YARMOUTH, Maine – Fifty-five percent of respondents to a recent HME Newspoll say they plan to reduce hours for certain employees so they don’t trigger an upcoming overtime rule.

The rule, which goes into effect Dec. 1, requires employers to pay overtime for salaried employees who work more than 40 hours per week and who make less than $47,476 per year.

“I don’t have a lot of salaried employees to start, but I do anticipate having to reduce hours to make sure overtime is minimized,” wrote one respondent.

Some respondents say they may have to do more than just shave a few hours.

“I could see this resulting in full-time employees becoming part-time employees,” wrote one respondent.

Alternatively, 26% of respondents say they plan to pay more overtime to comply with the rule, and 19% say they will raise salaries to avoid it altogether.

Of the respondents who will raise salaries, some say that might come at the expense of losing other benefits, like a company vehicle or vacation time.

A number of respondents say they plan to change salaried positions to hourly positions, a move that exempts those employees from the rule.

“Our retail manager’s salary is currently below this threshold, although close to it with bonus based on sales,” wrote one respondent. “We will likely change the position to hourly, calculate in set overtime and keep the bonus. It will be challenging and will likely be seen as a negative by the employee.”

A number of respondents say the rule will not affect them.

“I already pay overtime,” said one respondent.

WASHINGTON – A $900-million takedown by the Medicare Fraud Strike Force on June 22, the largest in history, included schemes involving durable medical equipment.

The nationwide sweep resulted in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for alleged false billings.

“As this takedown should make clear, healthcare fraud is not an abstract violation or benign offense—it is a serious crime,” said U.S. Attorney General Loretta Lynch, who announced the takedown with Department of Health and Human Services Secretary Sylvia Burwell. “The Department of Justice is determined to continue working to ensure that the American people know that their healthcare system works for them—and them alone.”

The individuals have been charged with various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The crimes involve various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment and prescription drugs.

In the Southern District of California, five individuals, including a doctor and pharmacist, were charged in a scheme to pay bribes and kickbacks to doctors in exchange for prescribing durable medical equipment and compound pain creams that were not medically necessary. The indictment alleges that, in this case alone, about $27 million in false and fraudulent claims were submitted.

The cases are being prosecuted and investigated by U.S. attorneys offices nationwide.

Including these most recent actions, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings.

CQRC expresses ‘disappointment’ over House inaction

WASHINGTON – The Council for Quality Respiratory Care has called on Congressional leaders to act on legislation that would retroactively delay cuts that go into effect July 1. Although the Senate on June 22 unanimously passed S. 2736, an unexpected sit-in in the House of Representatives over gun control last week prevented a similar bill, H.R. 5210, from being passed before lawmakers adjourned for the July 4th recess. “We are extremely disappointed that the PADME Act was not passed before the July 1 deadline, and strongly urge Congress to act immediately when they return to Washington. Delaying these cuts is crucial to protecting patients and providing the time needed to adequately study how cuts are impacting beneficiary access and care services,” said Dan Starck, Chairman of CQRC.

East meets west in acquisition

EXTON, Pa. – ABC Home Medical Supply has acquired Experea Healthcare, announced yesterday. Both companies are providers of disposable medical supplies, including urological, incontinence and wound care supplies. ABC Medical has a strong presence in the eastern United States while Experea ifs focused on the West Coast. “Bob Wolf and his team at Experea have created a premier provider of medical supplies on the West Coast, an area that we at ABC Medical have been interested in expanding for some time,” said Keith Jones, president and CEO of ABC Medical.

PlayMaker CRM, Emerge partner

HUNTINGTON, N.Y. – Emerge Sales and PlayMaker CRM have joined forces to bring sales training and sales software to HME providers. “Our sales training methodology teaches sales reps to shine the spotlight on how their company can better serve referral sources and outlines an easy-to-follow process for generating more orders,” said Mike Sperduti, CEO of Emerge Sales. “Combining that strategy with a powerful sales tool like PlayMaker CRM ensures that reps can effectively manage those relationships to maximize ROI.” The first offering from the partnership will be a webcast on July 20 at 2 p.m. EST: “Time to Grow Your HME Business Now!” During this one-hour webcast, Sperduti will share essential tactics that can strengthen HME sales processes and improve bottom lines.

Edward Vishnevetsky passes away

DALLAS – The HME industry is mourning the passing of healthcare attorney Edward Vishnevetsky this week. Vishnevetsky, counsel in the Dallas office of K&L Gates, passed away on Monday, June 20, while on vacation in Costa Rica. He specialized in healthcare and commercial litigation, representing a variety of organizations, including DME providers. Among his accomplishments: helping to remove dozens of providers from Medicare pre-payment audit and defending more than 50 providers through all stages of Medicare appeals. Vishnevetsky was a familiar face at industry events like Medtrade, and he 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. His funeral service will be held in Dallas next week.

TwinMed snags Medicaid contract

SANTA FE SPRINGS, Calif. – TwinMed has been awarded a $225 million contract to provide incontinence supplies to Medicaid beneficiaries in New York. Under the five-year contract, TwinMed will establish minimum quality standards for adult and youth size diapers, and reduce costs, while maintaining the existing provider network, according to a press release. “TwinMed is committed to providing better care at a lower cost to Medicaid beneficiaries throughout the State of New York and are pleased to partner with Governor Cuomo and the New York State Department of Health to deliver, maintain and exceed current standards as outlined by the Governor’s New York State Medicaid redesign,” said Kerry Weems, CEO. TwinMed is a national distributor of medical supplies, primarily to skilled nursing facilities. New York’s Medicaid program is one of the largest in the country with more than 5.3 million enrollees.

BioScrip completes offering

DENVER – BioScrip has completed a public offering of common stock, netting approximately $83.15 million. The company will use the proceeds to fund the cash portion of its acquisition of HS Infusion Holdings; repay a portion of outstanding borrowings from its revolving credit facility; and for general corporate purposes, according to a press release. BioScrip announced earlier this month that it would acquire the Hammonton, N.J.-based Home Solutions for $85 million—$80 million of it in cash.

Brightree names new CEO

ATLANTA – Brightree announced its acquisition by ResMed earlier this year and now it has a new CEO. Matt Mellott will take the lead at the software company, replacing current president and CEO Dave Cormack, who will transition to a multi-year advisory role. Mellott joins Brightree from MedBridge Healthcare, a sleep disorder diagnostic testing and respiratory therapy company. In his 12 years at MedBridge, most recently as president, he helped to grow the company to include 140 sleep disorder centers and 21 HME locations across 22 states. “Leading a home medical equipment provider has helped shape my understanding of what post-acute care providers value in a software partner,” he said in a press release. “I’m looking forward to sharing those insights, accelerating Brightree’s already impressive pace of innovation and further enhancing its customers’ ability to deliver exception care, while building lasting businesses.” Prior to MedBridge, Mellott served in a variety of executive finance leadership and CFO roles. He began his career with KPMG, one of the Big Four accounting firms.

