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    04/20/2016
    HME News Staff

    WASHINGTON – Senate Finance Committee leaders have asked CMS to delay applying the next round of Medicare reimbursement cuts in rural areas.

    In an April 18 letter to Health and Human Services Secretary Sylvia Burwell, Finance Committee Chairman Orrin Hatch, R-Utah, and Ranking Member Ron Wyden, D-Ore., express their concerns that six months isn’t long enough to detect and correct problems with the rollout of competitive bidding to non-bid areas.

    “It is unlikely that CMS will be able to monitor, analyze, and make any necessary changes prior to July 1, 2016,” the letter states. “The ability of the real-time claims monitoring that CMS uses for items provided in competitive bidding areas to assess the short-term impact of the DMEPOS fee schedule rate reduction in non-competitive bidding areas is questionable.”

    CMS started rolling out bid pricing to non-bid areas on Jan. 1. It plans to complete the transition on July 1.

    The letter also calls for CMS to monitor changes in the percentage of HME providers accepting Medicare business since Jan. 1, and provide information on beneficiary complaints in those areas.

    In March, Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.C., introduced S. 2736, a bill to delay the cuts until at Oct. 1, 2017. It currently has 19 co-sponsors.

    Industry stakeholders are working to secure a Democratic co-sponsor for a companion bill in the House of Representatives.


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    04/22/2016
    HME News Staff

    WASHINGTON – Senate Finance Committee leaders have asked CMS to delay applying the next round of Medicare reimbursement cuts in rural areas.

    In an April 18 letter to Health and Human Services Secretary Sylvia Burwell, Finance Committee Chairman Orrin Hatch, R-Utah, and Ranking Member Ron Wyden, D-Ore., express their concerns that six months isn’t long enough to detect and correct problems with the rollout of competitive bidding to non-bid areas.

    “It is unlikely that CMS will be able to monitor, analyze, and make any necessary changes prior to July 1, 2016,” the letter states. “The ability of the real-time claims monitoring that CMS uses for items provided in competitive bidding areas to assess the short-term impact of the DMEPOS fee schedule rate reduction in non-competitive bidding areas is questionable.”

    CMS started rolling out bid pricing to non-bid areas on Jan. 1. It plans to complete the transition on July 1.

    The letter also calls for CMS to monitor changes in the percentage of HME providers accepting Medicare business since Jan. 1, and provide information on beneficiary complaints in those areas.

    In March,Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.C., introduced S. 2736, a bill to delay the cuts until at Oct. 1, 2017. It currently has 19 co-sponsors.

    Industry stakeholders are working to secure a Democratic co-sponsor for a companion bill in the House of Representatives.

    Influential group backs bid bill

    WASHINGTON – The National Federation of Independent Business has written a letter of support for S. 2736, a bill that would delay a second round of Medicare reimbursement cuts scheduled for July 1.

    The NFIB cites the high proportion of HME providers that are small businesses and the high level of service those companies provide in its letter.

    “The next round of the competitive bidding cuts threaten the viability of these small businesses,” the group stated.

    AAHomecare says the NFIB represents 325,000 small and independent business owners nationwide and its endorsement carries significant weight on Capitol Hill.

    AAHomecare gave a shout-out to Don Jones, president of Southern Medical Equipment Corp., and director of federal affairs for the Alabama Durable Medical Equipment Dealers Association, for securing the NFIB’s support.

    The Senate bill would delay the upcoming cuts until Oct. 1, 2017. Stakeholders are working on a companion bill in the House of Representatives.

    Groups surveys drivers on sleep apnea

    ARLINGTON, Va. – The American Transportation Research Institute has launched an online survey seeking input from commercial drivers on a number of issues related to sleep apnea. ATRI is surveying drivers on their perspectives, personal experiences and knowledge of sleep apnea. It also seeks information on the sleep apnea assessments and treatments that drivers may have received, as well as the perceived effectiveness of those treatments. The survey results will be synthesized with other sleep apnea and driver fatigue research analyses, and then analyzed by several leading sleep apnea experts. The ATRI has made “Understanding the Impacts of Sleep Apnea on Commercial Drivers” one of its top research priorities this year. The survey was initially distributed at the Mid-America Trucking Show in late March, where more than 100 drivers participated.

    Alliance continues Ariz. expansion

    Prescott, Ariz. – Alliance Homecare has acquired Bradshaw Home Medical, also based in Prescott, Ariz. Valley Healthcare Group, parent to Alliance Homecare, now operates 10 DME locations in Arizona and Nebraska, and 10 accredited sleep centers. “This acquisition helps us to remain focused on providing the best patient care possible, while working to offset the cuts in Medicare in the rural areas,” said Ron Evans, owner of Valley Healthcare Group, in a release. “We now service patients from the southern border of Arizona to Prescott and Prescott Valley, and we are expanding to other areas in Arizona soon, covering 75% of the state’s population from the southern border up to northern Arizona.” The two companies will remain independently owned and operated. Evans, who launched Valley Respiratory Services in 2006 with his wife, has grown his business through acquisitions like Heartland Health Therapy in 2014, RTA Homecare in 2013 and Alliance in 2012.

    InfuSystem buys infusion pump assets

    MADISON HEIGHTS, Mich. – A subsidiary of InfuSystem Holdings, a national provider of infusion pumps and related services in the U.S. and Canada, has reached an agreement to acquire the infusion pump assets of Philadelphia-based InfusAID. Per the deal, InfuSystem will acquire about 400 infusion pumps from InfusAID, a privately held regional provider of ambulatory infusion pumps and service to medical facilities. “Similar to our acquisition of Ciscura in 2015, the pumps we acquire from InfusAID will come to us with 18 medical facility relationships that will help us gain additional market share as the marketplace continues to consolidate,” Erik Steen, CEO of InfuSystem, stated in a press release. “We also believe this transaction will offer clinicians and patients better access to more affordable in-network care via InfuSystem’s 340-plus insurance payer contracts.”

    Docs criticize Medicare’s diabetes policies

    LEAWOOD, Kan. – The American Academy of Family Physicians sent a three-page letter to HHS Secretary Sylvia Burwell on April 13, expressing its concerns that the prescribing process for diabetes testing supplies has become “overly burdensome.” Also in the letter: That the competitive bidding program has resulted in patients receiving unbranded or inaccurate supplies. The AAFP argues that it should be acceptable for physicians to write prescriptions for “diabetic supplies” to encompass syringes, needles, test strips, lancets, glucose testing machine, etc., along with frequency. Current policy requires everything from a documented diagnosis to a patient’s testing log. The AAFP also calls on CMS and the FDA to better communicate about the quality and safety of monitoring systems sold under the bid program.

    Diabetes manufacturer snags contract

    MINNEAPOLIS – Arkray USA has contracted with the 340B Prime Vendor program to provide diabetes care products, including its GlucoCard Shine and GlucoCard Expression meters, to patients in qualifying healthcare facilities. "Arkray's accurate, reliable and easy-to-use diabetes management products help patients of 340B hospitals and clinics live healthier lifestyles and lower healthcare costs," said Arkray USA President Jonathan Chapman.

    Drive|DeVilbiss debuts SmartLink app

    CHARLOTTESVILLE, Va. – Drive|DeVilbiss Healthcare and WillowTree, a UX design and app development company, have announced the launch of their new SmartLink App for their IntelliPAP 2 CPAP device. The app interfaces with the device wirelessly over Bluetooth, pulling data daily to keep track of patient progress. The app also allows patients to play an interactive role in their therapy: It provides feedback on their therapy; reports for daily, weekly, monthly and yearly usage; notifications for high leak and low usage; reminders for replacing supplies, such as mask and tubing; help videos for setting up and maintaining the unit. “With effortless feedback, clinically relevant notifications and alerts, and tailored, actionable insights into one’s sleep therapy, the SmartLink app will enrich the mundane relationship an individual with sleep apnea traditionally has with their equipment,” said Ed Link, chief marketing officer for Drive|DeVilbiss, in a release. 

    People news: Jay Broadbent, Kay Johnson

    Kay Johnson, owner of Midwest Medical Services in Watertown, S.D., has been named the 2016 MAMES Above and Beyond Award winner. The award is given to MAMES members who go “above and beyond” in the fight to protect access to quality care. Johnson, who currently serves on several MAMES committees, invited Sen. John Thune, R-S.D., to participate in a meet-and-greet with all MAMES members from South Dakota at Midwest Medical to discuss the impact of the competitive bidding pricing roll out. She alsorecently volunteered to testify in front of the US Small Business Administration on federal regulations impacting her small business...The Small Business Administration has named provider Jay Broadbent Utah Small Business Person of the Year. Broadbent founded Alpine Home Medical in 1997, with a single employee operating out of a delivery van. Today, it is the largest independent HME provider in Utah with nearly 200 employees. Broadbent, CEO, also heads up the B in Motion Foundation with his wife Kristie to provide wheelchairs and other mobility equipment to users who can’t afford it. Broadbent and the winners from the other 49 states and U.S. territories will be honored in Washington, D.C, in May.

