NEWARK, N.J. – U.S. Healthcare Supply, a national contract supplier for mail-order diabetes supplies, and two of its executives have agreed to pay the government more than $12.2 million to resolve allegations that they violated the False Claims Act.

The settlement resolves allegations that U.S. Healthcare Supply and Oxford Diabetic Supply, both based in Milford, N.J., set up and controlled a fictitious entity to make unsolicited telephone calls to Medicare beneficiaries to sell them DME. The companies then allegedly submitted claims for the equipment to Medicare in violation of the Medicare Anti-Solicitation statute.

“Cold-calling people to sell them expensive medical equipment is prohibited for a reason: unsuspecting patients shouldn’t be coerced into making medical decisions about devices and equipment—which they may not even need—on the basis of a sales pitch,” said Paul Fishman, U.S. Attorney of the District of New Jersey, in a release.

U.S. Healthcare Supply has agreed to pay $5 million plus interest; Jon Letko, its owner and president, has agreed to pay $1 million plus interest. John Letko’s brother, Edward Letko, owner and president of Oxford Diabetic Supply, has agreed to pay $6 million plus interest.

This isn’t the first time CMS has run into trouble with diabetes suppliers. Arriva, the largest of only nine providers to be awarded mail-order diabetes contracts in the latest round of competitive bidding, was rumored to have its provider number revoked by the National Supplier Clearinghouse, underscoring the dangers of having so few providers covering such a large market. On July 21, the company said the matter had been take care of.

WASHINGTON – CMS has delivered a one-two punch to the HME industry, with precious few days left to line up legislation to slow down the spread of competitive bidding.

The agency on Thursday first published an update to its “impact monitoring” of competitive bidding, saying the program continues to have no impact on access to HME. Then it published a new set of payment amounts for HME as part of Round 1 2017, which goes into effect Jan. 1.

For one of the most common products put out to bid, oxygen concentrators (E1390), the new payment amount will be, on average, $77.97. Miami will have the highest amount at $90.01; and Chester, Lancaster and York counties in South Carolina the lowest at $70.04.

For CPAP devices (E0601), the new payment amount will be, on average, $42.68. Again, Miami will have the highest amount at $47.50; Riverside, Calif., will have the lowest at $37.58.

CMS’s update on monitoring and the new payment amounts (and their associated savings) complicate the industry’s efforts to pass legislation that would soften the blow of a second phase of cuts that went into effect in non-bid areas on July 1. Stakeholders have targeted September, before Congress recesses again for the November election, as the prime time to get legislation passed.

“We’re especially concerned about the disruption for beneficiaries following the application of bidding derived-pricing to rural and non-bid areas, reducing prices by 50% to 60%,” AAHomecare stated following the news. “We’re getting widespread reports that these cuts are beginning to severely impact our industry’s ability to support seniors and people with disabilities in small communities nationwide.”

CMS says its latest round of data collection on assignment rates for July and early August of 2016 show no change compared to the same period in 2015, before bid pricing was rolled out to non-bid areas.

“Overall, there was no change in the July/August rate of assignment for 2016 (99.89%) versus the July/August rate of assignment for 2015 (99.91%),” the agency stated.

AAH strongly disagrees. It has spent much of its time in the past few month collecting anecdotes about the impact of the bid program on access to HME.

“CMS’s statement asserting that the bidding program isn’t affecting beneficiary access flies in the face of both common sense, as well as what we’re hearing from home medical equipment providers, hospital discharge planners, and HME patients across the nation,” the association stated.

AAH also pointed out that CMS initially downplayed concerns about contract awards to unlicensed providers.

“Just a few months ago, the Office of Inspector General confirmed that significant numbers of unlicensed providers had, in fact, taken part in Round 2 of the bidding program in several states that license HME,” the association stated. “Time will also tell how well today’s claims by CMS hold up.”

Now that CMS has announced the new single payment amounts for Round 1 2017, it’s in the process of extending 1,523 contract offers to 198 bidders. It says small providers make up 46% of those being offered contracts. It plans to announce contract suppliers this fall.

At press time, AAHomecare said it would provide an analysis of the new payment amounts as soon as possible.

Round 1 2017 represents the third round of competitive bidding pricing in the country’s biggest cities. The original Round 1, with contracts spanning three years, went into effect Jan. 1, 2011.

NEWARK, N.J. – U.S. Healthcare Supply, a national contract supplier for mail-order diabetes supplies, and two of its executives have agreed to pay the government more than $12.2 million to resolve allegations that they violated the False Claims Act.

The settlement resolves allegations that U.S. Healthcare Supply and Oxford Diabetic Supply, both based in Milford, N.J., set up and controlled a fictitious entity to make unsolicited telephone calls to Medicare beneficiaries to sell them DME. The companies then allegedly submitted claims for the equipment to Medicare in violation of the Medicare Anti-Solicitation statute.

“Cold-calling people to sell them expensive medical equipment is prohibited for a reason: unsuspecting patients shouldn’t be coerced into making medical decisions about devices and equipment—which they may not even need—on the basis of a sales pitch,” said Paul Fishman, U.S. Attorney of the District of New Jersey, in a release.

U.S. Healthcare Supply has agreed to pay $5 million plus interest; Jon Letko, its owner and president, has agreed to pay $1 million plus interest. John Letko’s brother, Edward Letko, owner and president of Oxford Diabetic Supply, has agreed to pay $6 million plus interest.

This isn’t the first time CMS has run into trouble with diabetes suppliers. Arriva, the largest of only nine providers to be awarded mail-order diabetes contracts in the latest round of competitive bidding, was rumored to have its provider number revoked by the National Supplier Clearinghouse, underscoring the dangers of having so few providers covering such a large market. On July 21, the company said the matter had been take care of.

CMS revises enrollment app, fee schedule

WASHINGTON – CMS has revised the 855S enrollment application and the July 2016 DMEPOS fee schedule, it announced in a Sept. 8 MLN Connects e-newsletter. The agency plans to publish a revised 855S this fall and providers must begin using it Jan. 1, 2017. Until then, CMS will accept both the current and the revised form. The agency has also revised the fee schedule for 66 codes. For most codes, the revised payment amounts for July 2016 are higher than the original payment amounts, according to AAHomecare.

CDC: Number of COPD-related deaths decreasing

WASHINGTON – From 2000 through 2014, the age-adjusted rate for COPD-related deaths decreased 22.5% for men and 3.8% for women aged 25 and over, according to new data from the Centers for Disease Control and Prevention. The COPD-related death rate decreased for both men and women aged 65-84, and for men aged 85 and over. The rate increased for both men and women aged 45-64, and for women aged 85 and over. The major underlying causes of death for COPD-related deaths were COPD, heart disease, and cancer for both men and women, the CDC says.

BioScrip, Home Solutions tweak deal

DENVER – The price tag for BioScrip’s acquisition of Home Solutions has dropped from $85 million to $75 million, according to news reports. The cash component of the consideration has been dropped from $80 million to $67.5 million. To speed up the deal, the two companies have also agreed to eliminate the need for stockholder approval; instead, they have agreed to a shareholder meeting following the close of the deal to seek such approval and provide Home Solutions with certain contractual protections in the event such approval is not obtained. BioScrip and Home Solutions now expect to close on the deal in the second week of September. Together, the companies are expected to generate more than $1 billion in revenues.