In addition to Mellott, Brightree named Bobby Ghoshal COO. He will oversee the company’s technology, product management initiatives, business operations and finance functions. Ghoshal was previously vice president of information technology in ResMed’s Americas group.

Brightree was acquired by ResMed in April 2016.

Am-Med Diabetic Supplies slapped with lawsuit

INDIANAPOLIS – Indiana Attorney General Greg Zoeller is suing Am-Med Diabetic Supplies for allegedly violating the state’s Do Not Call laws by making more than 55,000 illegal robocalls to residents, according to news reports. The company, also doing business as Beyond Medical USA, allegedly made the calls, including 25,000 to residents registered on the Do Not Call list, to offer them diabetic supplies. Additionally, the company allegedly failed to disclose the true identity of the caller or company during the calls. After receiving six consumer complaints, the AG’s office launched an investigation. The lawsuit seeks civil penalties of up to $25,000 for each wrongful call.

DeVilbiss merits award

PORT WASHINGTON, N.Y. – DeVilbiss Healthcare has received a Digital Health Award for its SmartLink App for the IntelliPAP 2 CPAP System. The app received the Award of Mertis in the Telehealth/Remote Patient Monitoring category. “Drive DeVilbiss has long been recognized for producing high quality, highly reliable PAP therapy technologies, and it is an honor to be selected as a winner in the 2016 Digital Health Awards competition,” said Mitch Yoel, executive vice president of business development for Drive DeVilbiss Healthcare.

VGM Forbin advises on new ADA regs

WATERLOO, Iowa – Owners of privately held businesses now have to think about their online marketing when complying with the Americans with Disabilities Act. Websites are now included as part of Title III of the ADA, according to VGM Forbin. This means company websites will soon be legally required to comply with a set of standards called the Web Content Accessibility Guidelines, or WCAG 2.0. The guidelines include visual and functional accessibility elements: How easily can people who are blind, suffer from color blindness or have light sensitivity navigate and interact with your website? VGM will hold a webinar on this topic on June 22.

People news: Mediware, Lab Tactical, LifeWalker Mobility

EY has announced that Kelly Mann, president and CEO of Lenexa, Kan.-based Mediware, has received this year’s Entrepreneur of the Year award for the Central Midwest. The award recognizes excellence and extraordinary success in such areas as innovation, financial performance, and personal commitment to business and community. Mann was among 21 finalists in the region and among seven selected for consideration for the Entrepreneur of the Year national program…Laboratory Tactical Consulting has appointed Ron Dixon vice president of consulting services. He will be responsible for the development and delivery of on-site consulting programs. Dixon, “The Professor” as his colleagues refer to him, joins Lab Tactical from Brightree, where he was a senior consultant. Previously, he was also a compliance manager at Rotech Healthcare…LifeWalker Mobility Products, the developer and manufacturer of the LifeWalker Upright medical walker, has promoted Scott Rieger to vice president of marketing and communications. He was previously director of marketing and corporate communications for the company. In his new role, Rieger will be responsible for defining and executing LifeWalker’s market development and branding strategies, sales support initiatives, public relations and advertising programs, and investor relations.

WASHINGTON – CMS is seeking to require providers to obtain bid surety bonds, according to a proposed rule.

In proposed updates to the End-Stage Renal Disease Prospective Payment System, CMS would require bidders to get a $100K surety bond for each area they bid in.

The rule also proposes forfeiture conditions for the bid surety bonds. If a bidder does not accept a contract offer when its composite bid is at or below the median composite bid rate for suppliers used in the calculation of the single payment amount, the bid surety bond for the applicable CBA will be forfeited and CMS will collect on it. In instances where the bidder does not meet the forfeiture conditions specified in the rule, the bid surety bond liability will be returned to the bidder within 90 days of the public announcement of the contract suppliers for the CBA.

The proposed rule also contained several other bid-related items.

Appeals process

The rule also proposes to an appeals process for all breach of contract actions that CMS may take under the competitive bidding program, rather than just for contract termination actions. As a result, CMS will no longer be issuing a notice of termination, but rather a notice of breach of contract, which will include any breach of contract action CMS intends to take.

Bid limits

The rule proposes that bid limits for individual items for future rounds of competitive bidding would be based on the unadjusted fee schedule rates. This would avoid a downward trend where the new, lower bid limits apply to each subsequent round of bidding based on fee schedule rates adjusted using bidding information from the previous round. This would help to enhance the long term viability of the program and would allow suppliers to take into account both decreases and increases in costs in determining their bids.

WASHINGTON – A second round of Medicare reimbursement cuts goes into effect in non-bid areas on July 1, but it’s not time to throw in the towel, AAHomecare said in a bulletin on June 29.

“There’s nothing like a crisis to help spur legislators to action,” the association stated. “We need to make sure that we let the House of Representatives and the Senate know that these cuts are taking rural providers and patients to the precipice of disaster.”

The Senate passed a bill that would delay the second round of cuts for one year, until July 1, 2017. But the House failed to pass a bill that would delay the cuts for three months before Congress recessed for the July 4th holiday.

The impasse is already resonating throughout the industry, with providers like Gary Sheehan deciding not to accept new patients on Nantucket Island effective July 1.

“The reality is fairly simple,” said Sheehan, CEO of Cape Medical Supply in Sandwich, Mass., in a statement on the company’s website.“The cost of acquiring and maintaining equipment, paired with the cost to provide the required services and support to patients, now far exceeds the reimbursement associated with that equipment and service. Because of that simple fact, we need to make extremely difficult decisions.”

New analysis from AAHomecare reveals the average change between the 2015 fee schedule and the July 1 rates, which incorporate two rounds of cuts, is 51.1% in non-bid areas.

“The July 1 cuts for rural providers are brutal and unsustainable,” the association stated. “Our industry’s task remains unchanged—we need to pass rural relief legislation.”

Congress returns from its break on July 5 and 6.

WASHINGTON – The U.S. Department of Health and Human Services on June 28 issued a notice of proposed rulemaking on changes to the Medicare claims appeal process.

In the NPRM, HHS proposes additional administrative action to:

·      expand the pool of available adjudicators with the Office of Medicare Hearings and Appeals;

·      increase decision-making consistency among the levels of appeal;

·      and improve efficiency by streamlining the appeals process so less time is spent by adjudicators and parties on repetitive issues and procedural matters.

The changes address the second prong of a three-pronged strategy to address a major backlog at the administrative law judge level of the appeal process.

The strategy entails:

·      investing new resources at all levels of appeal to increase adjudication capacity and implement new strategies to alleviate the current backlog;

·      taking administrative actions to reduce the number of pending appeals and encourage resolution of cases earlier in the process;

·      and proposing legislative reforms that provide additional funding and new authorities to address the appeals volume.

If the administration implements the changes outlined in the NPRM, in conjunction with the proposed funding increases and legislative actions outlined in the FY 2017 president’s budget, HHS estimates that the backlog of appeals could be eliminated by FY 2021.

Stakeholders may comment on the changes until 5 p.m. EST on Aug. 29.

