acquire a majority stake in naviHealth, a Nashville, Tenn.-based company that partners with health plans, health systems and providers to manage post-acute care. “The acquisition of naviHealth aligns with Cardinal Health’s strategic priority of offering the most complete and integrated suite of services to meet the needs of our integrated delivery network, hospitals and other customers,” stated Michael Petras, president of Cardinal Health at Home, in a press release. naviHealth services nearly 2 million health plan members and more than 75 partner hospitals and physician groups. Its executive management team will continue to lead the business. Its principal investor, Welsh, Carson, Anderson & Stowe, along with management, will continue to have an ownership interest. Cardinal Health’s distribution channel and suite of clinical products and services will accelerate naviHealth’s growth and expand its value proposition, according to the release.

Inogen ditches accounting firm in wake of investigation

GOLETA, Calif. – The board of directors at Inogen has dismissed BDO USA as the independent registered public accounting firm auditing the company’s financial statements, according to a recent Form 8-K filed with the Securities and Exchange Commission. In its place, Inogen has engaged Deloitte & Touche. The change follows an investigation into an accounting issue that delayed the company’s earnings for the fourth quarter last year. In the form, Inogen says “there were no disagreements with BDO on any matter of accounting principles or practices, financial statement disclosure or auditing scope or procedure.” The company says the accounting issue was due to a “lack of adequate controls that resulted in the improper use of technology to simulate medical documentation in 2014 and the first quarter of 2015.”

VGM takes bid show on road

WATERLOO, Iowa – The VGM Group will take to the road again with its Fall Seminar Series on competitive bidding. The fall/early winter series will be held in a dozen metropolitan regions encompassing the nine Round 1 2017 bid areas. Topics will include the 2016 roll-out of regional competitive bid reimbursement for all non-bid areas in the country, operational efficiency improvements, and generating alternative/additional revenue sources. Registration for Round 1 2017 opened Aug. 25.

PE firm recapitalizes US MED

MIAMI – An affiliate of H.I.G. Capital, a global private equity firm, has recapitalized United States Medical Supply, a mail-order medical supply business. H.I.G. will support US MED’s strategic growth plan, particularly by “aggressively purchasing value-enhancing add-on acquisitions,” said Camilo Horvilleur, managing director of H.I.G. Capital, in a press release. US MED provides medical supplies to patients suffering from chronic conditions, including diabetes, sleep/respiratory disorders and urological conditions, who need supplies daily.

MIT reports first profitable quarter

FREDERICKSBURG, Va. – MIT Holding, which has subsidiaries in home infusion and HME services, reported its first profitable quarter for the second quarter of 2015. The company implemented a turnaround plan last year and is now looking to grow, according to a press release. “In addition to organic growth goals of 20-25% per year on existing business, we expect acquisitions and the opening of new facilities in untapped geographic locations throughout the United States,” said Tom Duncan, president.

MSD acquires patient app

STOUGHTON, Mass. – Medical Specialties Distributors has acquired Verbal Applications, also known as VerbalCare, a developer of apps that allow patients to communicate better. “The strategic combination of MSD and VerbalCare enhances the ‘Total Enterprise Solution’ we provide our customers, which includes other technology products designed to help our customers improve efficiency and patient outcomes,” said Jim Beck, CEO of MSD, in a press release. Verbal Applications will operate as a wholly owned subsidiary of MSD. MSD offers home infusion equipment and other supplies.

Convaid goes back to school

TORRENCE, Calif. – Convaid is offering customers free wheelchair safety checks at their local dealers today. "This is a great opportunity for Convaid users to circle back to their dealers to make sure their Convaid is in top working order and still fits optimally to make sure each child is best outfitted for mobility at the onset of the school year," said CEO Chris Braun in a release. To that end, the wheelchair manufacturer is also offering seat extensions for children who may have grown over the summer.

Itamar gets injection of capital

FRAMINGHAM, Mass. – Viola Private Equity has committed to invest up to $28.4 million in Itamar Medical, the manufacturer of the WatchPAT home sleep test. “An investment of $30 million will enhance the execution of Itamar Medical's growth strategy and the leveraging of the many financial opportunities we are identifying in the market,” said Gilad Glick, CEO of Itamar Medical, in a release. Viola Private Equity, an Israeli-based technology growth capital and buyout fund, will become the largest shareholder of Itamar, according to terms of the deal. Jonathan Kolber and Sami Totah, both general partners at Viola Private Equity, will join Itamar Medical's board of directors.

Medtrade seeks retail innovation

ATLANTA – Medtrade is calling for submissions to its Innovative Retail Product Awards. The top eight products will be presented in a Medtrade session during the show in October. Similar to Medtrade Spring, Medtrade attendees and judges will then select the top three. “All of these efforts seek to combine ‘retail’ with ‘care,’ so we and friends of Medtrade came up with term ‘caretailing,’” says Kevin Gaffney, group show director, Medtrade. Entries are due Oct. 2. View rules, entry form and contract here.

Short takes: Salida, RESNA, BioScrip

Salida, Colo.-based Salida Medical & Respiratory has been accredited and certified as a Medicare provider by Community Health Accreditation Partner or CHAP…RESNA seeks volunteer subject matter experts to write new questions for its ATP certification exam. Experts from all areas of assistive technology are encouraged to apply. You do not need to be ATP certified…Investment firm Coliseum Capital Management has purchased 632,907 shares of Elmsford, N.Y.-based BioScrip for a total of $1.1 million.

People: Feenan, Garrish

SCA has named Michael Feenan vice president of its Personal Care Business in North America. In this role, he oversees all sales and marketing activities for the division and reports to SCA Americas President Don Lewis. Feenan most recently worked as a vice president for xpedx…SleepSafe Drivers has named Steven Garrish senior vice president, business development and new ventures. Garrish most recently held a position as senior director of fleet safety at Walmart, where he implemented a SleepSafe Drivers sleep apnea program.

WASHINGTON – For redeterminations and reconsiderations of claims denied following a post-payment review or audit, CMS has instructed the MACs and QICs to limit their scope to the reason the claim or line item was initially denied, according to a recent MLN Matters article.

In the past, the MACs and QICs have had the discretion to develop new issues and review all aspects of coverage and payment related to a claim or line item.

“In some cases, where the original denial reason is cured, this expanded review of additional evidence or issues results in an unfavorable appeal decision for a different reason,” CMS states in MLN Matters Number: SE1521.

The guideline applies to redeterminations and reconsiderations received by the MACs or QICs on or after Aug. 1, 2015. It will not be applied retroactively.

CMS points out, however, that there are two instances where the guideline does not apply: 1.) claims denied in prepayment reviews (the guideline applies only to post-payment denials); and 2.) claims denied in post-payment review for insufficient documentation and appealed with never-before presented documents (the guideline allows these claims to be denied for an issue other than the issue that was initially denied).

BALTIMORE – CMS has announced plans to test a Value-Based Insurance Design Model to improve care and reduce costs in Medicare Advantage plans.

The model will test whether giving MA plans flexibility to offer supplemental benefits or reduced cost sharing to enrollees with specific chronic conditions can lead to higher quality and more cost-efficient care. It will focus on enrollees with chronic conditions like diabetes, congestive heart failure, COPD, past stroke and hypertension.

“The Medicare Advantage Value-Based Insurance Design Model fills an immediate need for testing ways to improve care and reduce cost in Medicare Advantage Plans and offers the prospect of lower out-of-pocket costs and premiums along with better benefits for enrollees in Medicare Advantage,” said Patrick Conway, M.D., MSc, CMS deputy administrator and chief medical officer.

The model will begin Jan. 1, 2017, and run for five years in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee.

VBID models are increasingly used in the commercial insurance market and evidence points to the model as an effective tool, CMS says.