Combined therapy for COPD patients works, study says

LONDON – Adding home non-invasive ventilation to home oxygen therapy decreases the risk of re-hospitalization for COPD patients, according to a study presented last week at the 2016 European Respiratory Society International Congress. Patients in the study who received home non-invasive ventilation in addition to home oxygen therapy had a 51% decreased risk of re-hospitalization or death compared to those who received oxygen therapy alone. Patients who received home non-invasive ventilation went a median 4.3 months without dying or being admitted to the hospital, compared to 1.4 months for those who did not receive non-invasive ventilation, according to the study. Both ResMed and Philips Respironics participated in the multicenter, randomized controlled study, known as “Home Oxygen Therapy – Home Mechanical Ventilation” or HOT-HMV. In press releases, the companies pointed to the potential savings of combining home non-invasive ventilation and home oxygen therapy to care for patients with COPD, which costs the U.S. $36 billion in direct and indirect costs.

Medical Service Co. lands deal with health network

CLEVELAND – Medical Service Co. has hammered out a deal with Kettering Health Network that will pave the way for the provider to streamline the network’s discharge planning process, increase its patient engagement and reduce its hospitalizations. Kettering is a not-for-profit network of eight hospitals, 10 emergency departments, and 120 outpatient facilities serving southwest Ohio. Medical Service Co., with headquarters here, is a regional provider serving Ohio, Pennsylvania, New York and West Virginia. It regularly partners with hospitals, physicians, insurers and other healthcare providers to deliver patient care that controls costs, improves outcomes and reduces patient readmissions.

OIG tells CMS again: Switch to ASP for infusion drugs

WASHINGTON – The Office of Inspector General in a new report reiterates its concerns that, unlike most Part B drugs, Medicare payment amounts for DME infusion drugs are still based on average wholesale prices from 2003. Three years ago, the OIG published a report recommending changes to Medicare payments for DME infusion drugs; however, CMS has continued to reimburse for these drugs at prices that are unrelated to the amounts providers pay to acquire them. The OIG is concerned that paying for the drugs based on flawed AWPs may create access issues or lead to excessive billing. For example, payments that are below costs could make providers less willing to provide a drug, while payments that substantially exceed costs could make them over-utilize a drug. The OIG again recommends that CMS seek a legislative change that would require payments for DME infusion drugs to be based on average sales prices (ASPs), or use its existing authority to include DME infusion drugs in its competitive bidding program.

VGM enlists hospital execs in fight against cuts

WATERLOO, Iowa – The VGM Group has drafted a letter for hospital executives to use to fight back against sweeping Medicare reimbursement cuts. With many HME providers unable to accept Medicare at the new payment rates that were phased in on Jan. 1 and July 1, hospitals will likely have a difficult time discharging patients and experience an increase in readmissions, says VGM. “Since the beginning of the year, many hospital administrators have spoken out regarding Medicare’s actions, but many more are needed,” said John Gallagher, vice president of government relations. “The next few weeks are critical to getting legislative relief before irreversible harm continues.” The letter, as well as other ways to contact elected officials, is located at www.combatmedcuts.com. 

Harmar partners with Wheelchairs 4 Kids

SARASOTA, Fla. – Harmar has joined forces with Wheelchairs 4 Kids, a nonprofit organization that provides scooter and wheelchair lifts to children, to increase access. Harmar, along with its dealers, will assist in evaluating needs, arranging installation and providing ongoing support for the children. “Our shared mission is to help reduce the total cost of providing equipment to the children and ensuring a high-quality experience,” said David Baxter, vice president of marketing of Harmar, in a release. Wheelchairs 4 Kids, Harmar and 101 Mobility marked this new partnership by recently donating and installing a wheelchair lift for a 13-year-old boy with muscular dystrophy in Sarasota, Fla. 

Power soccer team prepares to ‘shock’ at Medtrade

ATLANTA – Team USA, the World Cup Power Soccer Champions, will play two exhibition games on Nov. 1 at Medtrade. Players will be introduced at AAHomecare’s Washington Update, and will play one game in the morning and one in the afternoon on the show floor. Local teams played at Medtrade two years ago, but “the level of play and skill from this world-class Power Soccer team will shock the exhibit hall this year,” said Wayne Merdinger, executive vice president and general manager of MK Battery, the primary sponsor and official battery of the U.S. Power Soccer Association and Team USA. Merdinger encourages others to sponsor the sport. For more information on Power Soccer sponsorships: http://fipfaworldcup.org/

Short takes: Stealth Products, VGM, state associations

Stealth Productshas redesigned its website to feature helpful resources, product specifications and technical data. It will be updated on a regular basis with videos, announcements and product launches…Jeremy Kauten, CIO and vice president of information technology at the VGM Group, has been selected for the 2016-2017 Leadership Iowa class. Kauten will work with fellow participants to increase engagement and promote “issues awareness” on key topics like economic development, health care, education, government services, environment, recreation and other issues…The Florida Alliance of Home Care Services (FAHCS) and the Georgia Association of Medical Equipment Suppliers (GAMES) will host a combined annual meeting from Sept. 11-13. The theme for the inaugural event, to be held on Amelia Island in Florida, is “Redefining the DME Supplier Role: Claiming DME’s role among healthcare specialty providers.” “Now more than ever DME providers must work together to share ideas, strategies, plans, stories, methods, secrets and solutions,” said Gene Sego, FAHCS president.

WASHINGTON – Medicaid Fraud Control Units in 2015 obtained 1,553 criminal convictions and 731 civil settlements and judgments for provider fraud and patient abuse and neglect, according to a new report from the Office of Inspector General.

Criminal recoveries were nearly $350 million, while civil recoveries reached nearly $395 million, the report states. Of those numbers, DMEPOS providers accounted for 33 criminal convictions with $12.7 million in recoveries; and 30 civil settlements and judgments with nearly $4.3 million in recoveries.

Overall, fraud cases accounted for 71% of convictions, with almost half of those involving unlicensed providers, including personal care attendants and homecare aids.

The number of civil settlements and judgments decreased from 908 in fiscal year 2011 to 731 in fiscal year 2015, according to the report.

YARMOUTH, Maine – HME providers typically lean Republican when it comes to politics and that holds true for the 2016 presidential election—even if some are aren’t overly enthusiastic about the party’s candidate.

Sixty-four percent of poll respondents report they favor Donald Trump, saying the billionaire businessman would turn the economy around.

“Mr. Trump is a businessman first, so I think he will lead our nation in a better direction financially,” said one poll respondent. “Mrs. Clinton, on the other hand, has never created a job in her life and her attempt at healthcare reform as First Lady was unpleasant at best.”

Respondent John Reed of Walnut Medical Services in Johnstown, Pa., agreed.

“I am hopeful that a new set of eyes looking at health care from a business perspective can lead to innovative solutions,” he said.

Other respondents disagree, saying Trump isn’t the most empathetic of candidates.

“Well, let’s see…Trump is on record making fun and mocking an individual with a disability in a public speech,” said one respondent, who was among the 24% who said they would vote for Hillary Clinton. “I highly doubt he will have the needs of the disabled as a priority.”

Clinton, they say, cares about people.

“Clinton has people at the center of her policies,” said Jane Holt of Cajane Healthworks in San Francisco. “Trump has not expressed any support for medical care.”