WASHINGTON – A recently published proposed rule contains several tweaks to the competitive bidding program, a positive development for the HME industry, stakeholders say.

Among the changes: CMS wants to move the bid ceiling to the 2015 fee schedule amounts.

“CMS has realized that, where they are right now, the bidding program is not all its cracked up to be,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “There’s access and all these other issues, so they are retroactively trying to tweak it.”

Currently, CMS resets the bid ceiling to each round of new bid rates, continually driving the rates lower and lower, say stakeholders.

“Eventually, providers would be paying CMS to take care of Medicare beneficiaries,” said Bachenheimer. “CMS actually acknowledges that they need to make sure the bidding program is financially stable on a long-term basis.”

The proposed rule also seeks to require surety bonds specifically for the bid program as mandated by the “doc fix” bill signed into law in April 2015. Bidders would have to (a) obtain a $100,000 bond for each competitive bidding area they bid in, and (b) forfeit the bond if they decline to accept a contract and their composite bid is at or below the offer.

The goal, say stakeholders, is to prevent speculative bidding.

“We want people to bid in areas where they are actually going to service patients,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “(We’ve seen) bidders who were not present in the marketplace, or with no history in those product categories and just submitted low-ball bids so they could get contracts to sell them.”

Another tweak in the proposed rule, which stakeholders call “interesting,” would introduce an alternative pricing methodology to address “price inversions.” This occurred in previous rounds when an item with a higher utilization got more “weight” than an item with lower utilization but more functionality.

Under the proposed rule, the supplier would submit one bid for a combination of HCPCS codes for similar items with different features. The single payment amount would be based on the median bid for the lead item.

The methodology is modeled after a concept in the market-pricing program championed by industry ally Rep. Tom Price, R-Ga.

“It’s very interesting and it’s a rational way to do it,” she said, “although there are many specifics that are not yet clear.”

WASHINGTON – The U.S. Department of Health and Human Services on June 28 outlined a number of proposed changes to the Medicare claims appeals process that it believes will help diminish a huge backlog.

Among the changes HHS seeks to make: to allow certain decisions made by the Medicare Appeals Council, the highest level of appeal, to set precedent for lower levels, a move that will eliminate redundancy and resolve inconsistencies in the interpretation of policies, Nancy Griswold, chief law judge of the Office of Medicare Hearings and Appeals, told Kaiser Health News.

“That makes a lot of sense,” said Andrea Stark, a reimbursement consultant with MiraVista. “We’ve been fighting and fighting the same things. Decisions get upheld and it’s not until we get to a higher level that we see a reversal.”

In general, the changes seek to expand the pool of available adjudicators for OMHA; increase decision-making consistency among the levels of appeal; and improve efficiency by streamlining the appeals process so less time is spent by adjudicators and parties on repetitive issues and procedural matters.

Another change cited by Griswold that makes sense, stakeholders say: to allow attorneys, not necessarily the administrative law judges themselves, to handle some of the procedural matters that come before the ALJ, the third level of appeal.

“That would enable the ALJ to move through more cases,” Stark said.

HHS believes that these changes, along with a number of proposed funding increases and legislative actions outlined in the president’s budget for fiscal year 2017, could eliminate the backlog in the appeal process by 2021.

Just how big is that backlog? In the first quarter of this year, the wait for an ALJ hearing was 796 days. By the second quarter, it was 861 days, AAHomecare has previously reported.

It’s a big enough problem that the American Hospital Association has taken HHS to court in an effort to get the government to meet statutory deadlines for timely review of claim denials. Medicare statute requires that ALJ appeals be resolved within 90 days.

Because hospitals and the government are still embroiled in that lawsuit—earlier this month, HHS had to prove to the court that it was making efforts to reduce the backlog—the timing of the proposed rule is suspect, stakeholders say.

“Are they really sincere, or are they meeting the requirements of a court case,” said Wayne van Halem, president of the van Halem Group. “Few of the things they’re suggesting haven’t been discussed before, including in the president’s most recent budget. It will be interesting to see what the details are.”

Stakeholders will have until Aug. 29 to submit comments on the proposed rule.

WASHINGTON – A second round of Medicare reimbursement cuts was set to go into effect in non-bid areas on July 1, but it’s not time to throw in the towel, AAHomecare said in a bulletin on June 29.

“There’s nothing like a crisis to help spur legislators to action,” the association stated. “We need to make sure that we let the House of Representatives and the Senate know that these cuts are taking rural providers and patients to the precipice of disaster.”

The Senate passed a bill that would delay the second round of cuts for one year, until July 1, 2017. But the House failed to pass a bill that would delay the cuts for three months before Congress recessed for the July 4th holiday.

The impasse is already resonating throughout the industry, with providers like Gary Sheehan deciding not to accept new patients on Nantucket Island effective July 1.

“The reality is fairly simple,” said Sheehan, CEO of Cape Medical Supply in Sandwich, Mass., in a statement on the company’s website.“The cost of acquiring and maintaining equipment, paired with the cost to provide the required services and support to patients, now far exceeds the reimbursement associated with that equipment and service. Because of that simple fact, we need to make extremely difficult decisions.”

New analysis from AAHomecare reveals the average change between the 2015 fee schedule and the July 1 rates, which incorporate two rounds of cuts, is 51.1% in non-bid areas.

“The July 1 cuts for rural providers are brutal and unsustainable,” the association stated. “Our industry’s task remains unchanged—we need to pass rural relief legislation.”

Congress returns from its break on July 5 and 6.

Pressures mount in sleep market

NEW YORK – HME providers report sleep patient volume is still growing, but not as much as in the past.

Sleep patient volume grew 3.6% in the last 12 months and is expected to grow 6% in the next 12 months, according to respondents to the “HME Sleep and Oxygen Survey” for the second quarter of this year, conducted by Needham & Co., a subsidiary of The Needham Group, an investment banking and asset management firm.

However, sleep patient volume was 6.6% and 7.9%, respectively, in a prior survey.

Providers also report that flow generator prices have declined 3.2%, compared to 2.1% in a prior survey, and mask prices have declined 2.4% vs. 1.4%. Driving lower pricing: the latest Medicare reimbursement cuts, according to Needham.
Other highlights from the report include ratings for ResMed’s flow generators have decreased, while ratings for Philips Respironics’ flow generators have increased. Flow generators from both companies are now both at 5.8 out of 7, according to the survey.

The survey also polled HME providers on home oxygen therapy. They report portable oxygen concentrators are expected to increase from 22.4% of the market to 26.8% of the market over the next 12 months. The highest rated POC, at 5.8 out of 7, was a private label device from Inogen, followed by the SimplyGo from Respironics and the G3 from Inogen.

The survey results are based on 87 respondents.

VGM’s retail experts hit the road

ATLANTA – The 2016 VGM Retail Science Roadshow will culminate in an eight-hour show at Medtrade, Oct. 31-Nov. 3 in Atlanta. Before Medtrade, however, the roadshow will make pit stops in Louisville, Ky., on July 19 and Dallas on Sept. 13. The roadshow is a one-day, hands-on educational event sponsored by VGM and led by Jim Greatorex and Maria Markusen. It provides practical tips, techniques and strategies for retail business. Attendees will also learn from vendors about the latest and greatest retail products. Pricing for VGM members is $79.99 for the first attendee, and $49.99 for additional attendees.