YARMOUTH, Maine – HME providers, especially those in rural areas, are making tough business decisions in preparation for Medicare’s national rollout of competitive bidding pricing on Jan. 1.

A number of providers in these areas say they’re limiting the number of brands they carry for each product category and giving preference to less costly products.

“It eliminates patient choice and forces us, as a company, to put out a brand that’s perhaps not as good,” said Amy Schmidt, a partner at Midwest Medical in Watertown, S.D., which stands to lose an estimated $25,000 per month as a result of reduced reimbursement.

CMS has yet to release the official zip codes for rural areas, and the final ceiling and floor rates that will be used to determine pricing in those areas.

For an idea of what providers are grappling with, however, during a recent webcast, Andrea Stark, a reimbursement consultant with MiraVista, used Bartlesville, Okla., as an example and calculated that, once fully phased in, the new pricing for oxygen concentrators would be $86.36 per month, a 47% reduction, if the town is considered a standard MSA, and $77.94, a 43% reduction, if it’s considered a rural area.

“It’s not pretty,” said Cindy Coy, manager of reimbursement for Avera Home Medical, which has 15 locations, including in North and South Dakota, and relies on Medicare for about 46% of its business.

A number of providers also say they’ll be looking to beneficiaries to take a more active role in their health care—paying out of pocket if they demand certain brands, and picking up their products and supplies, instead of receiving them in their home.

“We’re definitely looking to reduce our windshield time,” said John Novak, president of Total Respiratory & Rehab, which has a location in Lincoln, Neb., and which stands to lose about $10,00 per month as a result of reduced reimbursement (It would be more, but complex rehab, which is exempt from competitive bidding, makes up a good chunk of the company’s business, he says).

Providers say they’re also looking internally, to what they can do to make the most of what reimbursement they get.

“Our company is really looking at Lean concepts to figure out how we can do things more efficiently,” Coy said. “How can we eliminate the waste but keep patients at the forefront?”

WASHINGTON – For redeterminations and reconsiderations of claims denied following a post-payment review or audit, CMS has instructed the MACs and QICs to limit their scope to the reason the claim or line item was initially denied, according to a recent MLN Matters article.

In the past, the MACs and QICs have had the discretion to develop new issues and review all aspects of coverage and payment related to a claim or line item.

“In some cases, where the original denial reason is cured, this expanded review of additional evidence or issues results in an unfavorable appeal decision for a different reason,” CMS states in MLN Matters Number: SE1521.

The guideline applies to redeterminations and reconsiderations received by the MACs or QICs on or after Aug. 1, 2015. It will not be applied retroactively.

CMS points out, however, that there are two instances where the guideline does not apply: 1.) claims denied in prepayment reviews (the guideline applies only to post-payment denials); and 2.) claims denied in post-payment review for insufficient documentation and appealed with never-before presented documents (the guideline allows these claims to be denied for an issue other than the issue that was initially denied).

Researchers, former senator join fight

WASHINGTON – Nine leading U.S. researchers and a former U.S. senator have put pen to paper in the fight against proposed changes to coverage for lower limb prostheses. The work of the researchers was used by Medicare to back up its decision to make the changes. “We would like to go on record as stating that the works referenced do not support any of the changes outlined in the proposal,” they wrote in a letter to the U.S. Health and Human Services Department. “We are extremely concerned that the draft rule was not based at all on the current literature and science associated with the provision of prosthetic care.” The researchers go on to say: “We strongly oppose the draft.” The researchers include Steven Gard, Ph.D., executive director of Northwestern University Prosthetics-Orthotics Center; and Jason Highsmith, associate professor at the School of Physical Therapy & Rehabilitation Sciences at Morsani College of Medicine at the University of South Florida, and president of the American Academy of Orthotists and Prosthetists. Former Sen. Bob Kerrey, D-Neb., an amputee, wrote in a blog posted to The Hill’s website, that the draft rule should be thrown out. “Instead, Medicare should undertake a real discussion with stakeholder groups to resolve any concerns it may have about the status quo,” he wrote. “Otherwise, this really is a case of the government creating a problem rather than solving it.” Kerrey, who served in the Senate from 1998-2001, was governor of Nebraska from 1983 to 1987. He served as a Navy Seal in the Vietnam War and received the Medal of Honor.

CMS targets Medicare Advantage for alternative model

BALTIMORE – CMS has announced plans to test a Value-Based Insurance Design Model to improve care and reduce costs in Medicare Advantage plans.

The model will test whether giving MA plans flexibility to offer supplemental benefits or reduced cost sharing to enrollees with specific chronic conditions can lead to higher quality and more cost-efficient care. It will focus on enrollees with chronic conditions like diabetes, congestive heart failure, COPD, past stroke and hypertension.

“The Medicare Advantage Value-Based Insurance Design Model fills an immediate need for testing ways to improve care and reduce cost in Medicare Advantage Plans and offers the prospect of lower out-of-pocket costs and premiums along with better benefits for enrollees in Medicare Advantage,” said Patrick Conway, M.D., MSc, CMS deputy administrator and chief medical officer.

The model will begin Jan. 1, 2017, and run for five years in Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee.

VBID models are increasingly used in the commercial insurance market and evidence points to the model as an effective tool, CMS says.

Stealth prioritizes ALS orders

BURNET, Texas - Stealth Products, a division of Quantum Rehab, will begin offering expedited handling and shipping for all ALS orders, the manufacturer announced today. “At Stealth we understand the struggles facing patients fighting ALS and the rapid pace at which this terrible disease can progress,” said Lorenzo Romero, president, in a press release. “Because of this, Stealth wants to take this step to help get ALS patients the medical devices they need quickly to help make their lives as comfortable and manageable as possible.” Depending on the complexity of the order, the company is committed to completing ALS orders within 48 hours and custom orders within three to five days. It will also expedite shipping to arrive within two business days.

‘Get Out’ winners announced

ATLANTA – Erik Kondo won top honors in the 2015 Get Out, Enjoy Life contest for his side-wheelie photo taken during an off-road handcycling event in Vermont. His submission beat out more than 500. The photo will be featured on this month’s cover of Sports ‘N Spokes. Kondo sustained a spinal chord injury from a motorcycle accident in 1984. Amanda Timms took second place for her photo taken during a seven-day canoe trip around the Bowron Lakes in Canada; and Kim Harrison placed third for her photo entitled, ‘Target Practice.’ Sponsored by UroMed’s nonprofit program Life After Spinal Cord Injury, At Home Medical’s iPush Foundation, Sports ‘N Spokes Magazine and Wheel:Life, the five-year-old contest asks wheelchair users to submit photos of their favorite wheelchair accessible hot spots, wheelchair sporting events or recreational activities.

Sigvaris rallies behind ‘Lymphedema Act’

PEACHTREE CITY, Ga. – Sigvaris recently sponsored a group of advocates, including Robyn Bjork, a wound care and lymphedema specialist, to educate Rep. Jim Cooper, D-Tenn., about the condition and The Lymphedema Treatment Act. “We are proud to support patient needs in regards to better treatment and diagnosis for people with lymphedema and other leg diseases,” said Scot Dubé, president and CEO for North America, in a release. “We believe that regular use of compression and early intervention can improve lives and reduce related long-term health care costs.” The group shared personal stories about living with lymphedema and explained how compression garments could prevent infection and hospitalization.If passed,the act would amend Medicare statute to allow for coverage of compression supplies, improving coverage for the treatment of lymphedema from any cause.

Ascendant makes fifth pharmacy buy

DALLAS – Ascendant Solutions, an investment firm, and its healthcare subsidiary, Dougherty’s Holdings, has acquired Springtown Drug in Springtown, Texas, it announced Aug. 31. The acquisition is expected to add $4 million to Ascendant’s annual revenues and boost sales for Dougherty’s to more than $43 million in 2015, according to a press release. It’s the fifth such buy for Ascendant. In July, it bought The Medicine Shoppe pharmacy in McAlester, Okla.