The majority of poll respondents, 56%, identified themselves as Republicans, with 18% saying they are Democrats and 26% saying they don’t belong to either of the two major parties.

Several poll respondents expressed dismay that the poll focused only on the major party candidates. Also on the ballot in most states is Green Party candidate Jill Stein, who earned one vote; and in all states Libertarian candidate Gary Johnson, who earned several votes.

“Despite some reservations, I am voting for Gary Johnson,” said one respondent. “I hope that his respect for the free market will help all companies, including HME.”

The poll highlights the strange dichotomy in which providers find themselves this election year: They are businesspeople and, therefore, sensitive to the burdens placed on small businesses by the government, but they depend on that same government for their livelihood.

“It’s strange to see so many people in this industry who are voting for the side that favors smaller government and cuts in our budget, along with no entitlement programs,” said Lisa Wells of Get Social Consulting. “At the same time, these people are complaining about reduced reimbursement. You make your living off an entitlement program, Medicare, and yet you don’t think others deserve to receive entitlements—especially those you use your products? How does that work?”

WASHINGTON – After a tough week in which CMS trumpeted its competitive bidding program for HME as having no impact on access, all the while creating significant savings, AAHomecare hit back.

The association, with help from its recently engaged public relations firm DCI Group, held a teleconference for the media on Sept. 14 detailing how the roll out of bid pricing to rural areas on Jan. 1 and July 1 is having catastrophic effects on HME businesses and Medicare beneficiaries.

“Six months is not long enough to monitor this disruption,” said Tom Ryan, president and CEO of AAHomecare, which has been working doggedly with its champions in Congress to retroactively delay the July 1 cuts. “This limited phase-in is irresponsible.”

Together, the two rounds of reimbursement cuts represent a 50% to 60% reduction from the original fee schedule in rural areas.

Ryan had with him on the call four providers who gave reports from the front lines. Among them: Joey Tart of Family Medical Supply in North Carolina, who says at least 10 companies providing HME in the state have closed their doors in the past six to 12 months.

“When you take this pricing and put it in small areas, you can’t make up for the numbers in customers, so you end up closing that office,” he said. “Then someone has to drive many miles to service that patient, which they won’t, if they have to travel and spend that time.”

Provider Thad Connally of First Choice Home Medical in Kentucky says his company has reduced in size from 15 employees three years ago to six employees, including himself, today.

“Yet, the demand and need (for our services) are not going away—actually, they’re increasing,” he said. “We’re trying to figure out how to take care of people with little or no reimbursement. The financial side has been mind boggling.”

Ryan pointed out that the catastrophic effects of the bid program don’t affect small providers exclusively. William Guidetti of Apria was also on the call and said the national provider has experienced “more branch remediation than it thought possible.”

“Every day, we’re getting more and more alarming calls from patients,” he said. “We can’t be as responsive as we have been in the past.”

Ryan says industry stakeholders and their champions in Congress are under pressure to come up with a bill that would retroactively delay the second round of reimbursement cuts before Sept. 30, when lawmakers leave the Hill for the November election. How long of a delay and how the industry would pay for it are still unknowns. He did say the pay-for would likely be non-HME related, as the industry has “nothing left to give.”

“We have the utmost urgency to get this taken care of,” he said.

WASHINGTON – HME providers will see an overall reduction in Medicare reimbursement of 5.2% from the Round 1 re-compete to Round 1 2017, according to an analysis by AAHomecare.

The products with the biggest decreases in reimbursement when the latest iteration of the program goes live on Jan. 1, 2017: TENS devices at 45.1%, followed by CPAP devices at 18.5%.

On the flip side, the products with the biggest increases in reimbursement: manual hospital beds at 9.8% and nebulizers at 6.8%.

The areas that will be hardest hit as part of Round 1 2017 are Cincinnati, with an overall reduction across products of 9.3%; followed by Covington-Florence-Newport, Ky., with a reduction of 8.4%.

The area that will be hit the least hard: Riverside-San Bernardino-Ontario, Calif., which will see an overall increase of 1.7%; followed by Charlotte-Concord-Gastonia, N.C., which will see an overall decrease of 1.3%.

CMS announced new reimbursement for Round 1 2017 on Sept. 8. The agency is now in the process of extending 1,523 contract offers to 198 providers. It says small providers make up 46% of those offered contracts.

CMS plans to announce the providers who accepted contracts this fall.

Providers saw an overall reduction in reimbursement of 37% as part of the Round 1 re-compete.

WASHINGTON – The House of Representatives has followed the Senate and introduced a bill last week that would increase Medicare reimbursement for ventilators by 20% on Jan. 1, 2017.

H.R. 6012, known as the BREATH Act, would also establish policies and standards for determining appropriate use for ventilators.

The bills are in response to CMS’s decision late last year to reduce the number of codes for ventilators from five to two, and to reduce reimbursement by about 33%. The agency has been concerned with the drastic increase in the number of Medicare beneficiaries using ventilators—from 60,000 in 2010 to 178,000 in 2014.

The House bill was introduced by Rep. Larry Bucshon, R-Ind., on Sept. 13.

A similar bill in the Senate was introduced by Sens. Bill Cassidy, D-La., and Chuck Grassley, R-Iowa, in July.

Hospitals slam bid program

YARMOUTH, Maine – The VGM Group reported last week that administrators from more than 17 hospitals have sent letters to lawmakers in Washington, D.C., expressing their concerns about the lack of access to HME due to reduced reimbursement. VGM has created a map of the hospitals that have take action. “This is an ongoing campaign,” it stated in a bulletin. “Please continue to encourage your contacts at hospitals to reach out to their legislators.” AAHomecare reported last week that The University of California Health System has urged CMS to carefully evaluate the impacts of its competitive bidding program, saying that hospitals within its system continue to see significant problems obtaining DME. The comments were made in response to CMS’s latest rules proposal covering the bidding program (CMS 1651-P). The health system noted that many winning bidders have actually dropped out of the program, creating delays in patient discharges and forcing some patients to purchase items that should have been covered by Medicare.

Medicaid fraud unit secures millions in recoveries

WASHINGTON – Medicaid Fraud Control Units in 2015 obtained 1,553 criminal convictions and 731 civil settlements and judgments for provider fraud and patient abuse and neglect, according to a new report from the Office of Inspector General. Criminal recoveries were nearly $350 million, while civil recoveries reached nearly $395 million, the report states. Of those numbers, DMEPOS providers accounted for 33 criminal convictions with $12.7 million in recoveries; and 30 civil settlements and judgments with nearly $4.3 million in recoveries. Overall, fraud cases accounted for 71% of convictions, with almost half of those involving unlicensed providers, including personal care attendants and homecare aids. The number of civil settlements and judgments decreased from 908 in fiscal year 2011 to 731 in fiscal year 2015, according to the report.