Horton’s O&P goes high tech

LITTLE ROCK, Ark. – Horton’s Orthotics & Prosthetics now uses high-precision CAD/CAM scanning technology. The provider has acquired a Vorum CAD/CAM scanner and high-speed carver, becoming the first in the state to deliver a faster and more comfortable experience for patients needing new orthotic and prosthetic devices. This technology can digitally capture an amputee or injured patient’s limb shape with a pinpoint level of accuracy, the provider says. “Technicians can them use the program’s software to modify the shape and create a successfully fitting socket or brace design that can be fabricated quickly and efficiently,” it stated in a press release. “Using this technology, the initial fabrication processes that took nearly two hours will now take only two minutes.” Horton’s employs more than 35 at five facilities across the state.

Providers seek tax-exempt status for HME

LAS VEGAS – A group of providers on June 27 submitted more than 100,000 signatures to qualify an initiative to exempt certain HME from taxation for the November ballot, according to news reports. If it qualifies for the ballot, the initiative will ask voters whether certain HME, including oxygen tanks, ventilators and wheelchairs, should be exempt from the state’s sales and use tax. Orthotics, prosthetics and certain other medical supplies are already exempt. Provider Doug Bennett of Bennett Medical Services told a local news outlet that the group has self-verified 66,000 signatures and is confident the petition will go through.

ResMed secures contract

SAN DIEGO – ResMed has been awarded a three-year supplier group-purchasing contract from Premier, a healthcare improvement alliance. The contract will enable Premier member hospitals and providers to offer ResMed’s non-invasive ventilator products, according to a release. "Partnering with Premier also expands our market and provides us with more feedback from patients and providers to help drive our next innovations and keep pushing the boundaries in the medical technology space,” said Jon Yerbury, vice president of marketing, ResMed Americas. Premier unites an alliance of approximately 3,600 U.S. hospitals and 120,000 other providers.

TotalCare launches sleep pilot

BROOMFIELD, Colo. – TotalCare eHealth has finalized its Sleep Apnea Continuum of Care Program and launched a primary care pilot program. The program will provide a digitally connected patient experience across the continuum of care to increase patient engagement, improve outcomes and reduce costs. The pilot location is South Pointe Clinics in Lafayette, Colo. "We've always known that the key to effective sleep apnea management is at the primary point of care, and we are thrilled to have an enthusiastic partner in this pilot,” said Doug Hudiburg, CEO of TotalCare. “South Pointe understands the importance of reaching the un-diagnosed sleep apnea population within their current patient population and within their community in general."

BraunAbility, Permobil join forces to improve lives

WINAMAC, Ind. – BraunAbility and Permobil have partnered on a research project to improve the interface between wheelchairs and wheelchair accessible vehicles. The two organizations will collaborate on technical research and engineering with the ultimate goal of increasing independence and improving the total mobility experience for individuals with physical disabilities. “Individually our brands have contributed huge advancements in mobility over our long histories,” said Nick Gutwein, CEO of BraunAbility. “Now our paths have converged, and we are confident the result will be technology that empowers our customers with unprecedented freedom and the autonomy to more fully experience and enjoy life.” BraunAbility and Permobil are sister companies owned by parent company Investor AB.

Schryver Medical bolsters presence in Texas

DENVER – Schryver Medical Sales and Marketing, a provider of mobile imaging diagnostics, clinical laboratory services and DME, has completed its acquisition of Professional Clinical Laboratory. The acquisition bolters Schryver’s presence in the Texas market, where it began offering services last December following its acquisition of Community Portable X-Ray and MetroState Clinical Laboratory. Schryver, a portfolio company of Revelstoke Capital Partners, a Denver-based private equity firm, serves nearly 4,000 long-term post-acute facilities, assisted-living centers, and skilled nursing facilities, as well as numerous homecare patients.

Nonin Medical shakes up management

MINNEAPOLIS – Nonin Medical has made several changes to its senior leadership team. Mattew Prior has been named vice president of business development; he was previously vice president of product development. Greg Rausch has been named vice president of product development; he was previously director of advanced technology. Jill Wroblewski has been named senior director of marketing; she was previously director of business development. The changes, effective immediately, are meant to more quickly align the technology driven company with today’s rapidly changing customer needs, it says in a press release.

Good works

Aeroflow Healthcarerecently made a donation to help a local elementary school build a playground that is accessible for children at all levels of mobility. The donation will allow Fairview Elementary to install poured-in-place barrier free surfacing and new playground equipment. The Asheville, N.C.-based Aeroflow is committed to charitable acts, including canned food drives and fundraising…Convaid and R82 presented a donation at the 14th Annual Rett Syndrome Symposium. Convaid and R82 comprise the Pediatric Group of Etac NA.

Top honors

Pediatric Home Servicehas been recognized as one of Minnesota’s Top 150 Workplaces by the Star Tribune. PHS was named eighth best mid-size company. It’s the sixth year in a row that the St. Paul, Minn.-based PHS has made the list …Rex Pharmacy has been named the 2016 Pharmacy of the Year by McKesson. The award recognizes independent pharmacies that are driving the future of independent pharmacies, according to a release. The Atlantic, Iowa-based Rex Pharmacy was honored at an awards ceremony at the McKesson ideaShare 2016 conference in Chicago.

People news

James Newberry, a longtime practitioner and board member for the Board of Certification/Accreditation, passed away on June 27. He began his career as an orthotist/prosthetist while serving in the U.S. Air Force. Following his military service, he joined Mahnke’s Orthotics and Prosthetics in Oakland Park, Fla., where he spent more than 40 years as owner, practitioner and director of orthotics/prosthetics. He was certified by BOC since 1984, when the organization was founded…Chris Roussos, CEO of Epic Health Services, has been named EY Entrepreneur of the Year for the Southwest. Since becoming CEO in 2014, Roussos has brought unprecedented growth to the company, successfully positioning it as the sole nationwide provider of a complete post-acute continuum of care for pediatric patients. In less than two years, the company, a Dallas-based provider of pediatric skilled nursing, therapy, developmental, enteral and respiratory services, has completed 10 acquisitions and now operates in 17 states…Regina Gillispie of Best Home Medical in Barboursville, W.Va., has been appointed to the National Small Business Administration’s Health and Human Resource Issue Committee. This will provide Gillispie the opportunity to broaden the interest of DME issues.

WASHINGTON – The House of Representatives plans to vote on a bill this afternoon that would hit pause on a second round of Medicare reimbursement cuts that went into effect in non-bid areas on July 1.

Lawmakers have placed the bill, H.R. 5210, on the suspension calendar for a vote at 2 p.m. EST, according to The VGM Group. Once the bill is passed in the House, it will move to the Senate for approval, VGM says.