    Short takes: Medtrade, URise Products, Valumatrix

    Medtradeshow organizers are accepting submissions for conference session ideas until May 9. Ideas should address one of these tracks: audits, business operations, competitive bidding, continuing education and training, executive leadership, keeping it legal, retail/caretail, sales and marketing, sleep/oxygen or strategic planning. This year’s event takes place Oct. 31-Nov. 3 at the Georgia World Congress Center in Atlanta…The Doctors TV show on April 25 will air its inaugural “Funder Games,” featuring five healthcare startups with audience members voting on the new best product. The winner: URise Products and its just launched StandUp Walker. The walker is a stand-assist device combined with a modern take on a mobility walker…Valumatrix has signed an agreement to offer publishing services, including its “The Fifth Element Employee Newsletter,” through the Innovatix and Essensa Group Purchasing Portfolio. Innovatix is the nation’s leading non-acute care supply chain solutions company and GPO, serving 32,000 member pharmacies, senior living facilities and independent medical oncologists.

    Stock movers: Ray Huggenberger, Mick Farrell

    Inogen CEO Ray Huggenberger sold more than half of his shares in the company in a transaction April 15. He sold 29,635 shares at an average price of $48.59 for a total value of $1.44 million. He now owns 25,210 shares…ResMed CEO Mick Farrell sold 5,975 shares at an average price of $59.34 in a transaction on April 15 valued at $354,556. He now owns 154,723 shares.


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    04/28/2016
    HME News Staff

    WASHINGTON – CMS named the contract suppliers for the Round 2 re-compete of competitive bidding at 5:02 p.m. on Thursday.

    CMS says it has executed 586 contracts, 91% of those offered, for seven product categories. The contract providers have 2,200 locations to serve Medicare beneficiaries in competitive bidding areas.

    The agency also awarded nine contracts, 100% of those offered, for diabetes supplies as part of its national mail-order program.

    CMS says 92% of contract suppliers are already established in the bid area, the product category, or both. It says small suppliers, those with gross revenues of $3.5 million or less, make up 62% of the contract suppliers.

    “The bid evaluation process ensures that there will be a sufficient number of suppliers, including small suppliers, to meet the needs of the beneficiaries living in the CBAs,” the agency states in a fact sheet.

    Previously, on March 15, CMS announced the single payment amounts for the Round 2 re-compete. The amounts represent average reductions of anywhere from a few percentage points to up to 25%, over and above the amounts for the original Round 2. The amounts for original Round 2 were, on average, 45% lower than the original fee schedule.

    CMS says that, under the first two years under the Round 2 and the national mail-order programs—from July 1, 2013 to June 30, 2015—it has saved about $3.6 billion.

    “Health monitoring data indicate that its implementation is going smoothly with few inquiries or complaints and has had no negative impact on beneficiary health outcomes,” the agency states in the fact sheet.

    CMS goes live with the Round 2 re-compete and national mail-order programs on July 1.


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    04/28/2016
    HME News Staff

    WASHINGTON – AAHomecare has lined up Reps. Marsha Blackburn, R-Tenn.,andRenee Ellmers, R-N.C., to speak at the 2016 Washington Legislative Conference, slated for May 25-26 at the Washington Court Hotel. 

    Rep. Ellmers introduced a bill this week that would halt CMS’s plans to make dramatic changes to coverage for prosthetic devices, while Rep. Marsha Blackburn, R-Tenn., introduced a bill last year that would require prior authorizations for certain high-cost DME, including oxygen. 

    In addition, a general session on May 25 will feature a panel discussion about issues affecting rural providers. The panel, moderated by John Gallagher, vice president of government relations at VGM, and Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services, will address the challenges associated with serving patients in rural areas, and how to communicate these issues to patients and policymakers.

    “Conference attendees should make a point to attend the rural panel session, whether or not your company is in a rural area,” said Karyn Estrella, executive director of the Home Medical Equipment and Services Association of New England, in an AAHomecare bulletin. “Getting first-hand accounts of the challenges these companies face will be important to convey during your Hill visits.”

    As part of the conference, AAHomecare is coordinating Capitol Hill visits to lobby lawmakers on industry issues, include a bill to delay an upcoming second round of Medicare cuts in non-bid areas.

     


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    As stakeholders analyze list of contract suppliers, they worry about, among other things, out-of-staters
    04/29/2016
    Theresa Flaherty

    WASHINGTON – Industry stakeholders have begun the monumental task of analyzing the newest competitive bid contract suppliers.

    “We’re trying to get a feel for who won the most contracts in what product categories,” said Kim Brummett, vice president of regulatory affairs for AAHomecare.“One of the things we are looking at, since the pricing was lower, are they mostly the big nationals or are we still dealing with mom and pops that won hundreds of contracts.”

    CMS named the contract suppliers for the Round 2 re-compete of competitive bidding at the end of the business day on Thursday. The agency said it has executed 586 contracts for seven product categories. The contract providers have 2,200 locations to serve Medicare beneficiaries.

    The agency also awarded nine contracts for diabetes supplies as part of its national mail-order program.

    Stakeholders will also be looking to see whether the contract suppliers meet any and all licensure requirements—one of the rules of the program that CMS failed to ensure in the original Round 2.

    “I’d be very disappointed if it was a ton of licensure issues,” said Brummett. “We saw a lot more scrutiny at the CBIC this time, but we’ll do our due diligence and work with our state leaders to look at licensure.”

    Also under scrutiny: whether contracts were awarded to suppliers that can reasonably be expected to serve the CBAs in which they won contracts. CMS says 92% of contract suppliers are already established in the bid area, the product category, or both—a number with which stakeholders have said they disagree with.

    “We had the out-of-state issue last time, (with contracts going) to people who were not really committed to serving the community,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

    Ohio, where Invacare is based, was one of many states that saw contracts awarded in the original Round 2 to companies that were hundreds or even thousands of miles away—a problem that, at first glance, looks like it is being repeated in the Round 2 re-compete.

    “I just opened up the Northeast nebulizer file and it’s Florida, Texas, Florida, Mississippi, Puerto Rico, Alabama,” said Bachenheimer. “That’s just the first page.”

    Once the analysis is done, stakeholders will use any problems they uncover in their efforts to get a delay in a second round of cuts in non-bid areas on July 1. S. 2736, introduced March 17, currently has 23 co-sponsors, including the additions last week of Sens. Susan Collins, R-Maine, Tim Kaine, D-Va., and Mark Warner, D-Va.

    “That’s having some strong movement,” said Brummett. “We’ve got lots of people talking on the Hill. If this paints the picture that you still have the average supplier being 500 miles away I think it gives even more credence to say you can’t be doing that.”

    CMS goes live with the Round 2 re-compete and national mail-order programs on July 1.


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    04/29/2016
    HME News Staff

    WASHINGTON – Rep. Renee Ellmers, R-N.C., has introduced a bill that would halt CMS’s plans to make dramatic changes to coverage for prosthetic devices.

    H.R. 5045, the “Preserving Access to Modern Prosthetic Limbs Act of 2016,” would “impose a moratorium on the implementation of a proposed Medicare local coverage determination on lower limb prostheses,” according to a bulletin from the American Orthotics and Prosthetics Association.

    The bill would restrict CMS from implementing the proposed LCD until at least June 30, 2017. It would also require the agency and its contractors to remove it from their websites. Private payers like United Healthcare and Cigna have made coverage changes since the proposed LCD was made public in July.

    The bi-partisan bill has been co-sponsored by Reps. Marsha Blackburn, R-Tenn., and Jan Schakowsky, D-Ill.

    The changes in the proposed LCD include requiring a face-to-face visit and a completed rehab program to receive a prosthetic device.

    AAHomecare books Congressional champions for conference

    WASHINGTON – AAHomecare has lined up Reps.Marsha Blackburn, R-Tenn.,andRenee Ellmers, R-N.C., to speak at the 2016 Washington Legislative Conference, slated for May 25-26 at the Washington Court Hotel. 

    Rep. Ellmers introduced a bill this week that would halt CMS’s plans to make dramatic changes to coverage for prosthetic devices, while Rep. Marsha Blackburn, R-Tenn., introduced a bill last year that would require prior authorizations for certain high-cost DME, including oxygen. 