CMS finalizes emergency preparedness requirements

WASHINGTON – CMS has finalized a rule to establish consistent emergency preparedness requirements for healthcare providers participating in Medicare and Medicaid. The rule also aims to increase patient safety during emergencies and to establish a more coordinated response to natural and man-made disasters. The rule, which will be published in the Federal Register Sept. 16, requires providers to meet four common and well-known industry best practices: 1.) based on a risk assessment, develop an emergency plan using an all-hazards approach focusing on capacities and capabilities that are critical to preparedness for a full spectrum of emergencies or disasters specific to the location of  provider; 2.) develop and implement policies and procedures based on the plan and risk assessment; 3.) develop and maintain a communication plan that complies with both federal and state law; and 4.) develop and maintain training and testing programs, including initial and annual trainings, and conduct drills and exercises or participate in an actual incident that tests the plan. The rule goes into effect Nov. 15, 2016, but providers don’t have to comply with the rule until Nov. 15, 2017.

NHIA responds to OIG report on infusion payments

ALEXANDRIA, Va. – A recent Office of Inspector General report on payment for Part B DME infusion drugs is far too narrow to be the basis for new policy, according to the National Home Infusion Association. The OIG’s report recommends that CMS seek a legislative change that would require payments for DME infusion drugs to be based on average sales prices (ASPs), average wholesales prices from 2003. The NHIA argues, however, that Congress should “fix” the payment issue by passing the Medicare Home Infusion Site of Care Act, a bill that would require CMS to pay for home infusion services and related supplies under Medicare Part B. The NHIA also took issue with the OIG’s claims that home infusion providers are improperly driving over-utilization of one infusion drug, milrinone lactate. The association says providers fill prescriptions for the drug only at the direction of referring physicians.

Hospital readmissions on the decline, says CMS

WASHINGTON – CMS says the Hospital Readmissions Reduction program, which adjusts payments for hospitals with higher than expected 30-day readmission rates for targeted clinical conditions, and the Partnership for Patients program, which aims to decrease preventable complications during a transition from one care setting to another, are working. As a result of the programs, readmission rates have fallen by more than 5% in 43 states and more than 10% in 11 states, according to CMS’s newly released data. “Across states, Medicare beneficiaries avoided almost 104,000 readmissions in 2015 alone, compared to if readmission rates had stayed constant at 2010 levels,” wrote Patrick Conway, principal deputy administrator and chief medical officer, CMS, in a recent blog post. “Since 2010, the HHS Assistant Secretary for Planning and Evaluation estimates that Medicare beneficiaries have avoided 565,000 readmissions.”

Home I.V. Solutions provides $50,000 endowment

JONESBORO, Ark. – Home I.V. Solutions has created an endowed educational fund at Arkansas State University with a gift of $50,000. The Dean’s Excellence Fund will strengthen programs, faculty and facility for students in the College of Nursing and Health, according to a local news report. “The medical communities that have supported Home I.V. Specialists for 25 years greatly benefit from the exceptional education and training that students receive from A-State,” said Brandi Melton, vice president of Home I.V. Specialists. Home I.V. Specialists provides specialty pharmacy, home infusion, enteral and parenteral nutrition, and home medical equipment throughout Arkansas and southern Missouri.

Invacare sees stock movement

ELYRIA, Ohio – Invacare recently lost one investor, but gained two. Linden Advisors sold all of its stake in Invacare during the most recent quarter, according to a disclosure report filed with the Securities and Exchange Commission. It sold 48,554 shares of company stock valued at $604,497. Other hedge funds, including Gotham Asset Management, have sold their stakes in Invacare during the most recent quarter. On the flip side, Alphaone Investment Services bought 54,253 additional shares of Invacare stock in the most recent quarter, according to a report filed with the SEC. It now has a total of 341,253 shares valued at $4.2 million. Pure Vida Investments has also increased its stake in Invacare, buying an additional 67,500 shares, according to a report filed with the SEC. It now has a total of 292,500 shares valued at $3.6 million. Invacare updated investors on the transformation of its business at investor conferences last week.

FODAC seeks donations for relief efforts

ATLANTA – Friends of Disabled Adults and Children (FODAC) will collect DME and supplies at Medtrade to support disaster relief efforts in Louisiana. FODAC will work with its local contacts, particularly those in Baton Rouge and Livingston parishes, two of the worst-hit areas, to contribute the DME and supplies, as well as funding. FODAC asks manufacturers who are attending Medtrade, Oct. 31-Nov. 3 at the Georgia World Congress Center in Atlanta, to make contributions.

Register now for reduced rate
ATLANTA – Early registration for Medtrade ends at midnight on Saturday, Sept. 24. After that date, the $25 expo fee increases to $50, and the $99 conference/education session rate increases to $199. “Even without the early rates, it is a tremendous value,” said Kevin Gaffney, group show director. “However, if you want to get in on this incredible early rate, sign up before Sept. 24 ends.” Medtrade takes place Oct. 31-Nov. 3 at the Georgia World Congress Center in Atlanta.

Short Takes

Health Martwas ranked highest overall in customer satisfaction among chain drug pharmacies across the U.S. in the J.D. Power 2016 Pharmacy Satisfaction Study. The study measures customer satisfaction with pharmacies in four segments: mail order, chain drug stores, supermarkets and mass merchandisers…Shield HealthCare has relocated its Dallas operations and distribution to a larger facility in Carrollton, Texas. The new 52,000-square-foot facility will house 125 home medical supply experts, as well as a customer care center and distribution facility…Universal Power Group, a supplier of absorbent glass mat and gel batteries and chargers, has hired Bret Tracy as director of business development. Tracy recently launched Vita Mobility Werks, a start-up scooter importer, and previously worked at MK Battery and Pride Mobility…Long-time industry expert Louis Feuer has made available his first online series of courses and lectures. Leuer, president of Dynamic Seminars, now offers four courses and 18 lectures on how to build revenues through top-notch customer service…The Accreditation Commission for Health Care (ACHC) has a new partnership with the Florida Alliance of Home Care Services (FAHCS). The partnership allows FAHCS members to receive special pricing on ACHC’s accreditation services, as well as discounts on Accreditation University educational resources.

People: Zacharias, Hizzey

Claudia Zacharias, president and CEO of the Board of Certification/Accreditation, is a 2016 Circle of Excellence Award finalist by Baltimore SmartCEO. Under her watch, BOC has seen its revenue increase nearly 50%. In August, The Daily Record named her one of Maryland’s 2016 Most Admired CEOs … Duncan Hizzey has been named vice president of rehab services at Bellevue Healthcare. Hizzey, an ATP, has extensive industry experience. In his new role, he will help further develop the Bellevue, Wash.-based provider’s complex rehab team.

WASHINGTON – The Council for Quality Respiratory Care says lawmakers should heed the findings of a new white paper that raises concerns about the roll out of competitive bid rates nationwide.

The “State of Expert Judgment Regarding Medicare’s Competitive Bidding Program for Durable Medical Equipment,” published by The Moran Company, looks at the history and intent of the program, its implementation, the problems that result when bid pricing is used to develop reimbursement amounts for home respiratory care supplies and services, and other DME.

The white paper highlights several “deficiencies” with the program, including: use of non-binding bids; use of the median bid to calculate payment amounts; the use of composite bids, which it says incentivizes bidders to “game the system” by bidding low for some products and high for others.

“Given the problems with the competitive biding program outlined in this report, doubt has been cast on the validity of the pricing information the program has produced,” said The Moran Company. “Applying this information nationwide, to non-competitively bid areas, could lead to unsustainable reimbursement levels.”

The Moran Report underscores the need for legislation to roll back the cuts that took effect July 1, says CQRC Chairman Dan Starck.

