WASHINGTON – Per-capita healthcare spending grew by 5% and overall healthcare spending grew by 5.8% in 2015, according to a recent study by the Office of the Actuary at CMS.

Those rates continue to be below the rates of most years prior to the passage of the Affordable Care Act.

“Even as millions of people gained coverage, per-enrollee spending growth in private health insurance and Medicare continue to be well below the average in the decade before passage of the Affordable Care Act,” CMS stated.

The report concludes that expenditure growth in 2015 was primarily the result of increased use and intensity of services as millions gained health coverage, as well as continued significant growth in spending for retail prescription drugs.

On a per-enrollee basis, overall spending increased by 4.5% for private health insurance, 1.7% for Medicare and 3.8% for Medicaid.

Healthcare spending grew 2.1% faster than the overall economy in 2015, resulting in a 0.4% increase in the health spending share of gross domestic product, from 17.4% in 2014 to 17.8% in 2015. In the decade prior to the passage of the ACA (2000-09), healthcare spending increased 2.8% faster than GDP on an annual average basis.

Per-enrollee Medicare spending increased by 1.7%, about the same rate as in 2014 and below the average annual growth in per-enrollee spending during 2000-09 of 7%. Medicare spending, which represented 20% of national total healthcare spending in 2015, grew 4.5% to $646.2 billion.

Overall Medicaid spending and enrollment grew at a slower rate in 2015 than in 2014 with per-enrollee spending increasing 3.8%. Medicaid spending, which totaled $545.1 billion, accounted for 17% of total spending on health care. Similarly, growth in Medicaid enrollment slowed to 5.7% in 2015, significantly lower than the 2014 increase of 11.1%.

Out-of-pocket spending, which includes direct consumer payments such as copayments, deductibles and spending not covered by insurance, but excludes premiums, grew 2.6% in 2015, compared to the average annual growth during 2000-09 of 4.6%.

OIG: Two brands dominate mail-order market for diabetes supplies

WASHINGTON – Two brands of test strips account for half of the Medicare mail-order market for diabetes supplies, according to a new report from the Office of Inspector General.

The OIG, which looked at claims submitted from April to June 2016, also found that the top 10 brands of test strips accounted for 93% of the mail-order market. Altogether, suppliers submitted claims for 30 different brands of test strips.

The OIG conducted the study to help CMS understand which brands of test strips were provided to beneficiaries prior to the start of the Round 2 re-compete of the national mail-order program. The Round 2 re-compete began July 1, 2016, with pricing of $8.32 per box of test strips vs. $10.41 per box in the previous round of the program.

The Medicare Improvements for Patients and Providers Act requires CMS to award contracts to providers whose bids cover at least 50%, by volume, of all brands of strips on the market.

The top three brands by market share, according to the OIG, are Prodigy (28.2%), OneTouch Ultra (22.8%) and Embrace (11.5%).

In November, Sens. Dan Coats, R-Ind., and Mark Warner, D-Va., introduced the Diabetes Supplies Act to ensure that all Medicare beneficiaries have access to their preferred brand of test strips.

NSM extends reach in Southeast

NASHVILLE – National Seating & Mobility has acquired the rehab division of Georgia-based Integrity Medical. The acquisition include four branches in Augusta, Macon and Savannah, Ga., and Columbia, S.C. “We’re happy to be adding to our footprint in the Southeast with the team and quality operation acquired from Integrity Medical,” stated Bill Mixon, CEO of NSM, in a press release. “As we grow, the addition of highly qualified people continues to make us a better company.” Brian Byler, ATP, and Marc Smith, ATP, principals at Integrity Medical will continue with NSM. Chris Mayo, ATP, will continue in the Macon branch, and Steven Still, ATP, will provide products and services from Columbia. “Being part of the NSM team gives us the freedom and greater resources to provide mobility to our clients,” stated Byler in the release. Integrity Medical will continue to operate its DME division.

Inogen transitions management, expands board

GOLETA, Calif. – Inogen will have a new CEO on March 1. The company announced Dec. 6 that Scott Wilkinson, currently president and COO, will succeed Ray Huggenberger, who is retiring. Wilkinson will also join Inogen’s board of directors effective Jan. 1, 2017. Huggenberger will remain on the board following his retirement. Additionally, Byron Myers, founder and vice president of Inogen, will be promoted to executive vice president of sales and marketing effective Jan. 1, and Scott Beardsley, a senior partner at Novo Ventures, will join the board also on Jan. 1. Wilkinson has spent 11 years at Inogen, in a wide variety of leadership roles in everything from customer service; to sales and marketing; to global commercial, manufacturing and support operations. From 2000 to 2005, he worked at Invacare as a group product manager, helping to launch a $100 million in revenue oxygen product line.

Harmar names new CEO

SARASOTA, Fla. – Steven Dawson is the new CEO of Harmar Mobility, the company announced Dec. 9. He has also been appointed to Harmar’s board of directors. Dawson’s career includes leadership roles managing and executing transformation, growth and development of organizations across a variety of industries. “We are excited we were able to recruit Steve to lead Harmar,” said Jeffrey Lipsitz, managing partner at Cortec Group, Harmar’s controlling shareholder. “We had worked with Steve on another investment that was very successful and were impressed with his focus, high energy and ability to lead and develop teams.” Cortec acquired Harmar in 2012.

Abbott wants to ditch Alere

WALTHAM, Mass. – Abbott Laboratories has sued Alere in an effort to terminate its buyout of the company, according to news reports. Chicago-based Abbott has filed a complaint in the Delaware Court of Chancery, asking a judge to terminate the deal on the grounds that Alere is no longer the company Abbott agreed to buy 10 months ago. Alere’s problems include CMS revoking the billing privileges of its DME supply business, Arriva Medical, amid allegations that it submitted claims for 211 dead patients over the past five years. Previously, Alere sued Abbott in the same court, asking a judge to enforce the deal. That lawsuit is ongoing.

Diplomat Pharmacy unites infusion companies

FLINT, Mich. – Diplomat Pharmacy has launched Diplomat Specialty Infusion Group, a new brand to unite five subsidiaries: American Homecare Federation, At-Home IV Infusion Professional, BioRx, MedPro Rx and XAS Infusion Suites. “As we continue to build on the work we have done, we are excited to move forward with the launch of our new brand,” said Phil Hagerman, CEO and chairman. “Together, our combined resources allow us to continue to build upon our expertise and services for patients with specialized needs.” Diplomat Specialty Infusion Group will continue its focused services on hemophilia and other bleeding disorders, hereditary angioedema, Alpha-1 antitrypsin deficiency and immune globulin.