Brightree, ResMed announce further integration

ATLANTA – Brightree and ResMed have enhanced the integration capabilities of Brightree’s HME billing and management software with ResMed’s U-Sleep compliance solution. “As the healthcare industry transitions from a fee-for-service to an outcomes-based reimbursement model, providers are constantly seeking to improve patient outcomes and increase operational efficiencies,” said Dave Cormack, president and CEO of Brightree. The two companies began working together in 2013 to automate the onboarding of patients that use ResMed S9 PAP devices into U-Sleep and have announced several enhancements since that time, including the integrations of ResMed’s AirView patient management systems into Brightree’s systems in February.

Aeroflow fundraises for hospital

ASHVILLE, N.C. – Aeroflow Healthcare has raised more than $6,100 for Mission Foundation in support Mission Children’s Hospital. The foundation helps to ensure children receive care, regardless of ability to pay. Aeroflow has created outlets, including “Blue Jean Friday,” for employees to become involved in its fundraising efforts. “Patient care has always been Aeroflow’s No. 1 priority,” said Casey Hite, CEO. “We want to ensure that the people of Western North Carolina and beyond are receiving the care they need. By supporting Mission Children’s Hospital, we can help make sure more patients receive the care and treatment they need to be healthy.” Aeroflow recently earned a first-time spot on the Inc. 5000 list of fastest growing companies.

COPD patients benefit from app, same-day treatment

PHILADELPHIA – Early intervention facilitated by a digital health application provides key benefits for COPD patients, according to the results of a two-year clinical study by Temple University. COPD patients who used an app to report their daily symptoms and received same-day treatment recommendations from their healthcare provider experienced fewer and less severe exacerbation symptoms, leading to an improvement in daily symptom control, lung function and activity status. “Previous studies at other sites have questioned the efficacy of various telemedicine solutions in COPD patients, but those studies have not used a solution that enables same-day treatment in response to worsening patient symptoms,” said Dr. Gerard Criner, founding chairman of the new Department of Thoracic Medicine and Surgery at Temple University School of Medicine, director of the Temple Lung Center and the principal investigator of the study. The app allows COPD patients to report their respiratory symptoms and peak expiratory flow measurements, which are then assessed by a computer algorithm and compared with initial values to achieve a symptom deviation score—a measure of how serious the symptoms are relative to the baseline metrics. Scores in excess of a predetermined threshold are reviewed by a nurse and referred to a physician to prescribe treatment. The technology used in the study is a precursor to a solution currently offered by Temple University spin-off company HE Health Care Solutions.

Performance Health is on TRAC

AKRON, Ohio – Performance Health held its 17th annual Scientific Advisory Committee meeting, known as TRAC, in Vancouver, Canada, recently. Seventeen researchers and clinicians with expertise in physical therapy, chiropractic, exercise science, athletic training and massage therapy presented their research on Performance Health products. This year’s research focused on TheraBand CLX Consecutive Loops—its force characteristics, the biomechanical analysis of associated exercises; its integration with deep tissue massage and its ability to strengthen outcomes—and TheraBand Kinesiology Tape with XactStretch technology—skin blood flow following its application, its adhesive properties and its effectiveness.

YARMOUTH, Maine – The transition to ICD-10 kicks off Oct. 1, but many HME providers are behind the eight ball, say consultants.

“I think some of the more sophisticated companies are in tune with the transition,” said Sarah Hanna, president of ECS Billing & Consulting North. “I think those who have been led to believe that it’s an easy one-to-one translation are missing out.”

ICD-10 features expanded alphanumeric code sets, as well as an expanded number of codes—68,000 vs. 13,000 under ICD-9—aimed at capturing more information to ensure better patient care.

The scope of the changes, by themselves, could be daunting for providers, say consultants.

“They have to tackle all of the rentals, and getting the diagnoses linked to future CMNs and setting up those connections on all of the orders,” said Andrea Stark, a reimbursement consultant with MiraVista. “Then there’s the research involved with the one-to-many diagnoses or ‘mappings.’ It is going to be a challenge.”

The challenges are likely to disrupt cash flow, even for proactive providers, say consultants. That’s because the switch impacts everyone from providers to physicians to insurers.

“It’s not all in their control,” said Kelly Wolfe, CEO of Regency Billing and Consulting. “There are physicians offices we know of that are going to drag their feet on this.”

Fortunately, there’s a one-year grace period—until Oct. 1, 2016—in which physicians and other practitioners under Medicare Part B won’t be denied for not having the exact diagnosis code.

“That will bleed over onto us,” said Hanna. “As long as they use a valid code from the right code family, they can’t be denied solely on the specific ICD-10 code.”

SAN DIEGO – ResMed’s patient compliance software program, U-Sleep, is now connected to LabRetriever’s sleep lab electronic medical records platform. The new partnership means compliance data measured by U-Sleep will automatically flow into the LabRetriever EMR, streamlining processes and boosting efficiencies for sleep lab and HME partners, according to a press release. “The integrated approach we’ve taken with ResMed will reduce data entry, eliminate the task of adding patients into multiple systems, and enable sharing of patient therapy reporting across multiple platforms,” said Cheryl Hanner, vice president of LabRetriever, in the release. DME Data Solutions and Computers Unlimited have also become ResMed Data Exchange integration partners. ResMed launched the exchange in 2014 to integrate valuable data from ResMed patient management platforms with third-party electronic health and medical records, billing, and/or care management applications.

AHIA to launch home-mods app

WATERLOO, Iowa – Accessible Home Improvement of America will launch a new app called Live at Home on Oct. 26 at Medtrade. The app will enable home modification experts to do more work right in the client’s home, including designing on site; taking photos and inserting recommendations; and generating email proposals, according to a press release from The VGM Group. “This is a solution for members in the field looking for an easy-to-use, streamlined assessment and sales tool that is capable of creating professional proposals with HPPAA-compliant security,” said Jerry Keiderling, president of AHIA, a division of VGM Group, Inc. The app is available for the iPhone and iPad.

NCPA rejects ‘merger mania’

WASHINGTON - The National Community Pharmacists Association (NCPA) supports today’s hearing examining the consolidation in the healthcare marketplace, conducted by the House of Representatives Subcommittee on Regulatory Reform, Commercial and Antitrust Law. Of particular concern: the proposed Anthem-Cigna and Aetna-Humana mergers. “Policymakers cannot allow the ‘merger mania’ gripping the nation to proceed in a way that harms patients and the community pharmacists who serve them,” said Douglas Hoey, CEO of the NCPA, in a release. “NCPA urges Congress and regulators to be wary of claims by the merging parties that consolidation will necessarily increase efficiencies and drive costs down.” 

Permobil, AT&T unveil ‘connected wheelchair’

LAS VEGAS – Permobil and AT&T have developed wireless technology to increase independence and freedom for wheelchair users. The new technology allows users to monitor their chairs for seating and position and cushion pressure; battery level and predictive maintenance needs; and GPS location and fleet management. The data can be remotely accessed from the cloud and shared with caregivers, fleet technicians and clinicians. The two companies will unveil the new technology at tomorrow’s CTIA Super Mobility 2015 in Las Vegas.

Brightree to host educational, networking event

ATLANTA – Brightree will host “Brightree Summit – Tools of the Trade” in conjunction with Medtrade on Oct. 26. Attendees will learn best practices for increasing ROI and maximizing productivity; have the opportunity to meet with Brightree consultants; and take part in training sessions on inventory, pricing and sales orders. “As our industry continues to face increasing regulatory and reduced reimbursement pressures, providers continually look to improve their operational efficiencies,” said Dave Cormack, president and CEO of Brightree, in a release. AAHomecare’s Tom Ryan will also be on hand to discuss legislative efforts during an evening cocktail reception. To register, click here.