    In addition, a general session on May 25 will feature a panel discussion about issues affecting rural providers. The panel, moderated by John Gallagher, vice president of government relations at VGM, and Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services, will address the challenges associated with serving patients in rural areas, and how to communicate these issues to patients and policymakers.

    “Conference attendees should make a point to attend the rural panel session, whether or not your company is in a rural area,” said Karyn Estrella, executive director of the Home Medical Equipment and Services Association of New England, in an AAHomecare bulletin. “Getting first-hand accounts of the challenges these companies face will be important to convey during your Hill visits.”

    As part of the conference, AAHomecare is coordinating Capitol Hill visits to lobby lawmakers on industry issues, include a bill to delay an upcoming second round of Medicare cuts in non-bid areas.

    VGM announces keynote speaker

    WATERLOO, Iowa –World-renown memory expert Bob Gray has been tapped to give the keynote speech at the VGM Group’s Heartland Conference this year. Gray has taught his memory systems to several Fortune 500 and 100 companies, including Boeing, General Electric, FedEx, and Johnson and Johnson. The premise of his presentation, “Welcome to Your Brain,” is based on credibility and relationships, both of which can be greatly enhanced through a trained memory. “The Heartland Conference is all about connecting our members with tools and resources to help them improve their businesses,” said Sara Laures, VGM’s vice president of special projects and conference chairperson. “Bob’s presentation will provide members with a unique way to improve both personally and professionally through memory and recall techniques.” The conference is slated for June 13-16 at the Ramada Waterloo Hotel and Convention Center in Waterloo, Iowa.

    Philips Respironics builds new distribution facility

    MURRYSVILLE, Pa. – Philips Respironicsis working with a developer to build a new 260,000-square-foot distribution center in Westmoreland County, according to the Pittsburgh Business Times. The manufacturer is working with Exel, a division of logistics firm DHL, which started construction on the new facility in February and is expected to finish sometime during the second half of 2016. Once the project is completed, Respironics has indicated that it will lease the complex from Exel.

    Data wanted: Audit Key accepting new submissions

    WASHINGTON – AAHomecare encourages providers to submit data for the first quarter of 2016 to the HME Audit Key. The HME Audit Key collects summary data on audits and appeals. AAHomecare then uses the data to engage policymakers and government regulators on audit-related issues. The first round of data collection, which ended in February, found that 12% of HME claims for new Medicare patients were denied. Participation is free. Go to hmeauditkey.com.

    Compass Health Brands buys pain management product

    CLEVELAND – Compass Health Brands has acquired the Strengthtape brand of kinesiology tape, along with other associated assets from the privately held company Endevr of St. George, Utah. “Strengthtape helps to further expand our portfolio of professional and retail pain management products,” said Jim Hileman, interim CEO and CFO of Compass Health Brands. “By leveraging our extensive sales and logistics network, we expect to have an immediate impact on the sales of the Strengthtape products.” Strengthtape, the official kinesiology tape of the Ironman triathlon, is known for its long-lasting durability and effectiveness on common injuries. The product line includes 35-meter uncut continuous rolls, pre-cut 5-meter rolls, and precut kits. Roscoe Medical, which, along with Carex Health Brands, makes up Compass Health Brands, has had an exclusive distribution agreement with Endevr for more than a year.

    REMWorks leverages game-based education

    PITTSBURGH – REMWorks has partnered with EdLogics to develop a game-based health education platform that provides incentives to patients to better manage their sleep health and associated costly health conditions. REMWorks is the sleep wellness store opened by health insurer Highmark in December 2014. EdLogics is a health education-based consumer engagement company. The platform, which involves completing activities and games, and learning strategies for better sleep, was launched with Allegheny County of Pennsylvania employees in September. Prior to using the platform, employees scored an average of 67% on the sleep health baseline knowledge assessment. After, they increased their average score to 95%.

    Southern Home Medical exec resigns amid merger

    GREER, S.C. – Jeffrey Sarvis has resigned from his posts as president and CEO and director of the board of Southern Home Medical. “The merger transaction continues to move forward,” he stated in press release. “This requires my resignation.” Miguel Dotres will step up as interim president and CEO and director. He will lead the company through this transitional phase. Southern Home Medical did not give details on said merger. In March, the company, which owns and operates ApneaRx, reported $1.14 million in revenues and $60,983 in net income for 2015. “SOHM finished the year poised and financially ready to pursue sale, merger and/or acquisition opportunities and was able to quickly attract interest,” it stated in a press release. Southern Home Medical formed in 2007 with an eye toward rolling up HME providers. A year later, it also turned its focus on medical staffing.

    Comfort Medical buys resource for wheelchair users

    CORAL SPRINGS, Fla. – Comfort Medical, a subsidiary of Liberty Medical, has acquired Wheel:Life, a digital media publication and social community for wheelchair users. Wheel:Life, which has more than 26,000 followers on social media, served more than 100,000 website visitors in 2015. “We are excited to bring the resources and support of Wheel:Life to our customers, as well as provide the opportunity to Wheel:Life to continue expanding the community it serves,” stated Ryan Flannery, president of Comfort Medical, in a press release. Lisa Wells, founder and director of Wheel:Life, will continue to oversee day-to-day operations, partner relationships and ongoing events. Comfort Medical is a national mail-order provider of urological and ostomy supplies.

    Feds host listening session on sleep apnea proposal

    WASHINGTON – The Federal Motor Carrier Safety Administration and the Federal Railroad Administration will hold three public listening sessions in May to gather information on the prevalence of obstructive sleep apnea among those working in highway and rail transportation, according to a notice in Thursday’s Federal Register. The agencies also seek information on the potential costs and benefits from possible regulatory actions that address the safety risks associated with transportation workers who have OSA. The agencies plan to webcast each of the three sessions: May 12 in Washington, D.C., May 17 in Chicago and May 25 in Los Angeles. Previously, the two agencies announced a proposal to require sleep tests for transportation workers on March 8.

    Short takes: Invacare, NCART

    Invacareis an official supporter of the 2016 Invictus Games, which will be held May 8-12 in Orlando, Fla. The company has also donated sports wheelchairs and handbikes for competitors to use as part of the Games. Competitors will take part in 10 events, including archery, indoor rowing, powerlifting, road cycling and wheelchair rugby…NCART is asking for help on behalf of complex rehab advocate Archer Hadley of Austin, Texas. Hadley, who was a presenter at last year’s CRT conference, has been nominated for a 2016 National Philanthropy Day Honors program award. The winner of the award will be determined by online voting. NCART is asking those in the industry to vote* for Hadley at http://nominations.afpresources.org/2016npdvote. Scroll down to the “Carter Outstanding Youth in Philanthropy Group” section and check on the box Archer Hadley.


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    05/03/2016
    HME News Staff

    WASHINGTON – Longtime HME champion Rep. Tom Price, R-Ga., will introduce a bill in early May to delay a second round of Medicare reimbursement cuts in rural areas, according to The VGM Group.

    The “Patient Access to Durable Medical Equipment Act of 2016” will join a bill already introduced in the Senate that also seeks to push back the date of the cuts, which will usher in reimbursement based 100% on the competitive bidding program, from July 1, 2016, to Oct. 1, 2017.

    Unlike S. 2736, however, the House bill does not seek to speed up plans to limit federal Medicaid reimbursement for DME to Medicare reimbursement as a “pay for.” A draft of the bill states: “This act should not be enacted unless the increase in federal expenditures under this act is fully offset through a decrease in other federal expenditures.”

    The “pay for” for a bill in the House has been a sticking point for lawmakers there.

    Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., introduced S. 2736 back in March.

    The first round of cuts in rural areas—a 50/50 blend of current and adjusted reimbursement—went into effect Jan. 1.


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  • 05/06/16--10:14: Providers fear the worst
  • ‘CMS has really done themselves a number this time around’
    05/06/2016
    Liz Beaulieu

    YARMOUTH, Maine – Far-flung contract suppliers were a significant concern in the original Round 2, but it could be worse in the upcoming re-compete, HME providers say.

    For hospital beds in the Little Rock, Ark., competitive bidding area, for example, there is only one contract supplier, Camden Medical Supply, with a billing address, not even in the area, but in the state. The rest of the suppliers have addresses in North Carolina, Texas and Alabama.

    “In the original Round 2, there were local companies on the list, including local branches of national companies,” said Ted Oury, manager of Diamond Medical Equipment & Supply in Little Rock. “This time, almost nothing.”

    Even with local companies in the mix for the original Round 2, there have been access issues, Oury says, so he can’t imagine what it will be like on July 1, when CMS transitions to new pricing and suppliers.