ResMed recognized for responsible corporate behavior

SAN DIEGO – ResMed has been named to JUST Capital and Forbes magazine’s inaugural “JUST 100 List” for responsible corporate behavior. It is one of only three healthcare devices and services companies to join the list, which was generated based on criteria established from one of the largest surveys ever conducted on attitudes toward corporate behavior, involving 50,000 Americans over the last 18 months. The list ranks U.S. companies against their peers within 32 major industries. The ranking rates companies based on fair pay, equal opportunity employment, job creation, safety, compliance and respect for employees. The list will be featured in Forbes magazine’s “Impact and Philosophy” issue on Dec. 20.

Quantum hits milestone on Facebook

EXETER, Pa. – Quantum Rehab’s Facebook page has surpassed 15,000 “likes” and followers. Quantum created the page in 2012, seeking to connect with consumers and to participate in all areas of disability culture. “We use our Facebook page to keep all informed on product advancements, but we also post a lot of human-interest content,” said Megan Kutch, director of marketing, in a press release. “This mixture, along with direct consumer interaction, has made the Quantum Facebook page a true place for online disability culture.” The page is updated daily with feature-rich stories on everything from new products to inspiring news stories to community events.

SMRC cuts providers some slack

WASHINGTON – SMRC contractors will give providers more time to respond to results letters, AAHomecare reported this week. The association had notified CMS that providers were being inundated with letters, and reviewing them and gathering supporting documents has been an overwhelming process. If providers need more time, they can send a written request to the SMRC for a discussion and education session within 30 days of the date of the final results letter, AAHomecare says. In their requests, providers should request a 14-day extension to submit supporting documents.

EZ Access Bathing & Mobility donates scooter

ABERDEEN, N.C. – EZ Access Bathing & Mobility partnered with Stars N Stripes Scooters to donate a scooter to the Welcome Home Veterans Living Military Museum at Richard’s Coffee Shop in Mooresville, N.C. That organization will give the scooter to a mobility-impaired veteran. Chuck Barnes, owner of EZ Access, is himself a disabled Vietnam veteran. "EZ Access Bathing & Mobility is proud to be associated with Stars N Stripes Scooters,” said Barnes. “The quality of their products and their customer service are exceptional. Their desire to step up and give back exhibits their excellent values.”

FODAC gets greener

STONE MOUNTAIN, Ga. – The Friends of Disabled Adults and Children (FODAC) is the recipient of the Community Foundation of Greater Atlanta’s latest “Grants to Green” giving cycle. The $175,000 matching grant will support green updates to FODAC’s corporate offices and warehouse in Stone Mountain/Tucker, Ga., making it operate more efficiently and freeing up additional funds to support services. “FODAC has always promoted a ‘green’ initiative,” said Chris Brand, president and CEO of FODAC. “Repurposing and recycling used equipment provides much of our inventory to supply the needs of our clients and keeps almost 350 tons of equipment and related parts, like batteries, out of landfills.” FODAC provides equipment like wheelchairs and patients lifts to the disabled community at little to no cost.

AOPA seeks abstracts

WASHINGTON – The American Orthotic & Prosthetic Association has issued a call for papers for the AOPA World Congress slated for Sept. 6-9 at the Mandalay Bay Resort in Las Vegas. The committee is accepting abstracts for Clinical Free Papers, the Technician Program, Business Education Program and the Symposia, in addition to a special Student/Resident Poster Submission category. AOPA has a list of topics of special interest, including osseointegration, public health topics, CAD/CAM, alternative payment methods, and more. The submission deadline for clinical, technical, and symposia topics is March 1, 2017. The deadline for business topics is Feb. 1, 2017. For more information: www.aopanet.org.

SCA helps grant senior wish

PHILADELPHIA – SCA is continuing its partnership with Wish of a Lifetime, a nonprofit organization that seeks to fulfill the dreams of seniors to shift how society views aging, and Brookdale Senior Living, the nation’s largest operator of senior living communities. On Saturday, Dec. 10, Wish of a Lifetime will send 88-year-old James Salvatore to a naval base in Norfolk, Va., to tour an active military submarine. Salvatore, of Williamsburg, Va., is a Navy veteran. SCA is a leading global manufacturer of personal hygiene and forest products.

People news: VGM, HOMES, MedBridge

The VGM Group has tapped Jim Greatorex as vice president of its Accessible Home Improvement of America division. He will be responsible for overseeing AHIA’s nationwide network of certified providers and contractors, and helping them develop business strategies to educate consumers on the many products and services available to them to live independently. Greatorex joined VGM in 2015 as director of business development for its Retail Services division. Jerry Keiderling, formerly president of AHIA, is still with VGM but working in in a different division…Jason Canzano, managing director of Acelleron Medical Products, has accepted a board position with the Home Medical Equipment Services Association of New England. Canzano joined Acelleron Medical Products in 2013, when Preferred Home Health Care & Nursing Services, acquired the company. As managing director, Canzana finds new business opportunities inside and outside of the HME industry, manages daily operations and oversees Maternal Health & Wellness, a company acquired by Acelleron in 2014…MedBridge Healthcare, a provider of sleep disorder diagnostic services and treatment, has named Ghentry Pace as CEO. Pace brings more than 20 years of healthcare experience in clinical, operational and financial arenas. He has held executive leaderships roles in integrated healthcare systems, such as Intermountain Healthcare, and a number of Fortune 500 healthcare providers, including Apria Healthcare and Conifer Health Solutions. Most recently, he served as the senior revenue cycle leader for Fresenius Medical Care, a dialysis provider. As CEO of MedBridge, Pace will lead a staff of 545 direct services, sleep and respiratory professionals.

Product news: ApniCure, DeVilbiss

Redwood City, Calif.-based ApniCure has made its Winx Sleep Therapy System for obstructive sleep apnea available for direct purchase by consumers. Winx provides relief from OSA without a mask, making it ideal for patients who can’t or won’t use a CPAP machine, the company says. The system, which is cleared by the U.S. Food and Drug Administration, was previously only available in select sleep labs. Winx is currently available to consumers only in California, but ApniCure plans for broader distribution in 2017…Port Washington, N.Y.-based DeVilbiss Healthcare has been awarded a patent for its suction container replaceable filter cartridge. “This invention’s unique design helps to isolate the user and the suction device from the contents of the container by combining a traditional ball float shutoff mechanism with a replaceable hygroscopic filter cartridge,” said Allan Jones, director of engineering for DeVilbiss Healthcare. The container is meant to be used with medical suction and aspiration devices.