Short takes: Permobil, Medtrade, BioScrip

For the fifth year in a row, Permobil hosted a golf tournament on Sept. 10 to raise money for Muscular Dystrophy. “While we play golf for such a worthy cause, we also pay homage to those who cannot,” said Larry Jackson, president of Permobil, North America, in a release. U.S. Rehab, VGM, Numotion and National Seating & Mobility sponsored the event…Carter Pate, a member of BioScrip's board of directors, has become an NACD Board Leadership Fellow. The distinction is the highest level of credentialing for corporate directors and corporate governance professionals offered by The National Association of Corporate Directors. 

WASHINGTON – It’s game time for the HME industry, with stakeholders expecting a bill to “fix” the nationwide expansion of bid pricing to drop in the next few weeks.

“We’ve got a very small window,” said Tom Ryan, president and CEO of AAHomecare. “Our providers across rural America have been very vocal this summer. (They don’t want to) wake up to see an overnight decrease of 45%.”

The bill, drafted by Rep. Tom Price, R-Ga., would provide a 30% increase in reimbursement over the bidding-derived prices and a four-year phase-in period, and reinstate the bid cap at the unadjusted fee schedule. It has been sitting in the Congressional Budget Office waiting for a score.

Stakeholders are counting on the momentum created during the August legislative recess—when providers across the country met with lawmakers in their home districts—to push the bill across the finish line.

“I’ve made a lot of Hill visits in the past two weeks and I was amazed at how many offices said they had been contacted by not just providers but also beneficiaries about the rollout,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Simultaneously, stakeholders are building support for a bill that would prevent CMS from applying bid pricing to accessories for complex power wheelchairs. Introduced July 27 by Rep. Lee Zeldin, R-N.Y., H.R. 3229 has eight cosponsors so far.

“Clearly we’ve got a long way to go,” said Seth Johnson, vice president of government relations for Pride Mobility. “It’s incumbent upon those who had meetings in August to follow up with members to let them know they really need to co-sponsor that legislation.”

One issue that remains a source of frustration: the reintroduction of an audit reform bill, something stakeholders had hoped to see last spring. Rep. Renee Ellmers, R-N.C., has been negotiating with the House Ways and Means Committee to include a provision to reinstate clinical inference.

“It’s getting to the point where we are putting some pressure on to get this thing dropped,” said Ryan. “We need this audit relief.”

AAHomecare in August released an analysis that found wait times for an appeal at the administrative law judge level has increased 25% during the first half of 2015 and projects a backlog of 3 million appeals by the end of 2016 if the trend continues.

“We believe if there was clinical inference, then you wouldn’t have that backlog,” said Ryan. “It should never have gotten to this level.”

YARMOUTH, Maine - About half of the respondents to a recent HME NewsPoll (55%) say they’re ready for the transition to ICD-10 on Oct. 1. The bigger question: Are physicians and payers?

A whopping 70% of respondents say they expect some disruption in cash flow as physicians and payers navigate the new code set.

“(The transition) won’t disrupt cash flow through our fault, but who knows what will happen at the insurance companies,” said Janet Tersoff, billing supervisor at New Hampshire Pharmacy in Washington D.C. “I am concerned about some Medicaid HMOs, which already have problems paying at the right rate and recognizing the right modifiers.”

ICD-10 has 68,000 codes compared to 13,000 under ICD-9, as well as expanded alphanumeric code sets to identify disease etiology, anatomic site and severity.

Respondents like Stanley Saellam say physicians have been dragging their feet on ICD-10 implementation, operating under the assumption that time is on their side.

“They all say they don’t have to worry about it until Oct. 1, so they aren’t helping,” said Saellam, director of WellSpan Medical Equipment in Ephrata, Penn.

In a proactive move, respondent Dionne Franklin has been educating physicians on ICD-10 and asking them to use the new codes.

“I began issuing letters to the physicians for conversion of ICD-9 codes to ICD-10 codes about two months ago for capped-rental items and patients that we have seen in the last six months,” said Franklin, who works at Mobility & More in Loveland, Colo. “Also, I have had the physicians, nurse practitioners and physician assistants put both ICD-9 and ICD-10 codes on all prescriptions for the last two months.”

NASHVILLE, Tenn. – Post-acute care, including HME, is the Wild Wild West of health care, and that’s a good thing, several speakers said last week at the 11th annual HME News Business Summit.

In response to government pressure, hospitals are flooding their systems with data (think zettabytes) and changing their delivery models (think value vs. fee for service), but where and how they plug in post-acute care, while an increasing priority, is still very much to be determined.

“It’s a big opportunity,” said Fletcher Lance, managing director and national healthcare lead for the North Highland Company, who kicked off the Summit on Sept. 14 at the Nashville Marriott on the Vanderbilt University campus.

Lance offered up as an example of the opportunity a recent move by Cardinal Health, which distributes pharmaceuticals and medical products to hospitals, to spend $290 million to buy 71% of naviHealth, a three-year-old company that manages post-acute care services for those hospitals.

As HME providers jockey for position in this changing marketplace, they’ll want to keep a hyper-local focus, speakers said. Why? All hospitals may be focused on disease management, for example, but they’re probably doing it in different ways, they said.

“If you’ve seen one hospital, you’ve seen one hospital,” said Jim Hollingshead, president of ResMed Americas, during a panel on the HME provider’s role in connected health. “You need to talk to your actual customer (the hospital), because there’s so much variability.”

When they have these conversations with hospitals, providers will also want to walk the talk, speakers said.

“Use the language the referral source is looking for,” said Robin Randolph, marketing manager for North America for Fisher & Paykel, who also spoke on connected health.

While the short-term focus of hospitals may be on collecting data and changing delivery models, providers shouldn’t lose sight of the reason behind all the activity: improving care and reducing cost.

“The $100 million question is, what are you doing about it?” said Dave Gilbert, CEO of Evermind, a technology that tracks the use of home electrical appliances and powered medical equipment.

If there was an attendee in the room that was unconvinced of the need for providers to change what they do, how they do it and how they market it, Lance had this to say about the shift toward value-based care.

“The tipping point is getting closer and closer,” he said. “This is for real.”

DUBLIN, Ohio – Cardinal Health now offers certain products direct to the consumer through a new “Hospital Quality at Home” brand.

The brand offers products in advanced wound care, first aid, personal care and home healthcare.

“We remain committed to keeping the quality of patient care at the forefront, which is why Hospital Quality at Home products are a natural next step for our business,” said Heather O’Sullivan, vice president of clinical operations for Cardinal Health. “We understand that providing access to the same quality products used in hospitals can positively impact many lives.”

Select “Hospital Quality at Home” products are available nationwide on amazon.com. Products are also available at select Meijer Pharmacy and Bartell Drugs locations in the Midwest and Washington state.

Cardinal Health is a $103 billion-company that distributes products to pharmacies, hospitals, ambulatory surgery centers, clinical laboratories and physician offices.

In another outside-the-box move, it recently acquired a majority stake in naviHealth, a Nashville, Tenn.-based company that partners with health plans, health system and providers to manage post-acute care.

EZ-Access makes buy

ALGONA, Wash. – EZ-Access took a step toward expansion this week, acquiring Worldwide Mobility, it announced Sept. 14.

The move will allow EZ-Access, which manufactures accessibility products, including portable wheelchair ramps and wheelchair lifts, to add a line of external power vehicle lifts to its offerings, according to a release. The Mesa, Ariz.-based Worldwide Mobility has made scooter and power wheelchair lifts for more than 25 years.