The bill, known as the Patient Access to Durable Medical Equipment Act of 2016 or PADME, would delay the cuts—which, together with the first round of cuts, average 51.1% compared to the fee schedule amounts in 2015—for three months, until Oct. 1, 2016.

Before the July 4th recess, the Senate passed a bill that would delay the second round of cuts for one year, until July 1, 2017. The House, however, failed to pass its bill before the recess.

Live floor proceedings from the House can be viewed at www.houselive.gov.

WASHINGTON – Now that both the House of Representatives and the Senate have passed bills to delay a second round of Medicare reimbursement cuts, lawmakers have to hammer out the details—and fast.

The House yesterday passed a version of the bill that would delay the cuts that went into effect July 1 in non-bid areas for three months until Oct. 1. The Senate on June 24 passed a version of the bill that would delay the cuts for one year until July 1, 2017.

“Now the House and the Senate need to complete the process and send a bill to the president,” said Tom Ryan, president and CEO of AAHomecare. “With the new rates now going into effect, we need our champions in both the House and Senate to find a way to move forward immediately.”

Lawmakers are expected to begin a recess on July 15 and are not due to return until after Labor Day.

The bill passed in the House, an amended version of H.R. 5210, would also require the Department of Health and Human Services to conduct a study over the course of the three-month delay to identify issues related to patient access to DME.

Although the second round of reimbursement cuts has already gone into effect, the bill would reverse reimbursement back to the rates prior to July 1.

The cuts that went into effect July 1 effectively reduce reimbursement in non-bid areas by 51.1% when combined with a first round of cuts that went into effect Jan. 1.

WASHINGTON – Results are in for the AAHomecare HME Audit Key survey for the first quarter of 2016.

Sixty-nine percent of completed MAC prepayment audits nationwide were paid upon review, according to the survey, which included additional documentation requests from Oct. 1, 2015, through March 31, 2016.

Other results from the survey:

·      the average rate of audits denied increased 5% between the fourth quarter of 2015 and the first quarter of 2016, with the average percent of audits denied by net revenue ranging from 13% to 40%;

·      companies with net revenues from $3.6 million to $10 million had significantly higher denial rates—three times that of companies with net revenues from $0 to $1 million

While the survey is gaining momentum, industry stakeholders say increased participation is needed to gain support on Capitol Hill to create “smarter and fairer policies.”

“If future data on overturn rates confirms results like the ones we’re starting to see here, I believe we can make the case for reforms that both decrease the audit burden on suppliers and make better use of government resources,” said Kim Brummett, vice president of regulatory affairs for AAHomecare.  “What we need now is for more suppliers to join the program and complete the next survey round." 


Providers can begin submitting data for the second quarter of 2016 on July 15.

WASHINGTON – The HME industry may be up against its toughest challenge yet in its bid to slow down the spread of competitive bidding.

Now that both the House of Representatives* and the Senate* have passed bills to delay a second round of Medicare reimbursement cuts that went into effect in non-bid areas on July 1, leadership in both chambers is trying to hammer out a final bill—and fast.

“The biggest constraint we have now is time,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Congress plans to recess on July 15 and not return until September.

As part of hammering out a final bill, leadership must decide on the length of the delay (the House bill calls for three months; the Senate bill calls for one year) and the pay-for. Only the Senate bill included an HME specific pay-for: speeding up plans to match the federal portion of Medicaid allowables to bid-adjusted Medicare allowables from Jan. 1, 2019, to Oct. 1, 2018.

“There are political issues beyond us that are involved with this,” Bachenheimer said. “There are powerful people in the House that continue to be staunchly opposed to a Medicaid pay-for. We need to get agreement on a pay-for, or get another one going.”

So in a final push, stakeholders are asking providers to pressure their lawmakers, particularly those on the Energy and Commerce Committee in the House, to come to an agreement before the upcoming recess.

“The message is, ‘It’s too quick,’” Bachenheimer said. “No one has even had time to assess the initial cut, which is significant. We’re not stopping the program altogether. We’re just taking a breath.”

The first round of cuts that went into effect Jan. 1 in non-bid areas represented cuts of, on average, 25%. The two rounds of cuts together represent cuts of, on average, 51.1%, according to an analysis by AAHomecare.

Among the scenarios that could play out by July 15, stakeholders say: Best case, leadership decides to go with the Senate bill; worst case, they can’t come to an agreement and the bills stall. Somewhere in between: Leadership decides to go with the House bill, ideally with the promise of extending the delay when Congress is back in session in September.

“The good news is that we’ve shown that in both chambers there is a want and need to get something accomplished,” said Tom Ryan, president and CEO of AAHomecare. “We’ve been working 18 months for this, and what we’ve accomplished is tremendous, but we’re not there yet.”

Because there are politics at play that the industry can’t control, it must control what it can: leveraging the grassroots lobbying that has gotten it this far.

“We need to raise the noise level,” Ryan said.

http://www.hmenews.com/article/bid-delay-bill-passes-house

http://www.hmenews.com/article/bid-delay-bill-passes-senate

WASHINGTON – Results are in for the AAHomecare HME Audit Key survey for the first quarter of 2016.

Sixty-nine percent of completed MAC prepayment audits nationwide were paid upon review, according to the survey, which included additional documentation requests from Oct. 1, 2015, through March 31, 2016.

Other results from the survey:

·      the average rate of audits denied increased 5% between the fourth quarter of 2015 and the first quarter of 2016, with the average percent of audits denied by net revenue ranging from 13% to 40%;

·      companies with net revenues from $3.6 million to $10 million had significantly higher denial rates—three times that of companies with net revenues from $0 to $1 million

While the survey is gaining momentum, industry stakeholders say increased participation is needed to gain support on Capitol Hill to create “smarter and fairer policies.”

“If future data on overturn rates confirms results like the ones we’re starting to see here, I believe we can make the case for reforms that both decrease the audit burden on suppliers and make better use of government resources,” said Kim Brummett, vice president of regulatory affairs for AAHomecare.  “What we need now is for more suppliers to join the program and complete the next survey round." 


Providers can begin submitting data for the second quarter of 2016 on July 15.

National HME furthers reach

NEW YORK – Allcare Medical has merged with National HME, a portfolio company of Tailwind Capital. The acquisition will further National HME's reach in South Carolina and Georgia as a provider of technology-enabled DME for the hospice industry. "This key acquisition aligns with our vision for the continued growth of National HME, and further expands our ability to provide the most comprehensive DME solution to any hospice in the country," said Geoffrey Raker, partner at Tailwind Capital, a private equity firm and lead investor in National HME. This is second acquisition this year for National HME. In January, the provider acquired Springfield, Mo.-based Therapy Support, which has 21 branches in seven Midwestern states.