    Just two weeks ago, Oury says he received a call from a discharge planner trying to make arrangements for a bed for a Medicare beneficiary. He told her he didn’t have a contract for beds and, therefore, couldn’t help her.

    “She said, ‘I can’t find a bed anywhere,’” he said. “That was on a Friday. I know for a fact that this patient didn’t discharge until Tuesday. Medicare could have bought four beds for the cost of that extended hospital stay. I see it all the time.”
    The situation is even worse for nebulizers, a new product category, in the Boston bid area. None of the contract suppliers have billing addresses in the area or even the state—the closest is in Alabama. The rest? Florida, Texas, Mississippi and Puerto Rico.

    “CMS has really done themselves a number this time around,” said Gary Sheehan, president and CEO of Cape Medical Supply in Sandwich, Mass. “In some respects, they’ve done us a favor. We’re already getting push back from case managers asking, ‘What are we going to do?’”

    While concerns about out-of-state contract suppliers are very real, there may be instances where the supplier operates a hub-and-spoke business model. Its billing address may be outside of the bid area, but it may have an office locally that might not serve patients but does serve as a delivery point for the area.

    “We’re in markets that are 500 miles away, but we have three drivers and an RT and a warehouse guy there,” said Joel Marx, chairman of Medical Service Company in Cleveland.

    Also, in the original Round 2, suppliers that didn’t have a presence in an area made plans to subcontract or to “sell” their contract to local suppliers. In the Round 2 re-compete, however, there will be much less of that happening, providers say.

    “That might have worked the first time, but providers are smarter now,” Oury said. “Two-plus years into it, they realize they shouldn’t have taken that offer.”


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    05/06/2016
    HME News Staff

    The “Patient Access to Durable Medical Equipment Act of 2016” will join a bill already introduced in the Senate that also seeks to push back the date of the cuts, which will usher in reimbursement based 100% on the competitive bidding program, from July 1, 2016, to Oct. 1, 2017.

    Unlike S. 2736, however, the House bill does not seek to speed up plans to limit federal Medicaid reimbursement for DME to Medicare reimbursement as a “pay for.” A draft of the bill states: “This act should not be enacted unless the increase in federal expenditures under this act is fully offset through a decrease in other federal expenditures.”

    The “pay for” for a bill in the House has been a sticking point for lawmakers there.

    Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., introduced S. 2736 back in March.

    The first round of cuts in rural areas—a 50/50 blend of current and adjusted reimbursement—went into effect Jan. 1.

    House committee launches inquiry into prosthetic changes

    WASHINGTON – The House Committee on Oversight and Government Reform has launched an inquiry into the draft local coverage determination for prosthetics.

    In a letter to Department of Health and Human Services Secretary Sylvia Burwell, the committee says the LCD, released in July, relies on outdated data to limit access to clinically appropriate and medical necessary prosthetic care for Medicare beneficiaries.

    “We are concerned that this draft LCD would deny access to advanced and higher quality prosthetics that improve mobility, function and independence of those beneficiaries,” the committee states.

    To help it understand the draft LCD, the committee requests, among other things, documents to determine CMS’s justification and process for deferring to LCDs, rather than the national coverage determination.

    Last week, Rep. Renee Ellmers, R-N.C., introduced a bill that would halt the changes to coverage for prosthetics. The “Preserving Access to Modern Prosthetic Limbs Act of 2016” would restrict CMS from implementing the draft LCD until at least June 30, 2017.

    The bill would also require the agency and its contractors to remove the draft LCD from their websites. Private payerslike United Healthcare and Cigna have made coverage changes since it was made public in July.

    Hollister, Byram settle for millions

    BOSTON – Hollister and Byram Healthcare Centers have agreed to pay $11.4 million and $9.3 million, respectively, to resolve allegations that they engaged in a kickback scheme designed to increase sales and profits, the U.S. Attorney’s Office for the District of Massachusetts announced April 29.

    The settlement with Hollister resolves allegations that, from 2007 through 2014, it paid kickbacks to Byram in return for marketing promotions, conversion campaigns, and other referrals of patients to its ostomy and continence care products.

    The settlement with Byram resolves allegations that, in 2012 and 2013, it received numerous kickbacks from Hollister and three other manufacturers of ostomy and continence care products—Coloplast, Montreal Ostomy and Safe N’ Simple—in return for its agreement to conduct promotional campaigns and to refer patients to the products of these manufacturers. It also resolves allegations by the federal and California state governments that Byram submitted inflated claims to the Medi-Cal program in violation of state regulations that limit the amount a provider can bill for certain products.

    The settlements resolve allegations in a whistleblower lawsuit filed by two former employees and one current employee of Coloplast under the qui tam provisions of the False Claims Act.

    In response to the settlements, Bryam stated, "There is no finding of liability."

    "We are pleased to have put this matter behind us," stated Perry Bernocchi, CEO. "We look forward to continuing to serve our customers by delivering high-quality supplies and services prescribed by their health care professional, supporting their treatment and improving their health and quality of life."

    Claims against two other defendants, Coloplast and Liberator Medical Supply, were resolved in December 2015 for almost $3.7 million. The new settlements bring the total recovery in the case to $24.6 million.

    BOC to sunset new certifications

    OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) plans to stop accepting new applications for its orthotist (BOC), prosthetist (BOCP) and pedorthist (BOCPD) certifications. BOC says the move will help the organization grow and streamline the profession’s credentialing options. “BOC has been a recognized partner in these fields for more than 30 years and remains firmly committed to supporting our certificants and the millions of people who depend on BOC professionals to improve the quality of their lives,” said L. Bradley Watson, BOCO, BOCP, LPO, and chairman of the BOC board of directors.BOC will accept applications for the orthotist, prosthetist and pedorthist certifications through July 31, 2016.

    CVS touts infusion care at home

    WOONSOCKET, R.I. – Home infusion care is safe and clinically effective, and improves quality of life, all the while reducing costs, according to a new study by CVS Health Research Institute that has been published in Healthcare: The Journal of Delivery Science and Innovation. “As the U.S. healthcare payment system shifts from volume to value, we are focused on identifying new approaches to health service delivery that provide better care and improve patient outcomes, while lowering costs,” said Troyen Brennan, M.D., study author and chief medical officer for CVS Health. “Our research shows that home infusion care is a promising model that is both cost- and clinically effective, and is overwhelmingly preferred by patients when intravenous therapy is required.” Researchers conducted a systematic review of existing peer-reviewed research, evaluating infusion care for several conditions. They compared measures of quality, safety, clinical outcomes, quality of life and costs of home infusion services to those provided in medical settings. From a cost perspective, they found savings ranging between $1,928 and $2,974 per course of treatment for infusion care provided in the home vs. an institutional setting. CVS provides home infusion services through Coram, which it bought in 2013.

    Hoveround simplifies doctor-patient interactions

    SARASOTA, Fla. – Hoveround has introduced a comprehensive kit for physicians to make it easier for them to identify and gather essential information about a patient during an examination. The kit’s documentation, charts and checklist also help ensure insurance requirements are properly evaluated and assessed during the examination. “Fitting a Hoveround power chair to a patient’s specifications is an important step in maintaining their comfort and well-being,” said Tom Kruse, founder and president, in a release. “Our kit helps assist doctors, staff and patients with selecting the items available to build a Hoveround power chair.” Late last year, the Office of Inspector General told Hoveround to pay back the federal government $27 million for power mobility devices that it says did not meet Medicare requirements. Hoveround disagreed with the findings, saying that the OIG applied incorrect standards, and that the agency influenced the medical review and biased the results. 

    New tagline at Harmar ‘speaks to consumer’

    SARASOTA, Fla. – Harmar has launched a new tagline, “Lifts for Life,” to represent its mission of making lives better with its line of lifts. “This simple identification speaks to what Harmar’s products do for people who are mobility challenged,” said David Baxter, vice president of marketing. “This change also helps Harmar’s brand speak to the consumer.” Harmar will begin using the new tagline this month.

    Prism reports revenue increase

    TORONTO – Prism Medical announced revenues of $14.7 million for the first quarter ended Feb. 29, 2016, an increase of 20% compared to the same period last year. Adjusted EBITDA was $1.5 million. The company says government funding for its products in Canada is a key driver of sales. Prism also believes that the U.S. market holds the greatest long-term potential for revenue growth in both the home care and institutional markets.