WASHINGTON – Now that a rollback of a second round of Medicare reimbursement cuts in rural areas is a foregone conclusion, the big question is: How will CMS follow through on Congress’ directive?

At press time on Friday, the 21st Century Cures Act was on its way to a supportive president for his signature, after sailing through the House of Representatives on Nov. 30 and the Senate on Dec. 7. The huge bill will, among many other things, roll back cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers in those areas to recoup six months worth of payments.

“I think there’s a strong argument that can be made that CMS should do it on its own—they can pull by code and by zip code, and automatically reprocess the claims that way,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “That would be far more preferable, and far less of a hassle on providers.”

The other possible scenario: Providers will have to do the heavy lifting and re-file the claims themselves.

Until CMS has the statute in front of them, it’s not likely they’ll offer guidance, stakeholders say.

“Once it’s signed into law, we’ll contact CMS and sit down with Laurence Wilson, (director of CMS’s Chronic Care Policy Group), as soon as possible,” said Tom Ryan, president and CEO of AAHomecare. “It’s a good question.”

If providers are forced to re-file claims, they might look to how CMS handled a recent snafu in processing claims for accessories for complex power wheelchairs. Providers had to re-file claims for those products for Jan. 1, 2016, through June 30, 2016, because the agency couldn’t put a stop to a previously planned shift to bidding-derived pricing until July 1.

On the plus side, stakeholders say, CMS did allow providers to use an Excel spreadsheet to lump together their claims and submit them all at once.

“I know there have been some minor issues, but based on everything we have heard, by and large, the process has worked quite well,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products. “Payments weren’t as quick as many of us would have liked, but it has worked quite well.”

Speaking of accessories, stakeholders believe another provision in the Cures Act that further delays CMS’s plan to use bidding-derived prices for these products for another six months is less up-in-the-air, even as the agency last week released a 2017 fee schedule that does not include the KU modifier, the “fix” it put in place to pay for accessories at the original amounts.

“In this scenario, it’s just an extension of the current policy,” Bachenheimer said. “They just have to stop the change for those codes from going into effect Jan. 1. It’s a much more streamlined process.”

It behooves CMS to tread lightly on both issues, stakeholders say.

“If CMS takes the same tack with the DME rollback that they took with CRT, they’re going to get a lot of congressional pressure,” Johnson said. “Considering how knowledgeable (Rep. Tom Price, president-elect Donald Trump’s nominee for secretary of Health and Human Services) is and his position on these issues, I think they’ll be more timely with guidance and do whatever they need to do.”

WASHINGTON – President Barack Obama is set to sign into law today the 21st Century Cures Act, which offers some relief to HME providers in rural areas.

The bill, passed by the House of Representatives on Nov. 30 and the Senate on Dec. 7, will retroactively delay Medicare cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers to recoup six months worth of payments.

The same cuts will go back into effect, however, on Jan. 1, 2017.

Still, industry stakeholders say the bill sets the stage for legislative and regulatory action in 2017 to more broadly address unsustainable reimbursement for all providers.

“This is an important step forward in the ongoing effort to fix Medicare’s bidding program for HME,” said Tom Ryan, president and CEO of AAHomecare.

It’s still unclear, at this point, how CMS will follow through on the directive to delay the cuts.

The bill will also further delay Medicare’s plan to use bidding-derived prices for accessories for complex power wheelchairs for an additional six months, until July 1, 2017.

WASHINGTON – Recovery audit contractors identified and corrected nearly $441 million in improper payments in Fiscal year 2015—a decrease of 82.8% compared to 2014.

In a new report to Congress, “Recovery Auditing in Medicare Fee-For-Service for Fiscal year 2015,” CMS attributes the decrease to the prohibition on the RACs performing patient status reviews on inpatient hospital claims. Collections on inpatient claims were $2.02 billion in FY 2014 compared to $225.18 million in FY 2015.

The RACs were able to return a net of $141.87 million to the Medicare Trust Fund in FY 2015, although those savings don’t take into account program and administrative costs incurred at the third and fourth levels of appeal.

Throughout the four levels of appeals, a total of 170,482 appeal decisions were rendered for claims with overpayments in FY 2015. Of the appeals decided, 63,647 (37.3%) of claims were overturned in the provider’s favor.

For DME claims, specifically, 8,302 appeals were reported, 2,366 were dismissed and 5,515 (66.4%) were overturned.

YARMOUTH, Maine – The overwhelming majority of respondents to a recent HME Newspoll (85%) say the nomination of Rep. Tom Price, R-Ga., to the top post at the Department of Health and Human Services could signal the start of good things for the HME industry.

“It is an exciting time for the HME industry,” said one poll respondent. “I cannot recall a time when we have had a proponent of our industry who understands it in the way that he does at this level of government.”

Price, a longtime champion of the industry, has introduced multiple bills to create an alternative to the competitive bidding program called the market pricing program.

Not surprisingly, more than half of poll respondents (56%) said repealing the competitive bidding program and replacing it with MPP should be Price’s No. 1 priority.

“Competitive bidding has wrecked this industry and been awful for patient access,” said one respondent. “I think he will be a strong driver for reform of Medicare overreach in this industry.”

Other respondents, however, expressed caution.

“Repeal and replace sounds so simple but it will be a difficult and challenging task,” said Lori Sears, of Active Home Medical Supply in Lapeer, Mich. “I am comforted knowing there will be a physician that understands our industry leading the way.”

Price is also a well-known critic of the Affordable Care Act, and 28% of poll respondents say repealing and replacing that program should be his top priority.

“Price has repeatedly brought before Congress an alternative to the ACA,” said Mark Schmitt, with Altimate Medical in Morton, Minn. “Hopefully, he can now get the job done.”

Other priorities for Price should be reforming Medicare (8%) and decreasing Medicare regulations (8%), say respondents, many of who singled out a broken audit system.

“When 80% of unfavorable rulings are overturned, there is something wrong,” said one respondent.

While several respondents expressed surprise that anyone would disagree with Price’s nomination—“Price is the best pick for DME nation, hands down”—others viewed a bigger picture beyond the confines of the HME industry.