“It’s time for Congress to pass this legislation before patient care coordination and care management services are jeopardized,” he said.

The industry has a short window in which to pass a pair of bills that would soften the blow of the bidding program.

WATERLOO, Iowa – Ninety-one percent of respondents to The VGM Group’s “Supplier Impact Survey” strongly agree that the national rollout of competitive bidding has had a negative impact on their business.

Fifty-eight respondents say they have eliminated between one and five positions since the bid program hit non-bid areas on Jan. 1. An additional 14% say they have eliminated between six and 15 positions.

Seventy-four percent of respondents also say they are billing more claims non-assigned, or plan to.

“This data has been spread throughout congressional offices,” VGM stated in a bulletin to members. “A long-term replacement to the competitive bidding program must be put in place that does not produce negative outcomes, where patients struggle to receive the equipment that they need.”

More than 400 providers responded to the survey. Fifty-seven percent of them say they have at least 50% or more of their patient base in rural areas.

CMS rolled out bid pricing to non-bid areas in two phases on Jan. 1 and July 1. Together, the two phases represent an average cut in reimbursement of 50% to 60%.

WASHINGTON – The average percent of DME MAC prepayment audits denied nationwide increased 6% between Q4 2015 and Q2 2016, according to the latest results from AAHomecare’s HME Audit Key survey.

Other results from the survey, all for the second quarter of 2016:

·      36% of hospital beds, support surfaces and manual wheelchair new patients were subject to MAC prepayment audit.

·      72% of completed MAC prepayment audits nationwide were paid upon review. 

·      The supplier appeal rate for MAC prepayment denials decreased 10% nationwide between Q1 and Q2 of 2016.

·      51% of completed appeal determinations for respiratory products favored providers.

AAH last reported results* for the survey in July.

The association asks that more and more providers participate in the survey, regardless of the number of audits they’re receiving.

“With wider participation, we will be able to make a better case to policymakers for much needed audit reform measures, as well as increasing the value of the data for industry benchmarking purposes,” the associate said.

The next round of data submission for the HME Audit Key survey opens Oct. 15.

CLEVELAND – Spoken like a true lawyer, Bob Soltis’ advice for HME providers working claims through the Medicare appeals process: be brief and be concise.

Soltis, a former administrative law judge and the author of the recently published book “How to Handle Your Medicare Hearing,” spoke to HME News in the wake of the Department of Health and Human Services’ proposed changes to the appeals system, an attempt to reduce a massive backlog at the ALJ level.

HME News: How can providers be brief and concise during their ALJ hearings?

Bob Soltis: Stick to the issue. If an ALJ asks you to propose a decision, do that rather than go on and on about how the beneficiary has a right to the equipment. No one is arguing about that; where’s the documentation to support it? Forget briefs; just give them one or two pages about what they should find and why they should find it.

HME: How would you fix the badly broken Medicare appeals system?

Soltis: There are two things that could help solve the problem. The AFIRM Act before Congress calls for 119 more ALJ teams. That would double the number of existing teams. A team is an ALJ, two staff attorneys, assistants. We need more people with buckets to bail water, and this would lower the level of the water significantly.

HME: The second item?

Soltis: Better training for the ALJs. And it needs to be independent training, not just from CMS. That’s just indoctrination. It’s important to know the rules, but you need to bring in training from outside, too.

HME: In your previous book “Hurry Up and Wait: Our Broken Medicare Appeal System” you don’t write very favorably of the RACs.

Soltis: The Office of Medicare Hearings and Appeals is comprised of employees who have taken an oath to give the government an honest day’s work for an honest day’s pay. There are no such requirements for these contractors. If an HME provider has to wait three years to get paid, why do the contractors get paid in advance, when their work hasn’t been completely reviewed by the people who have oversight? Why should the RACs get preferential treatment over the appellant, the provider? When Truman and Johnson came up with Medicare, it was for the beneficiaries; those are the people who should be getting preferential treatment. We’re shoveling providers to the back of the line, while the contractors are getting the money.

WATERLOO, Iowa – Results from The VGM Group’s “Supplier Impact Survey” debunk CMS’s claims that its competitive bidding program hasn’t affected access to home medical equipment.

Forty-one percent of HME providers report they have reduced their patient service area 1% to 24% due to the phased-in rollout of bid pricing to rural areas on Jan. 1 and July 1.

“So many folks are saying, I’m beyond 25 miles (from the patient), I can’t go,” said John Gallagher, vice president of government relations for VGM. “And therein lies the access issue for patients.”

Thirty-eight percent of providers who completed the survey report that 75% to 100% of their patient base lives in rural areas.

More than anything, Gallagher says the survey shows that CMS is setting up a two-tiered system for Medicare beneficiaries: One tier for those who can pay out-of-pocket for the equipment they need but are having a hard time getting, and one tier for those who can’t.

“So when CMS tells Congress, ‘We cut utilization by 25%,’ sure they did, because patients are paying out of pocket or going without,” he said.

The problem is only going to get worse, Gallagher says. Only 19% of providers reported that 60% or more of their business is Medicare-related, and 74% say they are billing or plan to bill more claims non-assigned.

While CMS may turn a blind eye to these figures, Gallagher says members of Congress, particularly from the Plains states and the Midwest, aren’t.

“Those folks haven’t been engaged because competitive bidding hadn’t impacted them,” he said. “Now they’re engaged because the patient population is heavily (dependent) on Medicare.”

VGM plans to conduct the survey on a quarterly basis to brief lawmakers on the situation on a rolling basis. 

“I’m sure CMS’s response will be, ‘This is just a snapshot,’ ‘This is an industry grab,’” said Gallagher. “But if we have a good year to two-year trend, that will be important going forward.”

CHARLESTON, S.C. – HME providers need to up their game if they want to keep up with changes in health care, a health system exec and a health insurance exec told attendees of the HME News Business Summit last week.

Prepare to be disrupted

Why? Disruptive change in health care—not just incremental change—is coming, Dr. Patrick Cawley, CEO of the Medical University of South Carolina, the 80th largest health system in the country, told attendees.

“The equation for value in health care (value=quality/cost) is becoming clearer and when that happens, the demand for value grows,” he said. “(That) is going to push us very hard.”

And when health systems get pushed, they push back, demanding better value, in turn, from their healthcare partners—particularly post-acute providers in this new world of readmission penalties, Cawley said.

“Getting patients home quicker will be the challenge of the next 10 to 15 years,” he said.

An HME provider is a successful partner to a health system when it measures outcomes, but not just readmission rates, Cawley said. He wants data that reflects the six domains of value in health care: safe, effective, efficient, equitable, patient-centered and timely.

“You need to come at me with (these) numbers,” he said.

An HME provider must also “understand where technology is going” related to telehealth, mobile health and app development.

“(If not), it makes me question whether or not you’re a good partner to work with,” he said.

One of the early signs that disruptive change is coming in health care, Cawley said: “There was a time when we weren’t even talking about post-acute care; now we have a full post-acute care plan.”

Be better, get paid better

Highmark, one of the 10 largest health insurers, is willing to pay more to post-acute care providers that create value in health care, Nick Stupakis, vice president of Home and Community Services, a Highmark Health company, told attendees.

“Paying everyone the same is not good enough anymore,” he said.