    Convaid, R82 combine sales efforts

    TORRANCE, Calif. – The sales and marketing teams at Convaid and R82 have been combined, Chris Braun, president of Etac North America, announced in a recent letter to partners. Convaid sold to Etac AB in 2015. Etac offers products for the pediatric market through its R82 brand. “I am happy to announce that as of May 1, 2016, we are combining the R82 and Convaid sales and marketing teams to bring you one premium pediatric product line to support your customers with the broadest offering to provide the child and their caregivers the greatest freedom and ability to go places,” he said. Among the benefits of the change, Braun says, is one business development rep in a territory to take care of all pediatric needs, whether it’s products from the Convaid or R82 brand. Convaid products will continue to be ordered, custom-made and shipped from Los Angeles. R82 products will continue to be ordered and shipped from Charlotte, N.C., Braun says.

    PMDRX adds orthotic component

    GLENDALE, Ariz. – PMDRX has launched a new orthotic bracing exam and documentation component for prescribing practitioners to help them determine patient medical necessity for off-the-shelf orthotic bracing. The tool does not “force” qualification—it assists prescribers in painting a clear picture of whether or not a patient has medical necessity for a brace, helping to eliminate documentation errors. “Previously, orthotic device providers were reporting a documentation error rate as high as 85%,” the company states in a press release. Upon completion of an evaluation, prescribers have the ability to auto-format the completed exam into a CMS-compliant comprehensive report. They can also electronically authenticate and sign the final documentation with their password-protected signature.

    BioScrip reports loss in revenues

    DENVER – BioScrip reported net revenues of $238.5 million for the first quarter of 2016, compared to $244.4 million for the same period a year ago, a decrease of 2.4%. Adjusted EBITDA was $7.4 millionvs. $4.9 million. The company said it was “pleased” with results and that the decrease in revenue stems from a planned shift in revenue mix away from lower margin chronic infusion revenue to its core infusion business.http://www.hmenews.com/article/bioscrip-brings-turnaround-team-losses-mount

    Short Takes: HDIS, PlayMaker CRM, Somnoware Healthcare Systems

    Home Delivery Incontinent Supplies, a provider of incontinence products, celebrates 30 years of business this year. Besides delivering incontinence supplies directly to homes, HDIS in recent years began offering personal care products, home safety items and aids to daily living…PlayMaker CRM plans to nearly triple the number of employees at its new Raleigh office this year from five to 14. “The developers we’re looking for, they’re just not in Nashville,” said Thad Parker, vice president of engineering, in a release. “They’re in Raleigh."…Somnoware Healthcare Systems, a cloud-based platform for sleep wellness and sleep disorder management, has secured $9 million in Series A funding led by TransLink Capital, with participation from World Innovation Lab. The investment will be used to help its customers better manage sleep apnea, lower costs and improve patient outcomes.

    People in the news: Connally, Fletcher & Ricker, Whitehall, Vishnevetsky

    Thad Connally, president of the Kentucky Medical Equipment Suppliers Association, will be presented with the AAHomecare/Mal Mixon Legislative Advocate Award at the association’s Washington Legislative Conference later this month for his advocacy record at both the state and federal levels…Derek Fletcher has been named adult products manager for Molift, Immedia and R82, while Steve Ricker has been promoted to eastern region sales manager of the pediatric group comprised of R82 and Convaid…Ian Whitehall has been appointed chief sales officer of SP Industries, managing and directing all of the company’s global sales programs for three divisions: SP Scientific, SP Scienceware and SP Ableware…Healthcare attorney Edward Vishnevetsky was recently recognized as a Chambers USA 2016 "Legal Leader in the Field of Health Law" and as a 2016 Texas Super Lawyers "Rising Star” for the third consecutive year. 


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    05/06/2016
    HME News Staff

    WASHINGTON – In highly anticipated clarifications on coding and coverage requirements for ventilators, the DME MACs have acknowledged that coverage for the product category isn’t quite black and white.

    While the National Coverage Determination stipulates that vents are covered for neuromuscular diseases, thoracic restrictive diseases and chronic respiratory failure, the DME MACs acknowledge that these disease groups overlap conditions described in the local coverage determination for respiratory assist devices.

    “Each of these disease categories are conditions where the specific presentation of the disease can vary from patient to patient,” the DME MACs state in a joint publication published May 5. “For conditions such as these, the specific treatment plan for any individual patient will vary. Choice of an appropriate treatment plan, including the determination to use a ventilator vs. a bi-level PAP device, is made based upon the specifics of each individual beneficiary’s medical condition. In the event of a claim review, there must be sufficient detailed information in the medical record to justify the treatment selected.”

    The DME MACs also reiterate coding requirements for vents. As of Jan. 1, 2016, all products classified as vents must be billed using E0465 (invasive) or E0466 (non-invasive). Products previously assigned to E0450 and E0463 must use E0465; those previously assigned to E0460, E0461 and E0464 must use E0466.

    The DME MACs reminded providers that vents are classified in the frequent and substantial servicing (FSS) payment category, while CPAP and bi-level PAP items are in the capped rental payment category, and that policy prohibits FSS payment for devices used to deliver continuous and/or intermittent positive airway pressure, regardless of illness.

    “This means that products currently classified as E0465 or E0466, when used to provide CPAP or bi-level PAP therapy, regardless of the underlying medical condition, may not be paid in the FSS payment category,” they state.

    The DME MACs also say:

    • The upgrade billing provisions may not be used to provide a vent for conditions described in the PAP or RAD LCDs. Upgrade billing across different payment categories—again, vents are classified in the FSS payment category, while CPAP and bi-level PAP items are in the capped rental payment category—is not possible.
    • Medicare does not cover spare or back-up equipment, but it will make a separate payment for a second piece of equipment if it is required to serve a different medical purpose that is determined by the beneficiary’s medical needs.

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    05/13/2016
    Tracy Orzel

    WASHINGTON – A bill introduced in the House of Representatives last week that would delay an upcoming second round of Medicare reimbursement cuts has hit the ground running. 

    H.R. 5210, introduced May 12 by Reps. Tom Price, R-Ga., Dave Loebsack, D-Iowa, and Peter Welch, D-Vt., has 40 original co-sponsors.

    “It sends a great message,” said John Gallagher, vice president of government relations for The VGM Group. “Most of them are on the Energy and Commerce and Ways and Means committees. But we still need to get folks energized to move it.”

    Like its sister bill in the Senate, The Patient Access to Durable Medical Equipment (PADME) Act of 2016 would push back the second cut in non-bid areas from July 1, 2016 to Oct. 1, 2017. The only difference between the two bills is the “pay-for.”

    While the Senate bill has a pay-for that would speed up plans to limit federal Medicaid reimbursement for DME to the Medicare payment rates from Jan. 1, 2019, to Oct. 1, 2018, the House bill has a “placeholder pay-for” to give committees time to find an alternative approach.

    “On the House side, there were some concerns with Rep.Fred Upton, R-Mich., chairmanof the House Energy and Commerce Committee,” said Jay Witter,senior vice president of government relations for AAHomecare. “He’s focused on the 21st Century Cures Act, and is trying to control any pay-fors that may impact that legislation. But everyone agrees with the underlying policy that those cuts should be delayed.”

    With time ticking down, legislators plan to pass the bills by unanimous consent, the same way they passed a bill to stave off CMS's plan to apply competitive bid pricing to accessories for complex rehab power wheelchairs in 2015.

    “Normally you want to attach bills to a larger bill, but there really is no moving bill before July 1,” said Witter. “So the Senate Finance Committee designed this one to be non-controversial, so it can move quickly.”

    Ideally, stakeholders would like to see the bills passed in the next two weeks.

    “I know our champions want to pass it sooner rather than later to make sure CMS doesn’t have any excuse not to implement it,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “The objective is not to do it June 30; the objective is to do it in advance of that.”


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    05/13/2016
    HME News Staff

    NEW BRAUNFELS, Texas – The Justice Department will not bring criminal charges against former executives of the now defunct The Scooter Store, according to the San Antonio Express-News.

    “Based on the results of a five-year investigation, the Justice Department does not believe it has sufficient evidence to prove criminal liability beyond a reasonable doubt as to senior managers at The Scooter Store,” said agency spokesman Peter Carr in an email to the newspaper.

    The decision comes more than three years after federal and state agencies raided The Scooter Store as part of an ongoing probe into possible Medicare fraud.

    The former chairman and CEO of The Scooter Store, Doug Harrison, denied any wrongdoing in an interview with the newspaper in January 2014.

    A number of execs left The Scooter Store prior to the raid, including Mike Pfister, chief sales officer, in January 2012, followed by Harrison in March of that year, and numerous others.

    The Scooter Store and its management had also come under scrutiny by Congress. In April 2011, when the company found about $32 million to $64 million in overpayments and agreed to pay back $19.5 million, a pair of U.S. senators wanted to know why CMS accepted such an agreement.