“With the introduction of the Passport Vertical Platform Lift in 2014 and now the addition of external power vehicle lifts, we remain committed to offering our customers a complete line of products for all access solutions,” said Don Everard, EZ-Access CEO. “We are grateful for the years of loyalty dealers have shown us and believe that we can continue to build on our commitment as we expand our product offerings to help create opportunity for them.”

EZ-Access will move Worldwide Mobility’s manufacturing to its Algona, Wash., headquarters, and anticipates hiring additional employees and adding production space, according to the release.

CMS makes face-to-face changes official

WASHINGTON – CMS has updated its website to reflect a new law that allows a nurse practitioner, physician assistant or clinical nurse specialist to document a written order for DME following a face-to-face encounter. Originally, they could conduct the face-to-face encounter, but they needed a sign-off from a physician. CMS also stated on its website: “CMS will not start actively enforcing or expect full compliance with the DME face-to-face requirement until further notice.” The delay in enforcement applies to DME MAC, RAC, ZPIC and PSC reviews, but does not apply to CERT audits. The agency implemented the face-to-face rule on July 1, 2013, but hasn’t started enforcing it yet. CMS began enforcing a rule requiring detailed written orders on Jan. 1, 2014.

Dickinson Home Medical expands service

IRON MOUNTAIN, Mich. – Dickinson Home Medical Equipment is opening a second location in Bark River, Mich. The expansion, which was approved by Dickinson County Healthcare System's board of trustees, was prompted by requests from Delta County-based physicians to service their patients, according to a release. “We are pleased to accept the invitation to bring our home medical supply service to Delta County," said Randy Holmes, manager of Dickinson Home Medical, in the release. The expansion is expected to be completed by the end of October.

COPD trial uses mobile health to provide rehab at home

MINNEAPOLIS – The Minnesota HealthSolutions Corporation has tapped Novum, a consumer health engagement platform, as a partner on a mobile health clinical trial program designed to motivate and monitor people with COPD. Many of the millions of people affected with COPD are not able to participate in pulmonary rehab in a clinical setting and the program, delivered through the Novu platform, will enable them to complete home exercise more easily, according to a press release. “We believe that digital consumer tools can enable traditional protocols to work more efficiently in reaching patients, reducing hospital admissions and creating better outcomes,” said Ali Shirvani-Mahdavi, executive vice president of strategy and programs at Novu. In its next phase, the program will be evaluated in a controlled human study at the Mayo Clinic. Novu recently raised $20 million in funding from SSM Partners and Noro-Moseley Partners.

VGM nabs top spot for workplaces

WATERLOO, Iowa – The VGM Group has been named the No. 1 large workplace in Iowa by the Des Moines Register. The ranking is based on scientific surveys of employees conducted by Workplace Dynamics. This is the third time VGM has placed in the top three workplaces. “We want to have the best and brightest to provide great value and service to our thousands of customers,” said CFO Mike Mallaro. “Being recognized as the Top Workplace in Iowa is an affirmation of what we are doing for employees and customers.” VGM has 850 employees and more than 25,000 business customers, according to a release.

Invacare sponsors sports clinic

ELYRIA, Ohio – Invacare is sponsoring the National Veterans Summer Sports Clinic, Sept. 13-18 in San Diego. The clinic offers adventure sports and recreational activities, such as sailing, surfing, track and field events, kayaking and cycling (hand and tandem), to those who were recently injured. “The clinic helps participants improve their quality of life and realize that a disability doesn’t mean they can’t live life to the fullest,” said Dean Childers, senior vice president, Invacare. The company is a frequent supporter of events, including the National Veterans Golden Age Games in August.

Short takes

MiraVista, a consulting and outsourced billing company for DME providers, has redesigned its website to make its industry updates, and education events and tools front and center. The new site is also mobile friendly…PMDRX recently demoed its mobility exam and documentation technology to the office of U.S. Rep. Trent Franks, R-Ariz. With help from Franks’ office, PMDRX has completed an application for a $250,000 Arizona Innovation Challenge grant that would allow it to launch an aggressive marketing campaign to broaden its outreach to prescribing practitioners and mobility suppliers…Medtradewill have a dedicated area for showcasing point-of-purchase displays. “Ideas in Caretail: Point-of-Purchase and Small Spaces” will be offered in cooperation with The VGM Group and KC Fixtures. Medtrade will take place Oct. 26-29 at the Georgia World Congress Center in Atlanta…Noridian Healthcare Solutions has been re-awarded a contract for Jurisdiction D. It has administered the contract since 2006, processing claims for 17 states in the Midwest and West, plus American Samoa, Guam and the Northern Mariana Islands.

People news

Sandwich, Mass.-based Cape Medical Supply has promoted Michael Sheehan to COO. Sheehan has been the company’s executive vice president of purchasing and inventory since joining the company in 2007. In his new role, Sheehan will oversee much of the day-to-day operations of Cape Medical Supply. Sheehan’s brother, Gary Sheehan, is the company’s CEO. Cape Medical Supply was founded and has been run by the Sheehan family for almost 40 years…Jim Papac has rejoined Wohlen, Switzerland-based LEVO AG as president of Minneapolis-based LEVO USA. He introduced the company’s standing wheelchairs to the U.S. and Canadian markets in 1996. Most recently, Papac was the national standing products sales manager for Permobil…National Seating & Mobility has named Ann Mahaffey its new vice president of human resources.Mahaffey is tasked with developing human capital strategies, talent acquisition, performance management, organizational structure, total rewards programs and building a high performance culture…AAHomecare has hired Megan Friedlander as communications associate. Friedlander will work closely with AAH staff to keep members up to date on the latest news and initiatives from Washington, D.C.

WASHINGTON – There won’t be a cat-and-mouse game with premiums for Medicare Advantage plans this year.

CMS announced this week that premiums will decrease by about $0.31 next year, from $32.91 on average in 2015 to $32.60 on average in 2016. The agency says the majority of enrollees, 59%, will face no increase in premiums.

“Seniors and people with disabilities continue to experience stable premiums in Medicare health and drug plans,” said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. “Medicare Advantage and prescription drug plans remain affordable and provide high quality care.”

In past years, CMS has announced slight increases in the premiums for Medicare Advantage plans, only to reverse the increases.

CMS also announced that access to Medicare Advantage plans will remain strong, with 99% of beneficiaries having access to plans.

Additionally, CMS announced that in 2016, more plans will offer supplemental benefits for enrollees, such as dental, vision and hearing benefits.

Between 2010, when the Affordable Care Act was enacted, and 2016, premiums for Medicare Advantage plans are expected to decrease by nearly 10% and enrollment in those plans are projected to increase more than 50% to about 17.4 million enrollees, representing about 32% of the Medicare population.

The annual election period for Medicare health and drug plans begins Oct. 15, 2015, and ends Dec. 7, 2015.

WASHINGTON – The Office of Medicare Hearings and Appeals will expand a pilot project that it launched last year that seeks to settle appeals that are stuck at the administrative law judge level.

OMHA has announced that it will hold a conference call on Oct. 15 to discuss its plans to expand its Settlement Conference Facilitation pilot project.

The office did not provide details on how it plans to expand the pilot project, but it stated: “The teleconference will brief appellants on how they can request SCF and detail the new SCF process.”

Part B providers who are interested in participating in the call need to complete a registration form* and email it to omha.scf@hhs.gov.

As part of the pilot project, OMHA brings together the appellant and CMS to discuss resolving claims appealed to the ALJ level. If a resolution is reached, OMHA drafts a settlement document for both parties to sign. As part of the agreement, the request for an ALJ hearing is dismissed.

A recent analysis by AAHomecare revealed that the wait time for appeals at the ALJ level has increased nearly 25% during the first half of 2015. The average processing time at this level was 725 days in June.