“While I appreciate Price’s support of repealing competitive bidding, his stance on women’s and LBGT rights is appalling,” said one respondent. “I’d rather go out of business than deprive my fellow Americans of their right to choose or the freedom to marry.”

WASHINGTON – Industry stakeholders are looking into whether or not other payers should have to follow Medicare’s lead and retroactively delay reimbursement cuts that went into effect in rural areas on July 1.

Because so many other payers base their reimbursement on Medicare’s, shouldn’t they also have to allow providers to recoup six months of payments, from July 1, 2016, to Dec. 31, 2016, as outlined in the 21st Century Cures Act?

“When CMS dropped the fee schedule across the board on July 1, it caused Tricare rates to plummet, as most of those contracts were based on a percentage off the Medicare rate,” said Chris Smythe, vice president of Tycon Medical Systems in Norfolk, Va. “I would assume that if CMS changes the Medicare fee schedule back to its old rates during that time period, the Tricare rates will have to be adjusted as well.”

AAHomecare is trying to find out.

On the one hand, the association knows Medicare can’t tell other payers what to do.

“CMS never issues any guidance to other payers on what they should do,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “That would be up to the payer and the supplier.”

So AAHomecare is researching whether or not at least Tricare has an obligation to delay the cuts, because there is legislative language requiring them to follow Medicare reimbursement, says Laura Williard, senior director of payer relations for the association.

For Medicare Advantage and commercial plans, it would be more of a negotiation, Williard says.

“At this point, we are developing the strategy of what are possible discussions that can be had with these plans,” she said.

It sounds like a tall order, but AAHomecare is hot off a recent win in North Carolina, where it, along with the Atlantic Coast Medical Equipment Services Association, convinced Blue Cross Blue Shield not to apply the 2017 Medicare fee schedule update, which includes reimbursement based on the cuts going back into effect on Jan. 1, instead sticking to the 2016 fee schedule.

It’s all worth looking into as far as Smythe is concerned.

“For companies like ours, that serve a large Tricare population, even this six months of relief will be big,” he said.

WASHINGTON – Recovery audit contractors identified and corrected nearly $441 million in improper payments in Fiscal year 2015—a decrease of 82.8% compared to 2014.

In a new report to Congress, “Recovery Auditing in Medicare Fee-For-Service for Fiscal year 2015,” CMS attributes the decrease to the prohibition on the RACs performing patient status reviews on inpatient hospital claims. Collections on inpatient claims were $2.02 billion in FY 2014 compared to $225.18 million in FY 2015.

The RACs were able to return a net of $141.87 million to the Medicare Trust Fund in FY 2015, although those savings don’t take into account program and administrative costs incurred at the third and fourth levels of appeal.

Throughout the four levels of appeals, a total of 170,482 appeal decisions were rendered for claims with overpayments in FY 2015. Of the appeals decided, 63,647 (37.3%) of claims were overturned in the provider’s favor.

For DME claims, specifically, 8,302 appeals were reported, 2,366 were dismissed and 5,515 (66.4%) were overturned.

WASHINGTON – President Barack Obama on Dec. 13 signed into law the 21st Century Cures Act, which offers some relief to HME providers in rural areas.

The bill, passed by the House of Representatives on Nov. 30 and the Senate on Dec. 7, will retroactively delay Medicare cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers to recoup six months worth of payments.

The same cuts will go back into effect, however, on Jan. 1, 2017.

Still, industry stakeholders say the bill sets the stage for legislative and regulatory action in 2017 to more broadly address unsustainable reimbursement for all providers.

“This is an important step forward in the ongoing effort to fix Medicare’s bidding program for HME,” said Tom Ryan, president and CEO of AAHomecare.

It’s still unclear, at this point, how CMS will follow through on the directive to delay the cuts.

The bill will also further delay Medicare’s plan to use bidding-derived prices for accessories for complex power wheelchairs for an additional six months, until July 1, 2017.

BioScrip restructures credit

DENVER – BioScrip has proposed an amendment to its original credit agreement that would restructure an existing revolving credit facility, providing immediate access to $15 million.

“As stated on our third quarter earnings conference call, BioScrip is in the beginning stages of implementing an 18 to 24-month turnaround strategy and is focused on optimizing operational efficiencies to drive profitable growth and deliver on our financial commitments,” said Daniel Greenleaf, CEO, in a statement.

For the fourth quarter of 2016, the company is performing better than expected, Greenleaf said, with revenues projected to be at the high end of previously announced ranges of $232 million to $239 million.

BioScrip also issued a statement on the potential impact of the 21st Century Cures Act, signed into law Dec. 13, which will impose an average sales price model on Part B infusion drugs effective Jan. 1, 2017.

“The company estimates that the Cures Act as written will result in reimbursement reductions impacting therapies representing approximately 3% to 4% of total current revenue,” the statement reads.“While we are disappointed with the passage of the Act and the potential implications for our Medicare patients, we are confident in our business model and in the ability of our team to reach a level of financial productivity that is more reflective of the true value of the company.”

BioScrip has suffered losses in recent quarters. Net revenues for the third quarter of 2016 were $224.5 million, a decrease of 9.2% from a year ago. Net losses from continuing operations were $11.1 million vs. $24.5 million. 

The company has shaken up its executive team, installing Daniel Greenleaf as its new president and CEO. Greenleaf previously held positions at Home Solutions, which BioScrip acquired in September, and Coram. At both companies, he is credited with turning around an underperforming company.

NJ Transit takes 11 off rails…

NEWARK, N.J. – Eleven New Jersey Transit train engineers or conductors have been temporarily removed from duty under a new program to assess fatigue-related conditions like obstructive sleep apnea, according to news reports. Under the program, launched in October, engineers and conductors who show indications of potential fatigue symptoms will be removed until they can document that they’ve controlled or corrected their conditions, according to reports. Previously, NJ Transit allowed engineers with sleep apnea to keep working as long as they were being treated. The program was launched after the crash of a train traveling from New York to Hoboken in September that killed one person and injured more than 100 others. The engineer of that train suffered from sleep apnea.

…Truck drivers challenge fed on sleep

GRAIN VALLEY, Miss. – The Owner-Operator Independent Drivers Association filed a petition on Dec. 14 challenging language related to sleep apnea in the Federal Motor Carrier Safety Administration’s final rule on medical examiner certification, according to the Journal of Commerce. The appendix of the rule states: “If the medical examiner detects a respiratory dysfunction, that in any way is likely to interfere with the driver's ability to safely control and drive a commercial motor vehicle, the driver must be referred to a specialist for further evaluation and therapy." At question, according to the OOIDA, is whether or not that constitutes a recommendation or a requirement. The group also argues the language could violate a law that blocks the FMCSA from requiring sleep apnea testing for truck drivers without a formal rulemaking process.