    The Scooter store filed for bankruptcy in April 2013 and closed in September of that year.

    CMS revises scope of review on redeterminations and reconsiderations

    WASHINGTON – CMS has expanded the limits on the scope of review for redeterminations and reconsiderations to include complex prepayment audits, AAHomecare has announced. CMS’s initial instructions to the MACs and QICs applied the limits to post-payment reviews. AAHomecare worked with CMS on revised instructions that read: “For redeterminations and reconsiderations of claims denied following a complex prepayment review, a complex post-payment review, or an automated post-payment review by a contractor, CMS has instructed MACs and QICs to limit their review to the reason(s) the claim or line item at issue was initially denied. Prepayment reviews occur prior to Medicare payment, when a contractor conducts a review of the claim and/or supporting documentation to make an initial determination.” AAHomecare says the change should be helpful to providers as they work through the audit and appeal process.

    M&A activity: Securi-T, Sigvaris, National Sleep

    LARGO, Fla. – Securi-T USA has announced an acquisition that will allow the company to expand its portfolio of products beyond ostomy care.

    Securi-T USA, which has been serving the ostomy community for more than 20 years, has agreed to acquire PECO Medical, a Las Vegas-based designer and developer of continence care products.

    “For nearly two decades, providers have relied upon us for high-quality, reimbursement-friendly ostomy products, and they have encouraged us to expand into urological items,” said Greg Bosco, president of Securi-T USA. “We are happy to accomplish this through the planned acquisition of PECO Medical, and we look forward to expanding the existing customer base for PECO products.”

    The teams at Securi-T and PECO Medical will be working closely to ensure a smooth transition.

    “It will be business as usual for our valued customers,” said Michael Jones, president of PECO Medical.

    Sigvaris strengthens market position

    PEACHTREE CITY, Ga. – Sigvaris has completed a definitive agreement to purchase BiaCare, a Zeeland, Mich.-based manufacturer of short stretch wraps, compression garments and other products designed to treat patients with veno-lymphatic diseases and disorders. The acquisition strengthens Sigvaris’ market position and allows the company to serve even more patients under a single brand. “This transaction allows us to acquire an established manufacturer with a strong position in the U.S. market,” stated Urs Toedtli, CEO of Sigvaris Group. Sigvaris is part of an international medical device group headquartered in Winterthur, Switzerland, that focuses on the development, production and distribution of medical compression garments, including hosiery and socks. It has distribution in more than 70 countries on six continents.

    National Sleep makes buy

    CONCORD, N.H. – National Sleep & Respiratory has acquired Eastern Pulmonary Services. Salem, Mass.-based Eastern Pulmonary Services was founded by Phil Raby and Kate Raby in 1980. “We could not be more thrilled to be have Phil and Kate Raby and the entire Eastern Pulmonary Service staff as part of our team,” said Peter Falkson, CEO of National Sleep and Respiratory. “Their experience, dedication to their patients, and character will only make National Sleep & Respiratory better.” Formerly known as National Sleep Therapy, the company started making acquisitions in 2012.

    GAO pokes holes in CMS’s MA audit program

    WASHINGTON – The Government Accountability Office isn’t pleased with CMS’s progress in recovering substantial amounts of improper payments from Medicare Advantage organizations. The agency currently uses risk adjustment data validation audits to recover improper payments in the MA program. The GAO found that CMS’s methodology does not result in the selection of contracts for audit that have the greatest potential for recovery of improper payments. The GAO also found “substantial delays” in the audits. It says RADV audits of 2007 and 2011 payments have taken multiple years and are still ongoing for several reasons. Additionally, it noted that CMS did not expand the recovery audit program to MA by the end of 2010, as required by the Patient Protection and Affordable Care Act. In 2014, Medicare paid about $160 billion to MA organizations to provide healthcare services to 16 million beneficiaries. CMS estimates that about 9.5% of those payments were improper.

    ITC accepts ResMed’s request to investigate

    SAN DIEGO – ResMed has announced that the U.S. International Trade Commission has accepted its request to investigate alleged infringement of its patented technology by Chinese manufacturer BMC Medical and its U.S. distributor, 3B Medical. The ITC has agreed to review the alleged infringement of four ResMed patents by BMC’s first and second-generation flow generator products, the RESmart and the Luna. The patents that have been allegedly infringed include a patent relating to a flow generator and humidifier structured to reduce the risk of backflow of water from the humidifier into the flow generator when tipped; and a number of patents relating to a novel design for a flow generator and humidifier to improve performance and ease of use. ResMed is asking the ITC to stop BMC and 3B from importing and selling flow generators in the United States. ResMed has also filed a lawsuit in federal court in San Diego seeking damages.

    Alliqua reports growth

    YARDLEY, Pa. – Alliqua BioMedical, a provider of advanced wound care products, reported revenues of $4.6 million for the first quarter of 2016, an increase of 120% over the same period a year ago. Organic total growth was approximately 4%. Product revenue was $4.1 million for the quarter, a 177% increase over the same period in 2015. “We remain extremely encouraged by the compelling commercial opportunity for our portfolio of advanced wound care technologies and expect that our continued execution will drive improving growth trends over the course of 2016,” said CEO David Johnson.

    Bussani Mobility supports Mobility Awareness Month

    BETHPAGE, N.Y. – Bussani Mobility Team, along with the National Mobility Equipment Dealers Association (NMEDA), kicked off the fifth annual National Mobility Awareness Month by offering three wheelchair accessible vans through an online contest. Celebrated in May, the awareness month was created to educate seniors, veterans and caregivers about the many wheelchair accessible vehicles and adaptive mobility equipment options available. To win, participants must submit their written or videotaped stories about how they have overcome their mobility issues. The winners will be announced in June.
    Stock movers: Invacare and ResMed

    Heartland Advisors has picked up 88,747 additional shares of Invacare stock, the firm disclosed in a report filed with the SEC on May 3. Heartland Advisors now holds about 3.6 million shares valued at about $39.95 million. Invacare now makes up about 2.09% of its portfolio…Peter Farrell, a director at ResMed, sold 20,000 shares of the company’s stock at an average price of $55.90 in a transaction on May 4 valued at about $1.12 million. He now owns 367,978 shares valued at about $20.6 million.

    Short takes

    Enos Home Medical has acquired the hospice division of Cape Medical Supply. The deal makes the New Bedford, Mass.-based provider the largest hospice supplier in southeastern Massachusetts. The Sandwich, Mass.-based Cape Medical Supply is focusing on its sleep business…Watertown, N.Y.-based Howard Orthotics and Prosthetics plans to open a new location in Canton…Lighthouse Medical Equipment held a grand opening celebration on May 5 at its Bristol, Conn., location…Phillip Durchslag has joined SleepQuest as vice president of sales and marketing. Durchslag has more than 30 years of experience in branding, marketing and sales, most recently with Healthways…Alex Orthopedic celebrates 30 years in business this year. Founded in 1986, the company began as a manufacturer of orthopedic soft goods and soon expanded its product portfolio to include pillows, cushions, DME, diagnostic products, compression hosiery and designer canes.

     


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    05/13/2016
    HME News Staff

    WASHINGTON – A highly anticipated bill in the House of Representatives that would delay an upcoming second round of Medicare reimbursement cuts in non-bid areas has dropped with a bang.

    The bill, H.R. 5210, introduced Thursday by Reps. Tom Price, R-Ga., and Dave Loebsack, D-Iowa, has 40 original co-sponsors, including a number of members on the influential Energy & Commerce Committee.

    “We are extremely proud of our members who have remained determined and engaged to gather support for this legislation,” said John Gallagher, vice president of government relations for the VGM Group, in a press release.

    Like its counterpart in the Senate, H.R. 5210 would delay the second round of cuts for 15 months, from July 1, 2016, to Oct. 1, 2017.

    The delay would give industry stakeholders time to work with a new administration in 2017 on a long-term solution that ensures patients in rural areas have access to quality medical equipment, Gallagher says.

    Unlike S. 2736, however, the House bill has a “placeholder pay-for” to give House and Senate committees an opportunity to consider alternative approaches. The Senate bill’s “pay-for” would speed up plans to limit federal Medicaid reimbursement for DME to the Medicare payment rates from Jan. 1, 2019, to Oct. 1, 2018.

    The first round of cuts went into effect in non-bid areas Jan. 1, 2016.

    Each the first and second round cuts represent about 25% reductions in the prior fee schedule.


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  • 05/17/16--07:20: ResMed connects vents
  • Up next: portable oxygen concentrators
    05/17/2016
    HME News Staff

    SAN DIEGO – ResMed already offers CPAP devices with cloud connectivity and soon it will offer life support ventilators with the same capabilities.