When it comes to using templates confusion reigns. So HME News reached out to Michael Blakey to clear a few things up. Blakey, president of DMEevalumate, says he’s excited that the conversation around templates has evolved to the point where providers are asking what they are and if they should be embracing them.

HME News: So, can HME providers use templates or not?

Michael Blakey: They are certainly allowed. With all the noise surrounding competitive bidding, the face-to-face requirement and the PMD demo, what got lost was the bone that CMS was throwing the industry. In 2013, they clarified the use of templates and when they were permitted, and frankly encouraged them.

HME: What makes for a good template?

Blakey: Templates that coax a practitioner to address all the questions in a complete manner are ones that will provide the full and complete disclosure that CMS is looking for. Something that just has a statement on it, or has you circle yes or no, true or false, and doesn’t have a lot of space to write, is very much frowned upon by CMS.

HME: Physicians and other medical professionals are already using EMR/EHRs. Is the HME industry lagging behind?

Blakey: It’s not that HMEs are being left behind. It’s that EMR/EHRs are not being responsive to HME because doctors aren’t asking for HME to be included. The HME niche is so small and CMS changes the requirements for HME so often, that if they did an update for say, PMD, by the time the EMR did a nationwide update to its HME program, CMS has probably changed its policy.

BOSTON – MassHealth has given stakeholders its word that the agency will not pursue volume purchasing for HME like incontinence products.

The state in May included language to allow the state’s Medicaid program to contract directly with DME manufacturers and distributors, bypassing providers, in its proposed Medicaid budget for fiscal year 2016.

Although the governor in July signed the budget into law, MassHealth is not required to contract with DME vendors.

“We met with the department head of Medicaid and they told us that they’re not going to move forward with that,” said Karyn Estrella, president and CEO of Home Medical Equipment and Services Association of New England.

Provider Peter Tallas credits MassHealth’s decision not to leverage the language to stakeholder outreach. 

“I’d like to think that the conversations we had (with MassHealth) about the services we provide and our relationships with our customers had some bearing on that decision,” said Tallas, president and CEO of Pembroke, Mass.-based Charm Medical Supply. 

When the budget was first proposed, providers were quick to point out the additional costs associated with storage and delivery, as well as the service needs of patients. 

Unfortunately, stakeholders in Rhode Island didn’t have as much luck. They failed to convince Medicaid officials to hold off on its decision to reduce reimbursement rates by 50% for incontinence products. 

“I know that some of our members did submit comments, but based on the Office of Inspector General’s report on all 50 states, Rhode Island is just bringing (the reimbursement rate) in line with an industry standard,” said Estrella.

Last year, an OIG study found that Rhode Island had one of the highest reimbursements for incontinence products.

WASHINGTON – The Office of Medicare Hearings and Appeals plans to expand its Settlement Conference Facilitation pilot project and stakeholders hope the agency will make it more widely accessible.

Right now, to participate in the pilot project, providers must have a minimum of 20 claims or $10,000 in controversy; must appeal all claims for the same service; and must have filed the claims in 2013—none of which can be currently assigned to a judge.

Due to these strict criteria, very few HME providers have had the opportunity to come to the table with CMS and OMHA to work out a settlement.

“We’ve asked for changes to the minimum number of claims, the amount, the time frame for the appeals and things of that nature,”said Kim Brummett, vice president of regulatory affairs for AAHomecare.

OMHA is holding an open door conference call with Part B providers on Oct. 15 to brief them on how they can request a settlement and to discuss the new process.

Healthcare lawyer Ross Burris, who represented two O&P companies during the process, says the pilot project would also be more attractive to providers if CMS was able to discuss hard numbers.

“All CMS can do is tell you that they will pay a certain percentage of the claim,” said Burris, an attorney in the Atlanta office of Polsinelli. “I think it’s hard for suppliers to get their heads around exactly how much they’re giving up if they accept a settlement for less than the amount that they are appealing.”

One of the biggest hurdles providers face under the current system is understanding whether they are even eligible to participate.

“For some folks with claims from different time periods, different types of services, different types of denial reasons—just getting all the information together and organizing it to determine whether or not they even qualify has been a challenge,” said Wayne van Halem, president of The van Halem Group.

With wait and processing times still skyrocketing at the administrative law judge level, stakeholders say that, if fixed, the pilot project could be a viable alternative for providers.

“I can tell you from my experience, I know a lot of companies that would participate in a settlement conference,” van Halem said. “We’ve had a lot of requests for information about it, so I do think it is a reasonable solution (to the appeals backlog) if they are able to expand it enough to where people are able to participate.”

WASHINGTON – There won’t be a cat-and-mouse game with premiums for Medicare Advantage plans this year.

CMS announced last week that premiums will decrease by about $0.31 next year, from $32.91 on average in 2015 to $32.60 on average in 2016. The agency says the majority of enrollees, 59%, will face no increase in premiums.

“Seniors and people with disabilities continue to experience stable premiums in Medicare health and drug plans,” said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. “Medicare Advantage and prescription drug plans remain affordable and provide high quality care.”

In past years, CMS has announced slight increases in the premiums for Medicare Advantage plans, only to reverse the increases.

CMS also announced that access to Medicare Advantage plans will remain strong, with 99% of beneficiaries having access to plans.

Additionally, CMS announced that in 2016, more plans will offer supplemental benefits for enrollees, such as dental, vision and hearing benefits.

Between 2010, when the Affordable Care Act was enacted, and 2016, premiums for Medicare Advantage plans are expected to decrease by nearly 10% and enrollment in those plans are projected to increase more than 50% to about 17.4 million enrollees, representing about 32% of the Medicare population.

The annual election period for Medicare health and drug plans begins Oct. 15, 2015, and ends Dec. 7, 2015.

Stakeholders launch petition in fight over pricing for accessories

WASHINGTON – Stakeholders are now petitioning the Obama Administration to step in and reverse CMS’s plans to apply competitive bidding pricing to accessories for complex rehab wheelchairs on Jan. 1. The petition had 765 signatures at press time, with a goal of 100,000 by Oct. 23. “This will have a devastating people across the U.S,” the petition reads. “To protect access for people with severe disabilities, this policy must be rescinded.” This is only the most recent effort to reverse CMS’s plan. Rep. Lee Zeldin, R-N.Y., introduced a bill in July to prevent the agency from adopting the pricing, which could mean a 20% to 50% cut for providers. H.R. 3229 had 11 co-sponsors at press time.

Epic Health moves into enteral nutrition

DALLAS – Epic Health Services has acquired Option 1 Healthcare Solutions, a move that positions the company, which provides pediatric nursing and therapy services, to enter the enteral nutrition market. The deal allows Epic Health to add Washington state, Oregon and Nevada to its coverage area. It now does business in a total of 15 states. It also allows the company to add 6,300 patients to its base across six Western states. It now serves more than 26,000 patients, according to the release. The Chandler, Ariz.-based Option 1 Healthcare will operate as a subsidiary of Epic Health, and retain its headquarters and management team. Epic Health is a portfolio company of Webster Capital, a private equity firm with a focus on consumer and healthcare services companies with EBITDA between $3 million to $15 million.

Grant funds new mobility training

ARLINGTON, Va. – The Craig H. Nielsen Foundation has awarded a one-year, $49,000 grant to Barbara Crane and Laura Cohen to develop and deploy a seating and wheeled mobility training curriculum for entry level physical therapists and physical therapy assistants, and for continuing education for practicing clinicians. “There are limited training opportunities for professionals to gain the skills needed to prescribe a wheelchair effectively, particularly at the pre-professional level,” a press release states. “This project aims to address the shortage of knowledgeable clinicians through development and dissemination of pre-professional training materials.” The “plug-and-play” curriculum will be made available for voluntary use by academic PT and PTA programs, decreasing curriculum variability and improving opportunities for PTs and PTAs to graduate with the requisite knowledge. Crane is an associate professor of physical therapy at the University of Hartford; Cohen is executive director of the Clinician Task Force.