Philips opens new distribution center

EAST HUNDINGTON, Pa. – Philips Sleep & Respiratory Care held a grand opening for its new distribution center here on Dec. 13. The new center allows Philips to consolidate functions at leased buildings elsewhere in Westmoreland County and maintain its staffing level of about 250 employees, according to Trib Total Media. The 260,000-square-foot center allows Philips to make 850,000 deliveries annually; on average, it can process 3,500 shipments a day, according to the newspaper. Philips is the first business to open in the new Westmoreland Distribution Park North. The center was specifically designed for Philips’ needs and cost between $4 million and $6 million, according to the newspaper.

VGM seeks Heartland speakers

WATERLOO, Iowa – The VGM Group is now accepting speaker proposals for the 16th annual Heartland Conference, slated for June 12-15. Organizers are looking for sessions on a variety of topics, including retail, billing and reimbursement, executive, operations, sleep and respiratory, rehab and legislative. “Heartland’s diverse educational program is designed to ensure that attendees leave each session equipped with effective strategies to achieve operational excellence,” said Sara Laures, VGM’s vice president of special projects and the chairwoman of the Heartland Conference. The theme of this year’s conference is “Where Community Meets Opportunity.” Proposals are due Jan. 13. For more information: www.vgmheartland.com/speak.

NCPA agreement offers digital benefits to members

ALEXANDRIA, Va. – The National Community Pharmacists Association has extended its partnership with RxWiki, a digital health company. The five-year agreement allows RxWiki to continue offering NCPA members benefits like an annual digital health check; content and a newsfeed to power social media or email marketing campaigns; and a digital pharmacist platform that allows pharmacies to access branded websites, e-newsletters and mobile apps. “With more and more patients seeking health care solutions online, it is critical for independent community pharmacies to have a solid digital presence and rethink how they communicate with patients,” said NCPA CEO Douglas Hoey in a statement.

NCART seeks more survey responses

WASHINGTON – The good news is, NCART has received responses from 22 states for its National CRT Medicaid Survey. The bad news is, it still needs responses from Arkansas, Alabama, Colorado, Connecticut, Delaware, Georgia, Hawaii, Idaho, Illinois, Kentucky, Louisiana, Maryland, Maine, Minnesota, Missouri, Mississippi, Montana, New Hampshire, New Jersey, New Mexico, Nevada, Oregon, Pennsylvania, Rhode Island, South Carolina, Utah, Vermont, Wisconsin, West Virginia and Wyoming. “We know everyone is busy, but if you are a CRT provider in one of these states, we ask that you complete the survey,” said Don Clayback, executive director of NCART, in a bulletin on Dec. 13. NCART has extended the deadline to complete the survey to Dec. 21. Providers that complete the survey will receive a complimentary copy of the results of the survey, probably some time in January. NCART launched the survey to identify states with access issues. It plans to use the results of the survey to support efforts to pass separate benefit recognition legislation in individual states.

bflow, Allegiance integrate

LOS ANGELES – bflow has finalized its integration with Allegiance Group, bringing its users automated private patient pay and debt collections. “The Allegiance Group solution fits tightly into our vision for a more automated workflow for bflow customers,” said Ted Jones, CEO of bflow, in a press release. “We know this solution provider has a proven track record for improving their customers’ revenue.” bflow, based here, is a software as a service (SaaS) HME billing software and business management solution. Allegiance Group, based in Overland Park, Kan., offers CollectPlus, a four-phase, automated, billing and collection system that features an integrated patient payment portal and call center. “By bringing the CollectPlus solution to the bflow software platform, bflow customers can take advantage of the built-in revenue cycle solution for their private pay A/R needs,” said Bruce Gehring, senior vice president of business development, at Allegiance Group.

WASHINGTON – Industry stakeholders are trying to figure out why the recently released 2017 DMEPOS fee schedule appears to apply a “double dip” cut to rural rates for oxygen concentrators, lowering them to below competitive bidding rates.

To determine the fee schedule, CMS reduces payments for oxygen concentrators by a certain percentage to maintain budget neutrality in the face of increased utilization for oxygen generating portable equipment.

“This comes as somewhat of a surprise because rural rates are supposed to be derived from the competitive bid program, not this alternative methodology that applies to the fee schedule,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “We’re not quite sure what they did, but we don’t think it’s correct. CMS has yet to publicize the actual calculation.”

CMS has the authority to determine payment rates under the fee schedule and, separately, the authority to determine rural rates. As near as stakeholders can tell, CMS combined both authorities.

The result: The rural rate for oxygen concentrators is $77.16 per month compared to the Round 1 2017 single payment amount of, on average, $79 per month.

“This seems like a bit of a double dip,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “It makes no sense for rural rates to be lower then the bid rate. Rural rates are supposed to be the highest rates.”

Stakeholders at press time were determining their next moves.

“We are putting together a strategy to figure out how to tackle this and push back on it,” said Brummett.

Their first step: On Dec. 20, AAHomecare sent a letter to the associate general counsel at CMS, outlining what they believe has happened and why it’s a concern.

“We request that CMS recalculate these rates,” the letter states. “Given the approaching Jan. 1, 2017, effective date for the new fee schedules, this issue urgently concerns AAHomecare members.”

WASHINGTON – There will be an average decrease in reimbursement of 36.8% in 2017 for the top 25 HCPCS codes for HME, according to a new analysis by AAHomecare of the new reimbursement compared to 2016 and 2015 reimbursement. Low-air loss mattresses (E0277) will see the biggest hit: about a 58% decrease in reimbursement, on average, in 2017 vs. 2016. To perform the analysis of the recently released 2017 fee schedule, AAH segmented eight geographical regions and averaged the reimbursement for all the states within each region. At the high end, the “regional rate” in New England, will decrease 60.2% in 2017 vs. 2016; at the low end, the rate will decrease 53.6% in the Southeast.

Quantum Rehab sponsors seat elevation study

EXETER, Pa. – Quantum Rehab is sponsoring a Georgia Tech study examining how power adjustable seat height can affect the everyday lives of wheelchair users.