AAHomecare commissions cost analysis study 

WASHINGTON – AAHomecare has commissioned Dobson DaVanzo & Associates to conduct a study of provider’s fixed and variable costs for providing DME. The study will focus on respiratory products, wheelchairs, hospital beds and walkers. While previous cost studies have been conducted, this will be the first to consider categories under threat by competitive bidding. AAHomecare encourages all providers to participate in the survey, which will later be analyzed and shared with policymakers. “This is our opportunity to provide hard numbers industry-wide to Congress and CMS to explain the depth of cuts we are receiving compared to the actual cost of doing business,” said Laura Williard, senior director of payer relations for AAHomecare, in a press release.

NightBalance prepares to enter U.S. market

DELFT, Netherlands – NightBalance BV, a manufacturer of obstructive sleep apnea devices, has announced the completion of a EUR 12.5 million Series B financing round led by INKEF Capital and Gilde Healthcare Partners. The proceeds will allow NightBalance to intensify and expand commercial activities for its Sleep Position Trainer in Europe, and to prepare for the company’s entry into the U.S. market. The manufacturer is also planning further clinical studies in the U.S. and filing for 510(k) clearance with the U.S. Food and Drug Administration. John Lipman, former vice president of marketing and commercial development of Apnicure, has been appointed COO U.S. to head NightBalance’s operations here. The Sleep Position Trainer, worn around the upper body, measures the sleep behavior of the patient. Once a patient turns into the supine position, the device gives a gentle vibration, prompting the patient to change sleeping position, all without disrupting the “natural sleeping architecture,” according to the company.

Quantum Rehab launches enhanced website

EXETER, Pa. – Quantum Rehab has launched a “technologically enhanced” website to meet the expanding content and application needs of complex rehab consumers, clinicians and providers. “Our customers shared with us that they wanted unprecedented virtual access to our products, from technical specifications to 360-degree views, videos and beyond,” said Jim Schreiber, vice president of digital and product marketing. “Their input told us that no matter if it’s a consumer, clinician or provider, all wish an exceptionally content-rich site that places product information and resources in one, easy-to-navigate website.” The result is a website with expanded product pages that not only include added product information and materials, but also interactive color palettes. Users can request to be contacted by providers with a click of a button. Clinicians and providers also have their own resource areas.

GCE enters U.S. POC market

DALLAS – GCE Group has entered the U.S. and Canadian homecare markets with its GCE Healthcare range of respiratory care products. Effective immediately, the GCE portable oxygen concentrators under the Zen-O brand will be marketed to U.S. and Canadian customers. During the coming months, other products, including oxygen conserving devices, oxygen regulators and high purity gas control products, will also be marketed. GCE has tapped Jim Clement as general manager of GCE Healthcare to head up U.S. and Canadian operations. He’s formerly with DeVilbiss Healthcare.

Alliqua, BSN hammer out deal

YARDLEY, Pa., and CHARLOTTE, N.C. – Alliqua BioMedical, a provider of wound care products, has signed a definitive agreement with BSN Medical for the exclusive distribution rights for its Sorbion, Sachet and Sorbion Sana primary dressings in the U.S., Canada and Latin America. Per the agreement, BSN will pay Alliqua $4.4 million to purchase the rights of Alliqua’s existing distribution agreement with Sorbion GmbH & Co KG, now owned by BSN Medical. “The sale of Alliqua’s exclusive distribution rights for the Sorbion dressing products represents an opportunity for us to add important growth capital to our balance sheet and to focus our future investments on commercializing our own highly differentiated advanced wound care and regenerative technologies,” said David Johnson, CEO of Alliqua.

GF Health partners with Mercy Ships

ATLANTA – GF Health Products has agreed to donate medical equipment to Mercy Ships, a volunteer-based international charity that delivers free health care to Africa and other medically underserved nations. Mercy Ships, which operates the largest non-governmental hospital ship in the world, has performed more than 79,000 life-saving surgeries and docked in more than 580 ports since 1978.“We are proud to partner with Mercy Ships and its 1,400 volunteers in their mission to make health care accessible to developing nations,” said Ken Spett, CEO of GF Health, in a press release. “We are specifically supporting their ophthalmic surgery projects in impoverished communities with in-kind donations of our Hausted stretchers.”

Golden Technologies launches ‘extreme’ contest

OLD FORGE, Pa. – Golden Technology is giving away a new Golden Buzzaround Scooter as part of its “Golden Extreme Giveaway” contest. Consumers are encouraged to participate by sharing their story and a picture of their favorite Golden product on social media. “This contest is about celebrating how Golden products are changing people’s lives,” said Tim Robinson, director of digital media, in a release. “It’s not only a modern social media sharing contest, but it’s a great way to see the impact that these Golden products really have.”

VGM donates to flood victims

CHARLESTON, West Va. – The VGM Group has donated $1,000 on behalf of its membership in West Virginia in the wake of historic flooding that has impacted the state. The donation was made to the West Virginia Union Mission, which is providing clean drinking water, cleaning supplies and food, among other items, to residents. “It has been very difficult to see the images of the damage and pain caused by the flooding across the beautiful state of West Virginia,” VGM stated. “We hope this donation will provide some relief to the impacted residents.” VGM encourages others to donate to the mission or the American Red Cross.

Short Takes: BraunAbility, 3B Medical

FEV, the developer and provider of the wheelchair ramp gateway module used in BraunAbility-converted FCA vans, announced this week that it has hit the milestone of supplying 25,000 modules…Jeff Shields has been named vice president of sales at 3B Medical. He brings with him more than 30 years of HME manufacturer experience, including with ResMed and Inova Labs.

WASHINGTON – A bill passed in the House of Representatives last week that would delay a second round of Medicare reimbursement cuts is going through a “hotline” process in the Senate, AAHomecare announced yesterday at 5:30 p.m.

As part of this process, the bill has been introduced and has been distributed to all 100 offices in the Senate. If there is no objection to the bill within 24 hours, it will be considered passed with no objections, the association says.

“With Congress set for a lengthy recess at the end of this week, passing this legislation would give our champions in the House and Senate more time to work out a longer delay when they return to work in early September,” AAHomecare stated. “The legislation will also require the approval of President Obama to become law.”

The bill would delay a second round of reimbursement cuts that went into effect on July 1 until Sept. 30. Along with a first round of cuts that went into effect Jan. 1, the cuts represent a 51.1% reduction compared to the 2015 fee schedule, according to an analysis by AAHomecare.

The bill would also instruct the Department of Health and Human Services to study the impact of bidding-derived payment adjustments on beneficiary access and providers by September 2016.

The Senate in June passed a bill that would delay the second round of cuts for one year, until July 1, 2017.

Because the House and Senate passed different versions of the bill, stakeholders were working with lawmakers to come to a compromise before their recess on July 15.

WASHINGTON – Congress has failed to pass a bill that would delay a second round of Medicare reimbursement cuts for three months, until Sept. 30.

In the days before a long recess that kicked off July 15, the Senate had begun a “hotline process” to pass an amended version of H.R. 5210, which had already been passed by the House of Representatives earlier in the month.

As part of the process, the bill was introduced and distributed to all 100 offices of the Senate. If there were no objections within 24 hours, it would be considered passed. But somewhere along the line, the process failed.