Apria Healthcare doubles down on wound care

LAKE FOREST, Calif. – Apria Healthcare has extended its partnership with MoInlycke Health Care by taking fulfillment and support for the Avance Max negative pressure wound therapy system to acute facilities across the country. This complements Apria’s existing role as exclusive U.S. distributor of MoInlycke’s Avance Flex negative pressure wound therapy system for the home. “Transition planning upon admission with product continuity is now possible, benefitting patients and healthcare professionals alike,” said Dan Starck, CEO of Apria Healthcare, in a press release.

Senators want to review home infusion pricing with CMS

WASHINGTON – More than a dozen senators have written a letter to Senate Majority Leader Mitch McConnell and Minority Leader Harry Reid asking for time to review S. 275, the Medicare Home Infusion Site of Care Act, with CMS. “We urge that the average sales price pricing provisions from H.R. 6 or H.R. 2570 not be included in any legislation that does not recognize the services component of care that is included in S. 275,” stated the letter. The House of Representatives passed H.R. 6 and H.R. 2570, changing Medicare reimbursement of Part B DME infusion drugs to an ASP methodology. The senators argue, however, that without the inclusion of payment for required professional services patients are at risk of losing access to care. The 13 signers of the letter include Sen. Johnny Isakson, R-Ga., who sponsored S. 275

Speakers address ‘sleep tech boom’

ARLINGTON, Va. – Dr. David White, the former chief medical officer at Philips Respironics, will give the opening keynote at the inaugural Sleep Technology Summit & Expo Oct. 6-7 in Santa Clara, Calif. "Dr. White is widely regarded as one of the most influential experts in the world today when it comes to sleep," said David Cloud, CEO of the National Sleep Foundation, in a release. "His position at Harvard Medical School, as well as his relationship with Philips Respironics, put him on the front lines of the emerging sleep technology boom.” Philippe Kahn, CEO of Fullpower Technologies, will deliver a luncheon keynote and Dr. Michael Breus, better known as ‘The Sleep Doctor’ on the Dr. Oz Show, will serve as NSF's Sleep Technology Ambassador and Emcee. The Summit will bring together technology innovators, sleep experts, industry analysts and venture capitalists to share technologies and discuss the global investment landscape.

VGM retools government relations portal

WATERLOO, Iowa – The VGM DC Link page has a new look and a few new resources. In addition to staples like the Action Center and Resource Center, the updated site now features an event calendar and a designated page for state associations. The latter also features contact information for state associations, state licensure information, and speakers available for association events and conferences.

AOPA ‘salutes’ advocates

WASHINGTON – The American Orthotic & Prosthetic Association will recognize three individuals for their contributions to the O&P community next month. Rick Riley, CEO of Townsend Design; Teri Kuffel, vice president at Arise Orthotics; and Charles Kuffel, president and clinical director at Arise Orthotics will receive the Ralph R. “Ronney” Snell Legislative Advocacy Award at the 2015 AOPA National Assembly in October. The award is presented to individuals who advance legislative and regulatory goals for O&P. “Rick, Charles and Teri are O&P industry champions who consistently and unselfishly invest their personal time to inform and educate legislators, regulators, and other professionals with considerable impact,” said Charles Dankmeyer, AOPA president. “AOPA salutes their advocacy.”

ASP rises for several drugs

BALTIMORE – Fourth-quarter payments showed healthy increases for several respiratory drugs. Brand name drugs Brovana (J7605) rose 88 cents to $8.08 per dose and Perforomist (J7606) rose 40 cents to $8.88 per dose. Budesonide (J7626) was up 19 cents to $5.39 per dose. Ipratropium (J7644) was unchanged at just under 11 cents per dose. Albuterol (J7613) was down nearly 2 cents to just under 12 cents per dose.

RESNA seeks feedback on job analysis, education

ARLINGTON, Va. – RESNA is conducting a job analysis of work performed by assistive technology in schools. The goal is to identify core job responsibilities of ATPs in schools. Click here to participate in the survey. RESNA/NCART 2016 is accepting submissions for workshop and course proposals for its conference in July. Proposals are sought on several topics, including computer applications, emerging technology, and service delivery and outcomes. Proposal are due Nov. 19. For more information, click here.

People in the news: Henry Dale Smith, Todd Timbrook

H.D. Smith announced this week that Henry Dale Smith Sr., the company’s founder and chairman emeritus, has died at age 87. Smith founded H.D. Smith in 1954 with the mission of providing personalized service to local pharmacies in the Midwest. The Springfield, Ill.-based company has become the fourth largest national pharmaceutical wholesaler today…Continuum Rx, a Birmingham, Ala.-based provider of home infusion services, has added Todd Timbrook to its board of directors. Timbrook founded and was the CEO of Home Solutions, a provider of home infusion services that grew by more than 20% per year, on average. Continuum Rx operates joint ventures with six major health systems operating 25 hospitals.

WASHINGTON – ICD-10 went into effect today, but it will be several days, if not a month, before the impact of the new code sets in.

“It will take a couple of weeks before we have the full picture of ICD-10 implementation because very few health care providers file claims on the same day a medical service is given,” said Sean Cavanaugh, CMS deputy administrator and director,in a blog post. “Most providers batch their claims and submit them every few days.”

Once submitted, the claims take several days to be processed. Medicare must then wait two weeks before issuing payment. From start to finish, the entire process can take up to 30 days.

“Because of these timeframes, we expect to know more about the transition to ICD-10 after completion of a full billing cycle,” said Cavanaugh. 

ICD-10 features expanded alphanumeric code sets, as well as an expanded number of codes—68,000 vs. 13,000 under ICD-9—to identify disease etiology, anatomic site and severity.

According to a recent HME NewsPoll, 70% of respondents say they expect some disruption in cash flow as physicians and payers navigate the new code set.

However, there is one silver lining: Physicians and other practitioners under Medicare Part B won’t be denied for having the precise diagnosis code until Oct. 1, 2016. 

Should providers have any difficulty navigating the new code sets, CMS recommends contacting their MAC or the ICD-10 Coordination Center.

YARMOUTH, Maine – Medicare spending in certain competitive bid areas continues to nosedive, according to 2014 data added this week to the HME Databank.

In Riverside County, Calif., a Round 1 area, Medicare spending on oxygen concentrators dropped from $2.37 million in 2013 to $1.55 million in 2014. In 2011, the year the program rolled out, Medicare spending on E1390 was $3.28 million.

In other areas, like Allegheny County, which includes Pittsburgh, a Round 1 area, Medicare spending on oxygen concentrators remained relatively stable, from $1.48 million in 2013 to $1.31 million in 2014. That’s still a far cry, however, from the $2.17 million Medicare spent in 2011.

Overall, Medicare spending was $908.3 million for oxygen concentrators in 2014, compared to $1.06 billion in 2013, according to the Databank.

Which providers received the lion’s share of that spending in 2014?

Lincare took the No. 1 spot by a landslide, receiving $242.5 million from Medicare for E1390, according to the Databank. Not so close behind: Apria Healthcare at No. 2, receiving $26.4 million, and Inogen at No. 3, receiving $16.4 million. Rounding out the top five: Braden Partners (which does business as Pacific Pulmonary Services) and Health Care Solutions at Home.

In addition to oxygen concentrators, the Databank tracks Medicare spending for more than 400 products included in the bid program and tracks the top providers for more than 250 products.

For CPAP devices, for example, total Medicare spending was $136.2 million in 2014, compared to $169.5 million in 2013.