“Some users still face funding barriers to this clinically-necessary mobility technology, so this research study will ideally clarify through data as to why funding sources should cover it for those in need,” said Jeannie Sayre, vice president of clinical development for Quantum Rehab. “Based on Quantum’s consumer base widely using power seat elevation, we see our sponsorship of this study as an advocacy role toward those we serve.”

The Rehabilitation Engineering and Applied Research Lab at Georgia Tech has already conducted a pilot study on seat elevation. Ninety percent of those who participated in the study used the technology as a tool for increased safety and independence during activities of daily living. They also used it for transferring, reaching and preparing meals.

The upcoming study seeks to expand the scope of the research by using a larger participant group and data-logging technology. It will also feature real-time feedback to create a real-world portrayal of how seat elevation is used daily and its clinical benefits to users, Quantum says.

The study kicks off in the spring of 2017.

ResMed taps Nunez as new chief medical officer

SAN DIEGO – ResMed has named Dr. Carlos Nunez chief medical officer effective Jan. 3. Nunez most recently served as senior vice president of medical affairs for Becton, Dickinson and Company. He will be based in ResMed’s San Diego headquarters and will report to CEO Mick Farrell and President/COO Rob Douglas. Nunez has more than two decades of leadership experience in the medical field, with a focus on aligning the clinical realities of modern healthcare with the business strategies of global enterprises. At BD, he drove business strategy, innovation and public policy efforts across a business with $12 billion in revenue, while advising on safety, quality and regulatory matters. He has also held senior leadership positions at United HealthCare Group’s Optum division, CareFusion and Picis, a healthcare informatics company. ResMed’s current chief medical officer, Dr. Glenn Richards, will transition to the role of medical director for the company’s product development teams.

Mediware managers named to nat’l claims committee

LENEXA, Kan. – Two DME software product managers at Mediware Information Systems have been appointed to represent AAHomecare on the National Uniform Claims Committee for 2017. Rebecca Bowden and Kimberly Commito will participate in industry discussions related to maintaining the healthcare provider taxonomy code set, managing 1500 claims forms and monitoring legislative and regulatory changes that impact claims. NUCC comprises a diverse group of healthcare industry stakeholders representing providers, payers, designated standards maintenance organizations, public health organizations and vendors. The underlying goal of the committee is to help standardize data to transmit claims and encounter information to and from all third-party payers.

H.D. Smith launches VentureRx to support community pharmacists

SPRINGFIELD, Ill. – H.D. Smith has launched a new program to initiate and fullly support the start up, purchase, sale and related transition strategies of an independent or regional chair pharmacy. VentureRx empowers pharmacy owners to shape the future of their businesses, the pharmaceutical wholesale distributor said in a press release. “Recognizing the amount of pharmacies closing or selling to large chains, H.D. Smith developed VentureRx to support its largest customer base—community pharmacies,” said Chris Smith, president and CEO, in the release. The program is targeted at independents, small chains, long-term care facilities, and specialty or compounding pharmacies. In addition to financial services, VentureRx also offers expertise in store branding, marketing, merchandising, managed care, and full front-of-store designs and programs.

TiLite goes metric

PASCO, Wash. – Starting Jan. 16, TiLite wheelchairs will have metric nuts, bolts and fasteners. The change will affect lead times: 10 days for S Series and Twist, and 20 days for T Series and Z Series. Custom chairs will be scheduled based on complexity. Parts orders will be shipped within 48 hours. Imperial parts will be kept on hand for five years. The change will not affect measurements, tires, casters, armrests, hangers, bearings or upholstery. There will be a revised warranty for metric chairs: complete replacement within the first year, and metric frame kit, including all parts needed to make chair complete, after the first year. TiLite will also offer free metric tool kits with every order until March 1, 2017.

Bill-Ray Mobility wins with Friendly Beds

KIMBERLY, Wis. – The Benjamin Rose Institute on Aging presented its 6th Annual Innovation in Caregiving Award to Bill-Ray Home Mobility at its annual conference in November. Bill-Ray Home Mobility was selected for the award for its Friendly Beds, a device that allows people with disabilities or older adults with limited mobility to get in and out of bed more easily. The award recognizes individuals who, in the course of caring for an older adult or person with disability, solve a challenge that eases the burden on caregivers. Friendly Beds was developed by engineer Joe Vosters based on his experiences as a caregiver for his aging father and a brother in law who suffered a stroke. “I thought there was a need for a heavy duty system where the components work together for unique benefits,” he said. Friendly Beds comprises a 36-inch long trapeze that allows someone with limited mobility to move across a wide bed; a stable balance pole that helps them stand and maintain balance; pivoting assist rails that help them reposition and provide support for getting in and out of bed; and a transfer bar option that allows safe/independent bed transfers for individuals with no leg strength.

Brightree donates to three organizations

ATLANTA – Brightree has given monetary donations to three national nonprofit organizations that support the HME, and home health and hospice communities. The donations to Portlight Strategies, Hospice Foundation of America and Caregiver Action Network will help improve access to medical equipment and supplies, and provide educational materials and resources for patients, people with disabilities, caregivers and other health professionals. “These organizations provide great services to the HME, and home health and hospice, communities, and Brightree is proud to contribute to their efforts and help make a difference with the people they support,” said Matt Mellott, CEO. Each year, Brightree donates to charitable organizations on behalf of its customers, partners and employees in lieu of sending traditional holiday cards.

POWER Symposium partners with Medtrade Spring

LAS VEGAS – Juzo and Amoena are once again hosting their POWER Symposium ahead of Medtrade Spring. The symposium is scheduled for Feb. 27 to March 1, 2017, at the Mandalay Bay Convention Center. It brings together industry leaders, specialty retailers and medical professionals to exchange ideas on ways to re-energize their businesses, gain new perspectives on wellness and better connect with customers. It’s targeted toward specialty retailers catering to women’s wellness needs, including DME companies, women’s and hospital boutiques, O&P providers and medical centers. The symposium and Medtrade Spring have partnered to offer all attendees access to the Medtrade Spring Expo Hall at no cost. The symposium is in its seventh year.

WASHINGTON – CMS has updated the DME Center page of its website with information on how it plans to implement certain provisions in the recently passed 21st Century Cures Act.