    The company announced at the American Thoracic Society conference this week that it plans to bring cloud connectivity and its remote patient monitoring software, AirView, to its Astral life support ventilators later this year.

    “Cloud connectivity is a major factor in the future of health care,” said Raj Sodhi, president of the ResMed’s Healthcare Informatics business unit. “We’ve seen the great impact that ResMed’s AirView has had on patient outcomes and business efficiencies related to managing sleep apnea and other respiratory conditions.”

    ResMed already has more than 2.5 million of those patients monitored through AirView.

    Cloud connectivity will allow physicians and HME providers to access key patient data to better manage and improve the outcomes of the thousands of patients who currently rely on Astral vents at home. They will have the option of accessing patient data through AirView or the ResMed Data Exchange, which allows them to integrate their own electronic medical records with AirView.

    Select customers are currently piloting cloud connectivity on Astral vents.

    Next, ResMed plans to bring cloud connectivity to the portable oxygen concentrators of Inova Labs, which it acquired earlier this year.


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    Providers are accepting assignment, so the reimbursement must be adequate, agency reasons
    05/18/2016
    HME News Staff

    WASHINGTON – CMS announced this week that it believes reimbursement cuts implemented Jan. 1 in non-competitive bidding areas have not had a negative effect on beneficiary access.

    CMS compared the rate of assignment of claims for DMEPOS items for the first four months of 2015, which were paid at the unadjusted fee schedule rates, to the rate of assignment of claims for the same items for the first four months of 2016, which were paid at the new partially adjusted rates. 

    “The monitoring data shows that suppliers in all areas where the adjusted DMEPOS fee schedule rates have been implemented have continued to accept these adjusted rates as payment in full, suggesting that the adjusted fee schedule rates continue to be more than adequate in covering the costs of furnishing the DMEPOS items in all areas,” the agency stated.

    On Jan. 1, Medicare began paying for HME in regional and rural areas based on a 50/50 blend of the current fee schedule and adjusted rates from its competitive bidding program. On July 1, it will base pricing 100% on adjusted rates.

    Overall, there was no change in the rate of assignment for the first four months in 2016 (99.88%) compared to the first four months in 2015 (99.87%). There was also no change in the rate of assignment in rural areas in 2016 (99.9%) compared to 2015 (99.9%). The rate of assignment in non-contiguous areas changed slightly in 2016 (99.81%) compared to 2015 (99.90%).

    “CMS believes that the fee schedule adjustments implemented in January have not had a negative impact on beneficiary access to quality items and services,” stated the agency.

    CMS says it will continue to monitor data.


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    05/20/2016
    Tracy Orzel

    Springfield, Ill. – As Illinois looks to reduce spending on incontinence products, providers in the Prairie State say it’s going about it the wrong way. 

    In January, the Illinois Department of Healthcare and Family Services issued an RFP to select a single supplier that would provide all incontinence supplies to the state’s Medicaid beneficiaries. 

    “If you specialize in that market, it could mean closing down,” said David Doubek, president of Alsip, Ill.-based Doubek Medical Supply. “We’re a little more diverse, so we would survive, but it would be another punch to the gut.”

    In 2014, 406 providers delivered $51.2 million worth of incontinence supplies, according to the Great Lakes Home Medical Services Association.

    “How is one provider going to supply hundreds of orders of incontinence products a day,” said Doubek. “I would consider myself a middle to large-sized provider and it’s not even something that I would consider getting involved in.” 

    There’s also concern that product quality would decrease. 

    “Whoever won the RFP would be one-dimensional as far as product line,” said Doubek. “The shapes and sizes of people’s bodies are different. They may be serviced, but they’re not going to be serviced
    properly.”

    The deadline for the RFP was pushed back from April 22 to May 6, after negotiations to reduce reimbursement rates for incontinence products in lieu of a single supplier model failed.

    “We thought we had an agreement in place, but the day before they were supposed to pull the RFP, they changed their mind,” said Matt Peterson, president of the Great Lakes Association. “The department indicated that they had already received some submissions and they wanted to take a look at the offers.”

    Because the RFP does not provide a timeline beyond the May 6 deadline, Peterson says the ball is in the state’s court.

    “They can award one contract or decide not to award any contract,” he said. “It really is up to them at this point.”


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    They say the agency’s data is ‘grossly inadequate’ to assess impact of bid program
    05/20/2016
    Theresa Flaherty

    WASHINGTON – CMS took too narrow a view when it analyzed the impact of new payment amounts for HME using only one metric, industry stakeholders say.

    The agency on May 17 released data comparing the rate of assignment of claims for DMEPOS items for the first four months of 2015, which were paid at the unadjusted fee schedule rates, to the rate of assignment of claims for the same items for the first four months of 2016, which were paid at the new partially adjusted rates. 

    “They’ve taken one micro piece of data that doesn’t tell the story,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

    On Jan. 1, Medicare began paying for HME in regional and rural areas based on a 50/50 blend of the current fee schedule rates and adjusted rates from its competitive bidding program. On July 1, it will base pricing 100% on adjusted rates.

    Other key metrics that should have been included in CMS’s analysis, stakeholders say: the volume of claims submitted, patient outcomes data, and beneficiary complaints. A pair of bills, S. 2736 and H.R. 5120, which would push back the second phase of cuts, include provisions for more comprehensive monitoring of the program to understand its impact.

    “CMS has no clue what’s going to happen and they should want to understand the impact,” Bachenheimer said.

    As for the data CMS did analyze, stakeholders say the agency neglected to say whether the claims were for date of service or date received, meaning some of the claims for 2016 could have been paid at 2015 rates. The agency also neglected to say whether they included dual-eligibles, for whom providers must accept assignment.

    Most important, analyzing only four months of data does not a hard conclusion make, stakeholders say.

    “Fourmonths of claims is a ‘grossly inadequate sampling,’” stated AAHomecare in its analysis. “It is not possible to use such limited data and draw expansive conclusions as CMS did.”

    The short timeframe also doesn’t take into account the likely possibility that the impact of the cuts hasn’t been fully felt by providers—yet, Bachenheimer says.

    “I’d say it takes a business about a year to reconfigure, to go out of business, to downsize,” she said. “It’s not an instantaneous response.”

    Stakeholders say they’ll use this latest data from CMS to bolster support for the two bills this week at the AAHomecare Washington Legislative Conference. The Senate bill has 27 co-sponsors; the House bill, introduced May 12, picked up an additional 15 co-sponsors last week, bringing its total to 59.


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  • 05/20/16--10:43: Providers appeal for help
  • ‘They’ll miss us when we’re gone,’ says Karyn Estrella
    05/20/2016
    Theresa Flaherty

    PORTLAND, Maine – Providers from around New England took to the podium at a Small Business Administration hearing here last week, giving government officials and lawmakers an eye-opening look at what it’s like to be in the HME business right now.

    “I am here today to tell you that CMS's implementation of competitive bidding, capped rentals on home oxygen therapy and ongoing unnecessary audits…is as bad, if not worse, than what is going on with the Veterans Administration,” said Michael McDonald of Clinical 1 Home Medical. “The time has come for Congress to launch an investigation into this program.”

    McDonald was one of several HME providers who testified about the impact of competitive bidding and other issues on small businesses at the May 16 regulatory fairness hearing, one of several being held across the country.

    McDonald discussed his company’s own experience with the bidding program—“a complete disaster,” he said—and also questioned the impact on patients of a program in which local providers are not awarded contracts.

    “How in the world is a company in Florida going to provide same day delivery to Mass General Hospital on a Friday afternoon?” he said.

    Providers also testified on burdensome documentation requirements and excessive audits. Provider Darryl Coplan typically appeals audits at great time and expense to his company, but he always comes out on top.

    “We feel honored when we win, but it takes two-and-half years,” said Coplan, of Keene Medical. “How can companies survive when the government holds their money for that long?”

    One of the board members asked how most auditors get paid. Upon hearing that they are paid a percentage of the money they recoup, a shockwave—and a few low whistles—rippled through the audience, which included staffers from several lawmakers’ offices, including Sens. Angus King, I-Maine, Susan Collins, R-Maine, and Jeanne Shaheen, D-N.H.

    Perhaps some of the most powerful testimony of the afternoon came from Dr. Susan Bergman, a Massachusetts physician, who shared the stories of three patients who died either while waiting for necessary equipment or because Medicare coverage guidelines imposed limits. One of those patients: a 46-year-old triplegic who suffered two bouts of sepsis and ended up on life support.