Lincare and Apria, again, took the top spots here, receiving $6.7 million and $5.9 million, respectively, from Medicare in 2014, followed by American HomePatient at $3.3 million. Rounding out the top five: Norco and SleepMed Therapies.

WASHINGTON – ICD-10 went into effect Oct. 1, but it will be several days, if not a month, before the impact of the new code system sets in.

“It will take a couple of weeks before we have the full picture of ICD-10 implementation because very few health care providers file claims on the same day a medical service is given,” said Sean Cavanaugh, CMS deputy administrator and director, in a blog post.“Most providers batch their claims and submit them every few days.”

Once submitted, the claims take several days to be processed. Medicare must then wait two weeks before issuing payment. From start to finish, the entire process can take up to 30 days.

“Because of these timeframes, we expect to know more about the transition to ICD-10 after completion of a full billing cycle,” said Cavanaugh. 

ICD-10 features expanded alphanumeric code sets, as well as an expanded number of codes—68,000 vs. 13,000 under ICD-9—to identify disease etiology, anatomic site and severity.

According to a recent HME NewsPoll, 70% of respondents say they expect some disruption in cash flow as physicians and payers navigate the new code set.

However, there is one silver lining: Physicians and other practitioners under Medicare Part B won’t be denied for having the precise diagnosis code until Oct. 1, 2016. 

Should providers have any difficulty navigating the new code sets, CMS recommends contacting their MAC or the ICD-10 Coordination Center.

BraunAbility sells to Swedish investment firm

WINAMAC, Ind. – BraunAbility has signed an agreement to sell to Patricia Industries, a division of Stockholm, Sweden-based Investor AB.

BraunAbility will join Permobil on Patricia Industries’ roster of “high-quality, high-growth” companies, according to a press release.

“With the support of Patricia Industries, we will be positioned to accelerate our rate of growth, powered by product innovation, development of our brand promise within the communities we serve and continued expansion into global markets,” stated Nick Gutwein, BraunAbility’s president and CEO.

The manufacturer of wheelchair-accessible vehicles and wheelchair lifts generated $415 million in sales in 2014, according to the release.

BraunAbility is Investor AB’s first North American subsidiary, following the creation of Patricia Industries earlier this year. It will be managed out of the New York office.

BraunAbility was founded nearly 50 years ago by Ralph Braun, who was himself disabled and built his first wheelchair accessible vehicle in 1972.

In addition to Permobil, Patricia Industries also owns a majority stake in MoInlycke Health Care, a Gothenburg, Sweden-based manufacturer of wound care and single-use surgical products.

COPD Foundation adds coaching app to growing list of support tools

WASHINGTON – The COPD Foundation and ViiMed launched an interactive website and mobile app this week for coaching, education and wellness monitoring for COPD patients. COPD360coach uses educational modules comprised of online videos and courses taught by health professionals and COPD patients. The foundation envisions health systems and accountable care organizations deploying the technology to their patients to help them better managed their disease. COPD360coach is the brainchild of a Crowdshaped event in June co-hosted by the COPD Foundation and Novartis Pharmaceuticals. The COPD Foundation selected ViiMed to develop a solution combining what was derived from the Crowdshaped event into one, cohesive platform. COPD360coach joins the foundation’s existing initiatives COPD360social and its COPD Patient-Powered Research Network.

ACHC formalizes education division

CARY, N.C. – The Accreditation Commission for Health Care has re-launched Accreditation University as a division of ACHC to create a foundation for additional educational offerings. “The expansion of our educational products and services is a natural extension of our accreditation foundation, allowing us to leverage our expertise to better help providers achieve success,” said CEO José Domingos in a release. Additional products and services will be available through policy manuals, forms and other tools in 2016. Pharmacy, DMEPOS and sleep providers will also have access to consulting services through ACHC’s network of certified consultants.

Vent system gets coded

IRVINE, Calif. – CMS has assigned two HCPC codes to Breathe Technologies’ Life2000 Ventilation System, the medical device manufacturer announced recently. “Breathe Technologies recognizes the assignment of these codes as a significant advancement in addressing an unmet need for individuals living with respiratory insufficiency and neuromuscular diseases,” said President and CEO Larry Mastrovich in a release. The Life2000 Ventilation System received 510(k) clearance from the FDA in June and treats both acute and chronic respiratory failure in the home, as well as in institutional settings. The system will be commercially available in the U.S. in late 2015.

NCPA videos examine changing healthcare models

ALEXANDRIA, Va. – The National Community Pharmacists Association has launched a five-part video series that looks at how community pharmacies can adapt to changing healthcare models and improve patient care. Topics include the role of technology, marketing, and new models of payment, according to a press release. “Pharmacy is changing and the shift toward quality standards and value-based patient care presents opportunities, as well as challenges,” said NCPA CEO B. Douglas Hoey. “Community pharmacies are solution companies—every day, they are adapting and evolving to fill gaps in care.” The videos, which are sponsored by H.D. Smith, are each worth 0.1 CEU. Pharmacists must complete a pre-read and post-test before and after each video to receive credit. FMI.

HOMES gets pharmacy license requirement for DME dropped

AUGUSTA, Maine – The National Suppliers Clearinghouse will remove the pharmacy license requirement for certain DME items in Maine, the Home Medical Equipment and Services Association of New England has reported. To obtain such a license, a provider had to have a pharmacist in charge or PIC, not appropriate for DME providers, HOMES argued. The association began working on this issue last summer, when the NSC updated its State License Directory to include a requirement for a pharmacy license for some DME. It testified at the Maine Board of Pharmacy meeting in April to argue for at least a limited pharmacy license, but the board decided a license wasn’t needed for the items in question because they did not meet its definition of “device.”

Short takes: Brightree, AOPA, Masimo, Nonin & more

Brightree’selectronic health record solution for home health and hospice has been selected by Merida Health Care Group. Merida already uses Brightree’s solution for HME…The American Orthotic & Prosthetic Association has announced the winners of its annual student poster awards: Tyler Klenow has received the Otto and Lucille Becker Award for his orthotic abstract, “A Functional Comparison of Carbon Fiber AFO and Two Modular KAFO Conditions Using Outcome Measures in a Veteran Subject with Traumatic Brain Injury.” Lisa Abernathy has received the Edwin and Kathryn Arbogast Award for her prosthetic abstract, “Going Back in Time: A Content Analysis on the Media Portrayal of Characters with Antiquated Prostheses”…Masimo has committed to donating $5 million in Signal Extraction Technology Pulse Oximeters and Pulse Co-Oximeters and other medical equipment to Jordanian hospitals to help improve care for Syrian and Iraqi refugees and Jordanian citizens. The first shipment of equipment is already in use at Al-Bashir Hospital in Amman…Nonin Medical has promoted Christopher Holland to chief compliance officer. He was previously the company’s vice president of business development. In his new role, Holland will continue to lead business development, in addition to overseeing the company’s commercialization strategies and activities…YouCan TooCan Home Medical Supply has opened a new store in Colorado Springs, it announced today. The 2,500-square-foot store offers scooters, wheelchairs, lift chairs, respiratory equipment and aids to daily living. The store is owned by Marvin Holland, who acquired it in November 2014…Sleep Apnea Awareness Week,a campaign focused on increasing public awareness about the sleep disorder, takes place Oct. 1 through Oc. 7. Affiliates and members of the American Sleep Association from multiple sites will participate in the event, and affiliated sleep disorder treatment centers will discuss topics relating to sleep apnea. The ASA website will also present important information on the signs, symptoms, risks and treatment options of obstructive sleep apnea…U.S. Rehab has named Ron Turzy as vice president of complex rehab. He previously worked with HomeLink and U.S. Rehab. In his new role, he will work with the company’s outcomes program and seek national insurance contracts.