For a provision that delays CMS’s plans to apply bid-derived pricing to accessories for complex power wheelchairs for another six months, until July 1, 2017, the agency states:

“To implement the extension, the 2016 KU fee schedule amounts have been updated by the 2017 0.7% covered item update and will be added to the 2017 DMEPOS fee schedule file. Suppliers should continue to use the KU modifier when billing for wheelchair accessories and seat and back cushions furnished in connection with Group 3 complex rehab power wheelchairs with dates of services Jan. 1, 2017, through June 30, 2017.”

For a provision requiring CMS to retroactively delay reimbursement cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, the agency states:

“CMS is currently working to implement this section and will be providing contractor instructions for re-processing the applicable claims. There is no action required for the suppliers at this time. Formal instructions will be issued in the near future.”

President Barack Obama signed the Cures Act on Dec. 13.

YARMOUTH, Maine – 2016 was the year that HME providers fought back.

The most read story on www.hmenews.com in 2016 was “In wake of cuts, HME providers let chips fall.” When CMS implemented the Round 2 re-compete and the first phase of its nationwide rollout of competitive bidding on July 1, providers directed angry referral sources right to lawmakers. Other providers washed their hands of bid products and services—products and services that they had provided for years.

In the No. 2 spot was “Providers start dropping Medicare assignment.” A whopping 89% of the respondents to an HME Newspoll reported they had stopped taking assignment on certain products in the past year. In the No. 7 spot, another story about dropping assignment, “What are opportunities, pitfalls of billing non-assigned?”

The fighting paid off. In the No. 10 spot was “Industry gets assurance that bid relief is forthcoming,” a bellwether of what was to come in December, when Congress passed the 21st Century Cures Act, which contained a provision to retroactively delay the second phase of the nationwide rollout of competitive bidding. The bill also included a provision to delay CMS’s plan to use bid-derived pricing for accessories for complex power wheelchairs for another six months.

Not surprisingly, competitive bidding-related stories dominated much of the top 10, with “Trickle-down effect: Tricare rates nosedive” at No. 5, “Nowhere to hide: Reimbursement cuts multiply” at No. 6 and “CMS resets payment amounts for Round 2” at No.9.

Two stories about M&A activity also made the top 10: “ResMed gets ‘one-two punch’ with Brightree” at No. 3 and “Lincare offloads specialty pharmacy biz” at No. 8. It was big news—and a shock to some—when ResMed bought Brightree for $800 million. Stories in the wake of the announcement centered on the many questions the deal raised, including whether or not ResMed has direct-to-consumer plans, prompting the company to respond.

Last but not least, there was “CMS ready to roll with prior authorizations” in the No. 4 spot. This will also be a top issue in 2017: The agency announced in December that the first two codes up for the PA process will be for complex power wheelchairs and that it will apply the process in two phases in March and in July.

Happy New Year!

Here are the top 10 stories on www.hmenews.com in 2016:

No. 1: In wake of cuts, HME providers let chips fall

YARMOUTH, Maine – It’s only been a month since CMS rolled out draconian reimbursement cuts across the country, but HME providers have begun playing hardball.

http://www.hmenews.com/article/wake-cuts-hme-providers-let-chips-fall

No. 2: Providers start dropping Medicare assignment

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.

http://www.hmenews.com/article/providers-start-dropping-medicare-assignment

No. 3: ResMed gets ‘one-two punch’ with Brightree

SAN DIEGO – Some may think the price tag too high and the pairing unexpected, but ResMed officials say the company’s plan to acquire Atlanta-based Brightree makes all the sense in the world.

http://www.hmenews.com/article/resmed-gets-one-two-punch-brightree

No. 4: CMS ready to roll with prior authorizations

BALTIMORE – CMS is moving forward with its plans to implement a prior authorization process for certain DME and stakeholders say it should make life easier for providers.

http://www.hmenews.com/article/cms-ready-roll-prior-authorizations

No. 5: Trickle-down effect: Tricare rates nosedive

YARMOUTH, Maine – HME providers were caught off-guard when Tricare, the healthcare program for uniformed services members and their families, began ratcheting down its reimbursement rates to below Medicare’s new reduced rates.

http://www.hmenews.com/article/trickle-down-effect-tricare-rates-nosedive

No. 6: Nowhere to hide: Reimbursement cuts multiply

YARMOUTH, Maine – Third-party payers have wasted no time applying recently reduced Medicare pricing, respondents to the latest HME Newspoll say.

http://www.hmenews.com/article/nowhere-hide-reimbursement-cuts-multiply

No. 7: What are opportunities, pitfalls of billing non-assigned?

YARMOUTH, Maine – When it comes to billing Medicare non-assigned—something more and more HME providers have been forced to do—there are misconceptions about what can and can’t be done, say industry consultants.

http://www.hmenews.com/article/what-are-opportunities-pitfalls-billing-non-assigned

No. 8: Lincare offloads specialty pharmacy biz

CLEARWATER, Fla., and CHARLOTTE, N.C. – National HME provider Lincare will get $75 million for its specialty pharmacy business.

http://www.hmenews.com/article/lincare-offloads-specialty-pharmacy-biz

No. 9: CMS resets payment amounts for Round 2

BALTIMORE – CMS today announced the new single payment amounts for the Round 2 re-compete of competitive bidding.

http://www.hmenews.com/article/cms-resets-payment-amounts-round-2

No. 10: Industry gets assurance that bid relief is forthcoming

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.

http://www.hmenews.com/article/industry-gets-assurance-bid-relief-forthcoming

WALTHAM, Mass. – The parent company of Arriva Medical, a contract supplier under Medicare’s national mail-order program for diabetes testing supplies, has filed an appeal with the administrative law judge seeking to reinstate its billing status.

Arriva Medical expects the ALJ to hear its appeal within 30 days and issues a decision in three months, it stated in a Dec. 28 update on its website.

“We believe the recent action by CMS to remove Arriva from CMS billing is unlawful, arbitrary and capricious, and harmful to the more than 500,000 patients who depend on Arriva for these critical supplies,” it stated. “We are confident that Arriva is in compliance with CMS guidelines and look forward to an expeditious and favorable outcome.”

CMS revoked Arriva Medical’s billing privileges in November for allegedly submitting 211 claims for deceased patients between April 15, 2011, and April 25, 2016.

Arriva Medical says any errors were the result of “Medicare system flaws.”

Additionally, “the number of purported instances cited by CMS is de minimis relative to the nearly 5.8 million total claims filed by Arriva during that same period,” it stated.