HCS, which manages Highmark Health’s network of post-acute care providers, has created a scorecard for skilled nursing facilities and home health agencies, and HME could be next. The scorecard measures metrics like length of stay and cost per episode, and uses a five-tiered methodology to assign providers reimbursement rates.

“If you do what you say, and you’re truly the best provider, we’re going to pay you differently,” he said.

HCS has created a team of “network performance managers” that score providers and review their results with them, Stupakis said.

“It’s a new approach to partnering with providers to help them be better,” he said.

CHARLESTON, S.C. – Bernie Zimmer, Wayne Slavitt and Dr. Joseph Krainin all have different approaches to the HME industry, but they all believe this: Play the hand you’ve been dealt.

“We always need to be thinking what’s next,” said Zimmer, who has shifted his company, CHME in Foster City, Calif., largely away from Medicare and its competitive bidding program, toward a capitated business model with local and regional health plans. “Don’t come into my office if you want to talk to me about what’s happened.”

Zimmer, Slavitt and Krainin participated in a panel session at the HME News Business Summit last week titled “Mavericks: Shake up what it means to be in HME.”

It’s not easy, always thinking about what’s next, Zimmer acknowledges. To show health plans that CHME was a company worth working with and paying more, he dove into analytics, boosting his staff with IT engineers instead of customer service representatives.

“We blew up our office,” he said.

A former director of a sleep lab, Krainin has also grown disenchanted with Medicare and its regulations and reimbursement restrictions. So much so, that he started an all-cash business, Singular Sleep in Mount Pleasant, S.C., that offers online consultations with sleep health providers, home sleep tests and an array of sleep health products.

“I’m so much happier,” he said. “We’re growing, and we continue to grow. People forget that medicine is a business.”

Krainin says working with patients who are willing to pay cash are the patients you want to work with.

“Medicare patients—their compliance is low, they have no skin in the game,” he said. “My patients have an incentive to get healthy and stay healthy.”

Slavitt, founder and CEO of Mobül, has also found refuge in an all-cash business, selling HME from a slick showroom in Long Beach, Calif.

“The Medicare model is not a lasting model,” he said. “It’s not going away, but (providers) have been forced to rethink their business models.”

Zimmer says he still serves patients with insurance, whether it be Medicare or something else, because “that’s just what I’m passionate about.”

“There’s room for all us—the new wave of retail, the new models of delivery,” he said.

WASHINGTON – Lawmakers should heed the findings of a new report that raises concerns about the roll out of competitive bidding rates nationwide, says The Council for Quality Respiratory Care.

The report, published by The Moran Company, highlights several “deficiencies” with the program, including: use of non-binding bids; use of the median bid to calculate payment amounts; and use of composite bids, which it says incentivizes bidders to “game the system” by bidding low for some products and high for others.

“Given the problems with the competitive biding program outlined in this report, doubt has been cast on the validity of the pricing information the program has produced,” said The Moran Company. “Applying this information nationwide, to non-competitively bid areas, could lead to unsustainable reimbursement levels.”

“State of Expert Judgment Regarding Medicare’s Competitive Bidding Program for Durable Medical Equipment” looks at the history and intent of the program, its implementation, and the problems that result when bid pricing is used to develop reimbursement amounts for home respiratory care supplies and services, and other DME.

The report underscores the need for legislation to roll back a second round of cuts that took effect July 1, says CQRC Chairman Dan Starck.

“It’s time for Congress to pass this legislation before patient care coordination and care management services are jeopardized,” he said.

AAHomecare releases latest Audit Key results

WASHINGTON – The average percent of DME MAC prepayment audits denied nationwide increased 6% between Q4 2015 and Q2 2016, according to the latest results from AAHomecare’s HME Audit Key survey.

Other results from the survey, all for the second quarter of 2016:

·      36% of hospital beds, support surfaces and manual wheelchair new patients were subject to MAC prepayment audit.

·      72% of completed MAC prepayment audits nationwide were paid upon review. 

·      The supplier appeal rate for MAC prepayment denials decreased 10% nationwide between Q1 and Q2 of 2016.

·      51% of completed appeal determinations for respiratory products favored providers.

AAH last reported results for the survey in July.

The association asks that more and more providers participate in the survey, regardless of the number of audits they’re receiving.

“With wider participation, we will be able to make a better case to policymakers for much needed audit reform measures, as well as increasing the value of the data for industry benchmarking purposes,” the associate said.

The next round of data submission for the HME Audit Key survey opens Oct. 15.

Court pressures HHS over audit backlog

WASHINGTON – A federal court has ordered the U.S. Department of Health and Human Services to solve the backlog at the Administrative Law Judge level, according to an update from The VGM Group. In a decision handed down Sept. 19, the court denied HHS’s request to put litigation with the American Hospital Association on hold until Sept. 30, 2017. “Between fiscal years 2010 and 2014, the number of appeals filed at step three grew 936%, from 41,733 to 423,534,” noted the D.C. court. “Because of the consequent financial burden, some providers are ‘forced…to reduce costs, eliminate jobs, forgo services, and substantially scale back,’ all of which affects the quality and quantity of patient care.” While ordering HHS to resolve each pending appeal by the prescribed deadlines was described as “wishful thinking” by the court, VGM called the ruling “a great win for the health care industry.”

DASCO named Best HME Provider

CHARLESTON, S.C. – DASCO Home Medical Equipment of Westerville, Ohio, took home the 2016 HME Excellence Award for Best HME Provider at the HME News Business Summit on Sept. 19.

Carolina’s Home Medical Equipment of Matthews, N.C., took home second place; and Professional Respiratory & Rehab Medical Equipment & Supplies of Chattanooga, Tenn., took home third place.

Profiles of all of the award winners will appear in the Show Dailies distributed at Medtrade, Oct. 31 to Nov. 3, at the Georgia World Congress Center in Atlanta. They will also appear in future issues of HME News.

This year’s judges were Miriam Lieber and Anna McDevitt, both independent consultants; and Jonathan Sadock, managing partner and CEO of Paragon Ventures.

The judges evaluated provider performance in the following categories: financial, community involvement, staffing and quality control.

For more information on the HME Excellence Awards, go to http://hmeexcellenceawards.com/index.php.

Drive DeVilbiss expands e-commerce retail program

PORT WASHINGTON, N.Y. – Drive DeVilbiss Healthcare is expanding its Authorized E-commerce Retailer Program to online retailers in Canada. The program directs consumer traffic to a provider’s website through a web link and offers the opportunity to be featured on the Drive DeVilbiss Healthcare website. “Drive DeVilbiss introduced the program in the United States more than 5 years ago, and customers have thrived on the simplicity of the program, helping to grow their business online,” said Seth Diamond, vice president of the company’s commerce division.

Brightree gets connected at Medtrade

ATLANTA – Brightree will hold its Brightree Summit, which will have the theme “Get Connected!,” on Oct. 31 at the Georgia World Congress Center in Atlanta, in conjunction with Medtrade. The Summit will focus on interoperability—the key, Brightree says, to sharing data across the care continuum for greater coordination. The Summit will overlap with the first day of Medtrade’s education conference sessions, allowing attendees to best use their time and travel budgets to attend both events. “The Summit is the perfect place for our customers to engage with industry leaders and their peers, and learn how to enhance operations and efficiency,” said Brightree CEO Matt Mellott, who will deliver the keynote, in a release.