    “He needed to change his catheter every two weeks to avoid infections, but Medicare would allow only one per month,” she told the board. “His hospital expenses were well over $1 million.”

    Board members asked how much a catheter costs and upon learning it was typically less than $2, one said,

    “So for the cost of a few trips to Starbucks, (this could have all been avoided).”

    At the hearing’s close, SBA Ombudsman Admiral Earl Gay referenced recent hearings in the Dakotas, as well as a roundtable in Cheyenne, Wyo.

    “We need to continue to ask (lawmakers) to initiate legislative resolutions to these issues,” he said.

    With more than 10,000 people turning 65 every day, there’s no time to waste, said Karyn Estrella, executive director of the Home Medical Equipment and Services Association of New England.

    “If CMS thinks it is paying too much for home medical equipment now, wait until there is a shortage of providers,” she said. “They’ll miss us when we’re gone.”

     


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  • 05/20/16--10:39: The relationship builder
  • Laura Williard will help AAHomecare ramp up resources for managed care market
    05/20/2016
    Liz Beaulieu

    WASHINGTON – What’s the key to HME providers thriving in the managed care market? Relationship building, says Laura Williard, who was named last week to a new position at AAHomecare, senior director of payer relations.

    “I’ve built relationships with a lot of these payers,” said Williard, currently the senior director of regulatory affairs and contracting for Greensboro, N.C.-based Advanced Home Care. “Once you have those relationships, you can get in and talk with them about collaborative solutions, and it’s easier to work with them.”

    Here’s what Williard, who is also involved with the state associations in North Carolina, Georgia and Tennessee, had to say about how she plans to help providers make inroads into this growing, but sometimes elusive, market.

    HME News: How has your experience at Advanced Home Care prepared you for this larger role at AAHomecare?

    Laura Williard: When I first started at Advanced 24 years ago, we were 65%-70% Medicare, and 30%-35% Medicaid and managed care. We’ve essentially flipped that. Most of that growth has been in Medicare Advantage and Medicaid HMO plans.

    HME: What should be the foundation of the relationship between providers and managed care organizations?

    Williard: Data. It’s important when you’re dealing with these payers that you show your value and your worth.  What are the outcomes and volume of services you provide for their patients. If they’re considering cuts, what are other areas where you can eliminate cost out of providing the service. For example, you can go to them and say, “Let’s talk about the prior authorization process.” How much unnecessary cost is there for the payer and the provider in the operational processes? If you cut the cost of providing the service, it can minimize some of the impact of rate cuts.

    HME: What are some of the challenges of the managed care market?
    Williard: They often interpret the rules their own way. A recent example of that is a payer denying a detailed description because it just included the HCPCS code and description. The DME MACs have been passing those, but with this payer, it has taken three levels of appeals to get it overturned. The MACs pretty much interpret and audit the same way, so there’s some semblance of consistency. We want some of that to spread out to Medicare Advantage.

    HME: What are some of the benefits?

    Williard: You have the ability to talk to someone and negotiate with them on a smaller level. With Medicare, you’re fighting a huge battle. With managed care, there can be more flexibility.

    HME: What does it say that AAHomecare has developed a position specifically to focus on the managed care market?

    Williard: I think it shows a commitment to the industry. It shows it’s looking beyond Medicare. AAHomecare is trying to broaden the resources for providers to make the industry stronger.


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    05/20/2016
    HME News Staff

    NASHVILLE, Tenn. – Wellspring Capital Management is shopping for a buyer for National Seating & Mobility, according to news reports last week.

    The private equity firm has hired Piper Jaffray, an investment bank and asset management firm offering M&A services, to find a buyer for the complex rehab provider, which it says could be worth $400 million, according to an item on Fortune.com citing The Wall Street Journal.

    Wellspring Capital acquired NSM in early 2013. At the time, the provider had 68 branches located across 30 states.

    Since then, NSM has rolled up dozens of mobility providers, including, most recently the complex rehab division of Webb Medical Systems in Reading and Allentown, Pa., in February, and Home Medical Equipment in Garden City, N.Y., last November.

    NSM has also thrown its hat into the home accessibility market, launching AccessNSM in October. AccessNSM offers stair lifts, wheelchair lifts, ramps, door openers and barrier-free showers through seven locations from Massachusetts to North Carolina.

    Bill Mixon took over the reins as CEO of NSM from founder Mike Ballard in July 2015.

    Home Health United closes four retail stores

    MADISON, Wis. – Home Health United-Home Medical Equipment blames recent changes in Medicare reimbursement rates for its decision to close retail stores in Johnson Creek, Platteville, Portage and St. Mary’s Hospital. The provider will continue to provide these communities with HME, as well as home health, hospice and palliative care, but it will no longer have retail storefronts as of May 20. “Suppliers of home medical equipment across the country are dealing with the challenge of how to provide high quality products and services at severely reduced reimbursement rates,” the company says on its website. “These reductions have necessitated many changes in the way in which Home Health United provides equipment to patients and referral sources. Unfortunately, to manage these cuts, we have been forced to make some difficult decisions.” The company still has retail locations in Baraboo, Janesville, Madison West, Prairie du Sac and Reedsburg.

    Caire launches program to help with cash flow

    BALL GROUND, Ga. – Caire, a Chart Industries company, has launched a new program to help HME providers in today’s challenging reimbursement environment. As part of the Caire Cash Flow Management Program, providers can purchase a complete oxygen setup for $54 per month for 36 months with free shipping. “We understand the challenges that the industry faces and we have created a program that helps our provider partners address some of the challenges stemming from national competitive bidding,” said George Coppola, director of marketing at Caire. The package includes the AirSep, FreeStyle and Caire Companion 5 oxygen concentrators, all with a three-year warranty. A FreeStyle and Companion bundle gives providers a complete setup for a monthly cost well below the declining reimbursement rates for E1390 and E1392, Coppola says. “Providers can switch to a non-delivery modality to eliminate expensive cylinder deliveries, or upgrade their existing non-delivery fleet with new inventory,” he said.

    VGM broadens financing options

    WATERLOO, Iowa – VGM and Associates and Whitebridge Financial have forged a partnership to provide VGM members with better access to financing options. Per the partnership, Whitebridge will offer VGM’s more than 3,000 members nationwide a variety of flexible financing options to meet their diverse needs, with the goal of becoming their “one-stop shop.” “We are constantly looking for better ways to help our members provide easier access to the products their customers need to improve their quality of life,” said Clint Geffert, president of VGM and Associates. Whitebridge Financial, in business since 2010, approves a wider range of credit profiles by going “deeper into the credit spectrum,” generating higher acceptance rates, according to a press release. Its customers do business in a variety of markets, including health care, outdoor living, vacation and bedding.

    GF hits refresh on Basic American

    ATLANTA – GF Health Products has launched a new brand identity for its Basic American Products. The rebrand includes a new logo, and updated marketing materials and educational resources. “The new brand identity reflects our commitment to ongoing innovation, and re-stamps the hallmark of our legacy in quality and leadership in the extended care industry,” said David Walton, senior vice president. Basic American products are manufactured in U.S.-based manufacturing plants. The company also has a 10,000-square-foot showroom and educational center in Atlanta.

    Study: Not all oximeters are equal

    MINNEAPOLIS – Nonin Medical this week announced the results of an independent study that demonstrates its PureSAT pulse ox technology captures and reports deteriorating patient conditions better than other brands. Boulder, Colo.-based Clinimark Laboratories tested three oximeters: one from Nonin and two from other, large manufacturers. Two of them did not provide the clinical accuracy required to track desaturations in patients with low blood circulation and labored breathing, according to a press release. “Over the years, a number of inexpensive, imported FDA-cleared oximeters have flooded the market, all claiming to be accurate,” said Jim Russell, vice president of quaIity, regulatory and clinical affairs for Nonin Medical. “This study dispels the myth that all pulse oximeters perform alike, especially on challenging patients such as those with chronic obstructive pulmonary disease (COPD). The findings were published in a white paper at the American Thoracic Society and American Telemedicine Conferences this week.

    Short takes: Hollister, NCAMES

    Hollisterhas hired medical device veteran Carolin Archibald as vice president, U.S. and Canada, to lead the company’s ostomy, continence care and critical care businesses. In this newly created position, Archibald will also oversee the company’s Secure Start services and key accounts organizations in the U.S. and Canada. She was most recently president of Medela in the U.S., where she led more than 700 employees in sales, marketing, business development, R&D, operations, quality management, regulatory affairs, finance, IT and HR…NCAMES has launched a new website. It’s the same URL, www.ncames.org, with a new look. The website is powered by ARI Network Services, a gold sponsor of the association for 2016.


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