“We were told last night that the hotlined bill was put on hold,” The VGM Group stated in a “Legislative Update” to its members on Friday. “We are still trying to confirm which senator placed the hold.”

The second round of reimbursement cuts—which, together with the first round of cuts that went into effect Jan. 1 represent, on average, a 51.1% decrease in reimbursement—went into effect July 1.

The Senate passed a bill, S. 2736, in late June that would have delayed the second round of cuts for one year, until July 1, 2017. But the pay-for for the bill—speeding up plans to match the federal portion of Medicaid allowables to bid-adjusted Medicare allowables from Jan. 1, 2019, to Oct. 1, 2018—was considered “toxic” by some lawmakers.

So, ultimately, the Senate ran with the House bill, which has a shorter delay but a non-HME specific pay-for, with plans to take up the issue again in September when it returns from its summer recess.

VGM says industry leaders will meet with their champions to determine action items for when Congress resumes business in September.

“We appreciate all your grassroots efforts the past 12 months,” VGM stated in the update. “The calls, personal visits and emails to your members of Congress did not go in vain. Both the Senate and House passed separate bills earlier this month. The fact that we had not one, but three, unanimous consent hotlined in the Senate is unheard of and an impressive feat! Unfortunately, if only takes on Senator to stop our efforts.”

WASHINGTON – Total healthcare spending growth is expected to average 5.8% annually over 2015-2025, according to a report published July 13 by Health Affairs and authored by CMS’s Office of the Actuary. Projected healthcare spending growth remains lower than the average over previous two decades before 2008 (nearly 8%). “The Affordable Care Act continues to help keep overall health spending growth at a modest level and at a lower growth rate than the previous two decades,” said CMS Acting Administrator Andy Slavitt in a press release. “Per-capita spending and medical inflation also remain at historically very modest levels, demonstrating the importance of continuing to reform our delivery systems.” Overall, national health expenditures are estimated to have reached $3.2 trillion in 2015, according to the report.

CMS backs unique device identifiers

WASHINGTON – CMS has endorsed the use of unique device identifiers in billing records for medical devices, according to the Wall Street Journal. The ID numbers have been advocated by lawmakers and the U.S. Food and Drug Administration for years, but never by Medicare. The idea: Because the ID numbers would appear in databases of hospitals and big insurers, including Medicare, they would help the FDA to quickly find malfunctioning devices and order a recall if necessary, the Journal reports. CMS Acting Administrator Andrew Slavitt endorsed the use of ID numbers in a letter this week to a committee of the medical-billing industry, writing they would improve patient safety, according to the Journal.

Power soccer returns to Medtrade

ATLANTA – The United States Power Soccer Association returns to Medtrade this year. The USPSA will play two games on the show floor on Nov. 1, once in the morning and once in the afternoon. Exact times are to be determined. “These are skilled individuals, and everyone who watched the power soccer demo back in 2014 can attest to that,” said Kevin Gaffney, group show director of Medtrade. “I encourage Medtrade attendees to check it out this year.” Medtrade exhibitor MK Battery is a main sponsor for the USPSA and has been for many years. In a recent guest blog, Wayne Merdinger, executive vice president and general manager of MK Battery, called on others in the industry to sponsor USPSA, which will host the FIPFA World Cup of Soccer in Kissimmee, Fla., next year. Medtrade takes place Oct. 31-Nov. 3 at the Georgia World Congress Center.

Short takes from AAHomecare

Healthcare consulting firm Dobson DaVanzo & Associates will open the DME Industry Cost Analysis Study the week of July 18. The study, sponsored by AAHomecare, will look at the cost of providing HME in multiple product categories under threat by competitive bidding. There is no fee to participate and the data submitted is kept confidential…Providers can submit their second quarter audit data to the HME Audit Key starting July 15. The HME Audit Key requires providers to submit cumulative counts on pre- and post-payment audits and appeal claim outcomes under DME MAC, RAC and SMRC reviews. AAHomecare has two quarters of data collected so far…Noridian has been awarded the Unified Program Integrity Contract, or UPIC. The 10-year contract is part of CMS’s efforts to consolidate existing multiple integrity contracts. The UPIC is intended to integrate the work of the Zone Program Integrity Contractors or ZPICs, Program Safeguard Contractors or PSCs, Medicare-Medicaid Data Match or Medi-Medi, and Medicaid Integrity Contractors or MICs.

GPO contracts with Ossur for orthopedic products

CLEVELAND and FOOTHILL RANCH, Calif. – CHAMPS Group Purchasing has re-launched its custom contract with Ossur Americas for its osteoarthritis and injury solutions bracing and support products. The Ossur contract gives 7,000-plus CHAMPS members nationwide the opportunity to streamline products, according to a press release. “With this contract, our GPO contract price has expanded significantly and now covers Ossur’s entire catalog, including orthopaedic soft goods, braces, cold therapy and casting supplies,” said Jan Elder, director of contracting services for CHAMPS. The contract extends through December 2018.

Infusion foundation launches satisfaction survey

ALEXANDRIA, Va. – The National Home Infusion Foundation will launch a survey to develop a standardized set of patient satisfaction questions for home infusion providers to use in organizational assessment tools. The Patient Satisfaction Survey Study will help pave the way for improved quality of care, NHIF said in a press release. “Patient satisfaction surveys have gained increasing attention as essential sources of information for identifying gaps and developing effective action plans to improve overall quality of care in organizations across the health care continuum,” said NHIF Vice President of Research Connie Sullivan, R.Ph. A panel of home infusion professionals will finalize a set of validated questions. The Patient Satisfaction Survey Study builds on the National Home Infusion Association’s multi-phase Industry-Wide Data Initiative.

NCPA announces seminar lineup

ALEXANDRIA, Va. – The National Community Pharmacists Association has announced its 2016 lineup of seminars aimed at helping community pharmacies hone their merchandising and marketing skills. The one-day Front-end Profit Building Seminars offer CEUs and tackle topics like curb appeal, floor plans, cross-merchandising and inventory management. “In a world of shrinking profit margins and fierce competition from the big boxes, it is more critical than ever for community pharmacies to diversify their business to grow and thrive, and the pharmacy front end provides an excellent starting point,” said NCPA President Bradley Arthur, RPh, co-owner of Black Rock Pharmacy and Brighton-Eggert Pharmacy in Buffalo, N.Y. The seminars are sponsored by Good Neighbor Pharmacy.

Organizers announce ‘world changing’ speaker

WATERLOO, Iowa – Organizers of Essentially Women’s Focus Conference have announced best-selling author, entrepreneur and cancer survivor David Wagner as keynote speaker. Wagner will discuss how one encounter led him to initiate the pay-it-forward global movement “Daymaking.” “Our industry is becoming increasingly more challenging,” said Cindy Ciardo, manager of vendor relations for Essentially Women. “David will put our jobs back into perspective and remind us about what really matters, motivating us to make the world a better place by following his lead.” Wagner’s presentation, “Change the world—one person at a time—through simple acts of kindness,” will take place at 8 a.m. on Sept. 25. The full conference takes place Sept. 24-26 at the Sheraton Myrtle Beach Convention Center Hotel in Myrtle Beach, S.C.