Allegiance ignites possibilities

OVERLAND PARK, Kan. – The Allegiance Group, also known as A/R Allegiance Group, has a fresh look and purpose. As part of a rebranding effort, the company, which offers private-pay patient billing and collections, completed interviews, surveys and focus groups to determine its focus. What it found? A re-commitment to focus on purpose, it says. As a result, the company has a new logo, and an enhanced brand anthem and brand purpose that emphasize Allegiance’s role as a “spark that ignites possibilities.”

Collins Medical Equipment celebrates 85 years

FAIRFIELD, Conn. – Collins Medical Equipment celebrated 85 years in business with a grand re-opening ceremony Sept. 23. The family owned and operated business started as Collins Pharmacy in 1931. It added home medical equipment in the mid-70s. Collins sold its prescription department to CVS in 2002, and focused on HME and supplies. It launched a new division, “Collins Accessibility Solutions,” in 2010. Four generations of Collins managing the business today: Jack Collins, president; Chris Collins, general manager, who is celebrating 30 years; Tom Collins IV, finance; and Bryan Collins, sales and marketing.

AvaCare helps seniors fundraise

LAKEWOOD, N.J. – AvaCare Medical has partnered with GoFundMe to help seniors, disabled individual and their caregivers raise money for medical equipment and supplies. Anyone who needs assistance purchasing products from AvaCare’s website can start a GoFundMe campaign; the provider will kick in the last 10% toward a purchase. AvaCare recently launched a veterans initiative to offer 10% discounts to all active, reserve or retired U.S. veterans and their families.

VGM runs up to Woman of the Year award

WATERLOO, Iowa – The VGM Group has announced the members of its HME Woman of the Year Honorary Selection Committee. They are Andrea Walsh, executive vice president and chief marketing officer with HealthPartners; John Frank, CEO of Philips Respironics’ Sleep and Respiratory Care Business; Liz Beaulieu, editor for HME News; and Tanya Warren, head coach of the University of Northern Iowa women’s basketball team. The committee received 37 nominations for the award. Committee members will narrow the number of nominees down and VGM will select the winner. The HME Woman of the Year will be announced Nov. 1 at Medtrade.

ITC to investigate Fisher & Paykel

AUCKLAND, New Zealand – The International Trade Commission plans to investigate certain sleep apnea devices manufactured by Fisher & Paykel, it announced Sept. 19. The investigation is in response to a complaint filed by ResMed in August that seeks to ban imports of the Simplus full face mask, Eson nasal mask and Eson 2 nasal mask, which it says infringe on various ResMed patents. That complaint came after Fisher & Paykel filed patent infringement proceedings against ResMed, saying that ResMed’s AirSense 10 and AirCurve10 range of flow generator products, its ClimateLineAir heated air tubing and its Swift LT and FX masks infringe patents that it holds.

Study: OSA common in Type 1 diabetics

YARMOUTH, Maine – Obstructive sleep apnea is common in people with Type 1 diabetes, especially those who have had the disease for a long time, says a study reported on Medscape.com. The incidence of sleep apnea is linked to abnormal glycemia and microvascular complications, but not obesity. Sleep apnea was also associated with higher rates of complications, including retinopathy. The link between Type 1 diabetes and OSA has been reported in several previous studies, but this study is the first to use both continuous glucose monitoring and sleep studies.

Short takes: Wilpage, Option Care

Wilpage, a provider of home medical equipment in the New York metro area, has purchased Mediware’s CareTend software to boost its growing business. Wilpage says the cloud-based system will allow it to spend less time managing technology and more time taking care of patients…Option Care, a national provider of home infusion services, is now a contract provider of Exondys 51 (eteplirsen), the first drug therapy specifically for the treatment of Duchenne Muscular Dystrophy.

CHARLESTON, S.C. – DASCO Home Medical Equipment of Westerville, Ohio, took home the 2016 HME Excellence Award for Best HME Provider at the HME News Business Summit on Sept. 19.

Carolina’s Home Medical Equipment of Matthews, N.C., took home second place; and Professional Respiratory & Rehab Medical Equipment & Supplies of Chattanooga, Tenn., took home third place.

Profiles of all of the award winners will appear in the Show Dailies distributed at Medtrade, Oct. 31 to Nov. 3, at the Georgia World Congress Center in Atlanta. They will also appear in future issues of HME News.

This year’s judges were Miriam Lieber and Anna McDevitt, both independent consultants; and Jonathan Sadock, managing partner and CEO of Paragon Ventures.

The judges evaluated provider performance in the following categories: financial, community involvement, staffing and quality control.

The awards are hosted by HME News, a business newspaper for the home medical equipment industry.

For more information on the HME Excellence Awards, go to http://hmeexcellenceawards.com/index.php.

WASHINGTON – HME stakeholders have House Speaker Paul Ryan’s word that Congress will take up legislation that would retroactively delay a recent reimbursement cut in non-competitive bidding areas in a lame-duck session after the elections.

“We’ve had some of our folks in leadership talk to Ryan directly and he has said that he’s aware of the issue,” said Jay Witter, senior vice president of public policy for AAHomecare. “He said, ‘We’ll take care of it in the lame-duck session.’ That’s a good assurance that we haven’t had in the past that the issue will be addressed.”

Stakeholders were working toward passing legislation by Sept. 30, before Congress recessed for the upcoming elections, but lawmakers were consumed that week with passing a spending bill to prevent a government shutdown.

Because that spending bill is a stop-gap measure that funds the government only through Dec. 9, stakeholders know lawmakers will take up legislation when they return that could serve as a potential vehicle for their legislation.

“There will be a large omnibus package,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “That’s where we’re focusing.”

Stakeholders realize, however, that that’s where a lot of specialty interests will be focusing.

“There are a lot of people who are hoping and praying to get in there,” Bachenheimer said.

Stakeholders are relying on their champions in Congress to hammer out the details of their legislation, and navigate and negotiate the best way forward. The length of the delay and the corresponding pay-for are still in flux.

“The pay-for continues to be a concern,” said Tom Ryan, president and CEO of AAHomecare. “The industry has nothing left to give. Our champions understand this, and they’re committed to finding one.”

While the industry’s champions are doing much of the heavy lifting, stakeholders must keep up the noise level on why the bid program is flawed, and how it’s wreaking havoc on small businesses and impacting access to home medical equipment for Medicare beneficiaries.

“We know the troops are weary, but we can’t give up now,” Ryan said. “We’re almost there.”

Recent efforts to increase the number of boots-on-the-ground stories on the impact of the bid program, especially the reimbursement cuts that went into effect in non-bid areas on Jan. 1 and July 1, are raising eyebrows among lawmakers, stakeholders say.

“The Nantucket story, the Danville, Ill., story—lawmakers are coming to us about them,” Witter said. “Our message is getting through; we need to continue that. We need to arm our champions with ammo that, unlike CMS would have them believe, there is something going on here.”

WASHINGTON – Respiratory stakeholders have begun work to develop outcomes-based care models. Earlier this year, AAHomecare distributed a survey to respiratory stakeholders, exploring the possibility of developing a new payment methodology focusing on chronic respiratory management. After obtaining results, AAHomecare HME/Respiratory Therapy Council members and American Association for Respiratory Care executives met to begin to develop basic tenets for a chronic respiratory care model that is patient-focused, built on clinically validated standardized tools, and ultimately focused on improved outcomes. “A significant amount of progress was made developing the model framework, and I’m excited to broaden the input circle,” said Nick Macmillan, chairman of the Chronic Respiratory Home Care Models Subcommittee, in an AAHomecare bulletin. 

Veterans Safety Mobility Act moves forward

WASHINGTON – The Paralyzed Veterans of America has urged the Senate to follow the House of Representatives in passing a bill that would create standards for the provision of automobile adaptive equipment for veterans. "The independence that driving a vehicle gives back to paralyzed and disabled veterans is something none of us take for granted," said Sherman Gillums, Jr., executive director of Paralyzed Veterans of America, in a release. "We applaud the House for passing this legislation and making the safety of these adapted vehicles and those veterans who drive them a priority. We now urge the Senate to take immediate action and follow suit." Originally introduced by Reps. Jackie Walorski, R-Ind., Raul Ruiz, D-Calif., and Julia Brownley, D-Calif., the Veterans Mobility Safety Act, would require the Department of Veterans Affairs to set comprehensive standards for providers of automobile adaptive equipment, such as wheelchair lifts and reduced-effort steering and braking systems.

CMS provides Medicare Advantage updates for 2017

WASHINGTON – Medicare Advantage premiums will remain stable and for the seventh straight year enrollment is projected to increase to a new all-time high, CMS announced Sept. 22. The average monthly premium will decrease by $1.19, from $32.59 in 2016 to $31.40 in 2017, about 4%. The majority of Medicare Advantage enrollees (67%) will experience no increase in premiums. Enrollment will increase to 18.5 million in 2017, a 60% increase from 2010. Thirty-two percent of all Medicare enrollees will be in a Medicare Advantage plan in 2017 compared to 24% in 2010.

Masimo Foundation co-founds oxygen initiative

IRVINE, Calif. – The Masimo Foundation has co-founded the United for Oxygen Alliance as part of a Clinton Global Initiative. The alliance seeks to expand access to medical oxygen and pulse oximetry for women and children in Ethiopia, where 60,000 babies die in their first month and 30,000 children die of pneumonia due to lack of access to medical oxygen. “This cannot be overstated: regardless of where you live or where you were born, you deserve access to quality healthcare—including the life-saving benefits of reliable pulse oximetry and oxygen therapy,” said Joe Kiani, founder and CEO of Masimo. Other members in the partnership include the Bill & Melinda Gates Foundation, the United Nations, UNICEF and USAID. 

FDA approves artificial pancreas system

NEW YORK – The Food and Drug Administration has approved a commercial version of the Medtronic MiniMed 670G hybrid closed-loop system, an artificial pancreas system. "This announcement is a historic achievement for JDRF,” said Derek Rapp, CEO of the nonprofit dedicated to funding type 1 diabetes research. “After years of laying the ground work, this breakthrough is a testament to the reason JDRF exists—to help people with Type 1 diabetes lead better, safer, healthier lives while we continue on the path to cure and prevent the disease altogether.” Artificial pancreas systems are composed of insulin pumps, continuous glucose monitors and smart software to automate the delivery of the right amount of insulin at the right time. JDRF has supported the research and development of multiple systems across the globe.

Study: Aging plays role in COPD

BRITISH COLUMBIA – The number of patients with COPD could increase by more than 150% by 2030, despite a decrease in the number of smokers, says a new study from the University of British Columbia. The study, published in the American Journal of Respiratory and Critical Care Medicine, predicts the greatest increase in COPD—220%—will be among those age 75 years and older. “Many people think that COPD will soon be a problem of the past, because smoking is declining in the industrialized world,” said senior author Dr. Mohsen Sadatsafavi, assistant professor in the faculties of pharmaceutical sciences and medicine. “But aging is playing a much bigger role, and this is often ignored. We expect these B.C.-based predictions to be applicable to Canada and many other industrialized countries.”

O2 Concepts named top place to work

NEWTOWN, Conn. – O2 Concepts has been named one of the top 50 places to work in southern Connecticut. Employees ranked the company’s workplace extremely high in all areas of satisfaction as part of a survey by Hearst Connecticut Newspapers. “We are small enough to be nimble and responsive to customer needs, and everyone else is trying to catch up,” said one employee. O2 Concepts makes the Oxlife Independence Portable Oxygen Concentrator. In response to the award, the company stated, “We aim to not only improve and extend the quality of life of our customers, but of our employees, as well.”

NHIA honors Reps. Engel, Tiberi

WASHINGTON – The National Home Infusion Association has named Rep. Eliot Engel, D-N.Y., as the recipient of its Congressional Leadership Award. Engel is the lead sponsor of the Medicare Home Infusion Site of Care Act, H.R. 605, a bill that would require Medicare to pay for home infusion services and related supplies under Part B. “I have long been committed to closing the Medicare gap for home-based infusion care,” Engel said. “There is no reason to force patients battling cancer or serious infection to leave their homes for treatment when there is a safer, more comfortable and more cost-effective alternative available.” NHIA also gave the award to Rep. Pat Tiberi, R-Ohio, another supporter of the bill. Currently, Medicare only covers infusion treatments fully if they’re administered in doctors’ offices, skilled nursing facilities and hospitals.

People news: Elaine Stewart, Craig McCook

NRRTS has announced its 2017-2018 board members. Elaine Stewart is president elect, Mike Nadeau is vice president, Gerry Dickerson is secretary, Mike Osborne is treasurer, Jim Douglas is review chair DMAC A, Toby Bergantino is review chair DMAC B, Luke Moore is review chair DMAC C and Katie Roberts is review chair DMAC D. At-large directors are Carey Britton, Michelle Gunn, Keith Jolicouer, Andrea Madsen, David Mancini, Joe McKnight, Dave Murray and Bob Harry…Craig McCook was voted onto the board of directors of the Georgia Association of Medical Equipment Suppliers at the association’s annual meeting Sept. 12. McCook has several decades of experience in the HME industry, and is currently regional manager for Georgia at AeroCare.

WASHINGTON – Two senators recently introduced a bill that seeks to improve the transparency and accountability of the local coverage determination (LCD) process performed by the Medicare Administrative Contractors (MACs).

The Local Coverage Determination Clarification Act of 2016 would: require open and public meetings with the MACs that are on the record; require disclosure by the MACs of the rationale for an LCD and the evidence for that decision at the beginning of the process; provide stakeholders with a meaningful reconsideration process for an LCD; and prohibit the MACs from adopting an LCD from another jurisdiction without first conducting its own independent evaluation.

“Unfortunately, the LCD process MACs use is flawed, lacks transparency and does not provide meaningful opportunity for stakeholder input or appeals,” said Scott Whitaker, president and CEO of the Advanced Medical Technology Association (AdvaMed), in a statement. “Because of these shortcomings, American patients are at risk for being denied access to needed technologies and services.”

AdvaMed is a trade association representing medical device manufacturers. It has nearly 300 member companies, including Cardinal Health, Coloplast, ConvaTec, DJO, Hill-Rom and Philips Health Care.

Sens. Thomas Carper, D-Del., and Johnny Isakson, R-Ga., introduced the bill in late September.

A similar bill was introduced in the House of Representatives in July.