WASHINGTON – Congress has failed to pass a bill that would delay a second round of Medicare reimbursement cuts for three months, until Sept. 30.

In the days before a long recess that kicked off July 15, the Senate had begun a “hotline process” to pass an amended version of H.R. 5210, which had already been passed by the House of Representatives earlier in the month.

As part of the process, the bill was introduced and distributed to all 100 offices of the Senate. If there were no objections within 24 hours, it would be considered passed. But somewhere along the line, the process failed.

“We were told last night that the hotlined bill was put on hold,” The VGM Group stated in a “Legislative Update” to its members on Friday. “We are still trying to confirm which senator placed the hold.”

The second round of reimbursement cuts—which, together with the first round of cuts that went into effect Jan. 1 represent, on average, a 51.1% decrease in reimbursement—went into effect July 1.

The Senate passed a bill, S. 2736, in late June that would have delayed the second round of cuts for one year, until July 1, 2017. But the pay-for for the bill—speeding up plans to match the federal portion of Medicaid allowables to bid-adjusted Medicare allowables from Jan. 1, 2019, to Oct. 1, 2018—was considered “toxic” by some lawmakers.

So, ultimately, the Senate ran with the House bill, which has a shorter delay but a non-HME specific pay-for, with plans to take up the issue again in September when it returns from its summer recess.

VGM says industry leaders will meet with their champions to determine action items for when Congress resumes business in September.

“We appreciate all your grassroots efforts the past 12 months,” VGM stated in the update. “The calls, personal visits and emails to your members of Congress did not go in vain. Both the Senate and House passed separate bills earlier this month. The fact that we had not one, but three, unanimous consent hotlined in the Senate is unheard of and an impressive feat! Unfortunately, if only takes on Senator to stop our efforts.”

WASHINGTON – CMS’s efforts to reduce improper payments have saved nearly $42 billion, according to a new report.

The savings, from Oct. 1, 2012, to Sept. 30, 2014, equate to an average savings of $12.40 for every dollar spent, according to a new report form the Center for Program Integrity.

The CPI’s efforts include making sure enrolled healthcare providers are properly screened; using predictive analytics to prevent fraud, waste and abuse; and coordinating anti-fraud efforts with federal and external partners, including state Medicaid and agencies and law enforcement agencies.

“CMS’s efforts to proactively prevent potentially fraudulent and improper payments from being made have been increasingly effective, moving our efforts away from the ‘pay-and-chase’ method of recovering payments after they had already been made,” the agency stated in a press release.

In fiscal year 2013, savings from prevention activities represented 68% of total savings; that rose to nearly 74% in fiscal year 2014.

“CMS is dedicated to promoting better care, protecting patient safety, reducing healthcare costs, and providing people with access to the right care, when and where they need it,” the agency stated. “This includes continually strengthening and improving Medicare and Medicaid programs that provide vital services to millions of Americans.”  

CMS will release fiscal year 2015 numbers later this year.

WASHINGTON – The results of a postmortem on a bill that would have delayed a second round of Medicare reimbursement cuts are, well, complicated.

Initially, industry stakeholders believed a senator (or senators) put a “hold” on the House of Representatives-approved bill, killing its chances of passing before Congress adjourned for a long recess on July 14.

Now, they’re not so sure. They think the Senate may have just ran out of time to fully vet the bill, which it was less familiar with and which contained a number of non-HME specific Medicare and Medicaid-related provisions.

“It was taking the Senate time to go through it,” said Jay Witter, senior vice president of public policy for AAHomecare. “It was chaos. They were trying to get answers to questions, and they just ran out of time.”

It didn’t help, stakeholders say, that scheduled votes on high-profile bills fell through, prompting senators to pack up late on July 14 instead of July 15 as planned, not to return until after Labor Day in September.

Stakeholders maintain the lawmakers who passed bills to delay the cuts in the House and the Senate, and the leadership in the Senate that was managing the recent “hotline process” are in shock themselves about what happened.

“They are emboldened even more to get something substantive done in September,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “The momentum was so strong, and the disappointment so great. There were a lot of lawmakers thinking, are you kidding me?”

Stakeholders are already meeting with staffers to discuss their options. At this point, a go-forward delay may be their best bet, but “everything is on the table.”

“Everyone agrees we don’t want a ‘message’ bill,” Witter said. “We want something that gets signed into law, so we have to talk serious strategy.”

One lesson learned postmortem, stakeholders say: Get consensus from the House and Senate on one bill from the get-go.

“We need solid agreement before anything gets passed,” Bachenheimer said.

Since stakeholders aren’t sure whether or not a senator put a “hold” on the bill, they also need to get to the bottom of that.

“Personally, I think someone put a hold on it,” said John Gallagher, vice president of government relations at VGM & Associates. “If it was a hold, we need to find out why and rectify that, so it doesn’t happen again.”

YARMOUTH, Maine – HME providers are taking a hard look at what products they can continue to accept Medicare assignment on, from oxygen down the line to canes and crutches.

In a recent HME NewsPoll, the overwhelming majority of respondents (89%) said they have stopped taking assignment on certain products in the past year.

“In this last year, we have stopped accepting Medicare assignment on all DME except oxygen, vents and enteral nutrients,” said Heather Dominguez, executive director of reimbursement for Monterey, Calif.-based AdvantaCare Medical. “With the new cuts hitting, we are considering discontinuing Medicare services altogether.”

CMS on Jan. 1 reduced reimbursement, on average, by 25% in non-bid areas. It delivered a similar cut on July 1, for a total reduction in reimbursement of more than 50%.

Others aren’t just considering dropping Medicare altogether.

“As of April 1, 2016, we have stopped taking all new Medicare jobs which have competitive bid pricing,” said Paul Gammie, president of Gammie Homecare in Hawaii. “The prices offered are completely non-sustainable. The January cuts alone were enough to cause this action.”

The decision to stop accepting assignment reflects a new mindset for many providers, who have long felt doing so would alienate beneficiaries.

“It was our decision that it was time for our company to stop covering up, to our patients, Washington’s mistakes,” said Clark Robichaux, president of Wilmington, N.C.-based Oxy-Care, who stopped taking assignment on liquid oxygen Jan. 1, and nebulizers and some CPAP supplies July 1.

As for beneficiaries: What do they do when a provider stops taking Medicare assignment? Forty-seven percent choose to pay upfront, while 53% forgo equipment, respondents say.

“We are no longer able to bill for lift chairs and nebulizers,” said Nancy Dela Motte, manger at Miller’s Pharmacy in Wyckoff, N.J. “The customers who are able to pay upfront do but are not pleased.”

Those who can’t pay upfront go without—at risk to themselves and at great expense to the Medicare program.

“Many people will suffer injury and repeated hospitalization due to lack of inexpensive care at home offered by DME providers,” said Cindi Lamprecht, owner of Fremont, Neb.-based ProMedCare. “This is only going to create a greater financial burden on Medicare.”