In addition to the appeal, Alere has filed a complaint and related motions in the U.S. District Court for the District of Columbia seeking to compel CMS to stay the process regarding the competitive bidding contract termination while the ALJ appeal is ongoing and to compel CMS to provisionally reinstate Arriva’s billing number while the company pursues the ALJ appeal. It expects a decision on the complaint on or about Jan. 5.

Arriva Medical received a letter from CMS on Oct. 12, informing the company that effective Nov. 4, the agency was revoking its supplier billing number and barring it from re-enrolling in the Medicare program for three years. Then on Nov. 2, CMS upheld its decision based on a four-day, mechanical review.

“CMS reached this conclusion in spite of evidence provided by Arriva demonstrating that any errors were primarily the result of Medicare system flaws,” Arriva Medical stated.

Arriva Medical says it is confident in the merits of the case because:

·      Arriva and the Medicare beneficiaries its serves will suffer irreparable harm if injunctive relief is not granted;

·      The balance of equities and the public interest are decidedly in favor of Arriva;

·      Arriva is likely to succeed on the merits of the case because CMS’s action are depriving Arriva of protected property and liberty interests without due process; and

·      CMS’s refusal to grant Arriva a pre-termination hearing violates due process.

Sleep clinic agrees to pay $2.6M for dual role

SAN JOSE, Calif. – Bay Sleep Clinic and its related businesses have agreed to pay $2.6 million to settle allegations that they were involved in both the diagnosis and treatment of sleep patients, a violation of Medicare rules and regulations.

The government charged Bay Sleep Clinic and its related businesses—Qualium Corp., which operates 20 sleep clinics, and Amerimed Corp., which does business as Amerimed Sleep Diagnostics and Amerimed CPAP Specialist—with fraudulently billing Medicare for medical devices in violation of rules and regulations that prohibit providers of sleep tests from supplying medical devices and from sharing a sleep lab location with a DME supplier.

The government also charged the companies with fraudulently billing Medicare for sleep tests allegedly performed by technicians lacking the required licenses or certifications, and with fraudulently billing Medicare for sleep tests that were allegedly conducted at un-enrolled and unapproved locations.

The allegations against Bay Sleep Clinic were set out in an amended False Claims Act complaint filed by the government on Aug. 8, 2016.

The government intervened in a whistleblower action filed under the qui tam provisions of the False Claims Act. The act allows for private persons, such as Elma Dresser in this case, to file actions to provide the government with information about wrongdoing and then obtain a portion of the government’s recover. Dresser will receive about $545,000.

As part of the agreement, Bay Sleep Clinic has voluntarily terminated its two existing Medicare enrollments and agreed not to re-enroll as providers in the Medicare program for a period of three years.

The claims resolved by the settlement are allegations only and there has been no determination of liability.

AvaCare Medical buys online scrubs company

LAKEWOOD, N.J. – AvaCare Medical, an online medical supply store, has acquired Medical Scrubs Collection, an online medical scrubs store.

AvaCare CEO Steven Zeldes and CFO Mark Bakst say they plan to use their “skills in entrepreneurship” to bring the same growth that they’ve experienced at AvaCare to the Howell, N.J.-based Medical Scrubs Collection.

“We see this as an opportunity to pass on our success at AvaCare Medical to Medical Scrubs Collection,” said Zeldes. “Having worked in the healthcare industry for years, this company fits right into our line of expertise. We also know that many customers at AvaCare Medical are caregivers who can benefit from this acquisition.”

Bakst will also serve as the new CEO at Medical Scrubs Collection.

Medical Scrubs Collection opens the door for AvaCare Medical to expand into the nursing home, hospital and assisted living industries.

“(We plan to offer) them the same easy online shopping experience,” he said.

Medical Scrubs Collection has made a name for itself with its quick checkout, easy returns, personal wish lists and true-to-fit sizing guide. It also offers price match guarantees, as well as large discounts.

AvaCare Medical’s acquisition of Medical Scrubs Collection follows the launch of its new and improved website in June.

VGM names new CFO

WATERLOO, Iowa – The VGM Group has promoted Jeff Rummel, its controller and vice president of accounting, to CFO. Rummel succeeds Mike Mallaro, who became CEO in 2016, following the death of Van Miller, CEO and founder, in 2015. In his new role, Rummel, who joined VGM in 2015, will be responsible for providing strategic and financial leadership. “In Jeff’s time at VGM, he has endeavored to understand our various businesses in the depth needed to contribute meaningful counsel,” Mallaro said in a press release. The promotion is effective immediately. Rummel will also continue to serve as controller until VGM fills that position.

Invacare informs holders of repurchase rights

ELYRIA, Ohio – Holders of Invacare’s 4.125% convertible senior subordinated debentures issued Feb. 12, 2007, and due 2027 have the right to surrender their notes for repurchase by the company, it confirmed Dec. 24. A put option under the indenture governing the debentures entitles each holder to require the company to repurchase for cash all or in part (in principal amounts equal to $1,000 or multiples thereof) of their debentures on Feb. 1, 2017, for a purchase price equal to 100% of the principal amount of the debentures, upon the terms and subject to the conditions set forth in the indenture and the debentures. The purchase price will not include accrued and unpaid interest. The company will pay, on the interest payment date, accrued and unpaid interest on all of the debentures through Jan. 31, 2017, to all holders who were holders of record on Jan. 15, 2017. As of Dec. 23, 2016, there was $13.4 million aggregate principal amount of the debentures outstanding. The offer expires at 5 p.m. EST on Jan. 30, 2017.

WASHINGTON – Republicans in the House of Representatives have set Feb. 20 as a target date to get a bill repealing Obamacare to President-elect Donald Trump.

Trump himself plans to take executive actions to undo the Affordable Care Act on his first day in office, said Vice President-elect Mike Pence in an article on The Hill.com.

Healthcare experts have warned that repealing the program without an immediate replacement would create chaos. Twenty million people are covered under the act.

HME providers are no fans of the ACA. A recent HME Newspoll showed that 28% of respondents think repealing and replacing the program should be Rep. Tom Price’s top priority as secretary of the Department of Heath and Human Services.

WASHINGTON – A key Senate committee will reportedly hold a confirmation hearing for Rep. Tom Price, R-Ga., the nominee for secretary of the Department of Health and Human Services, ahead of President-elect Donald Trump’s inauguration.

An aide to Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, says the hearing could be held Jan. 18, according to news reports.

The HELP Committee is one of two committees of jurisdiction for the confirmation process. The other, the Senate Finance Committee, has not officially released dates for the hearing. The Finance Committee, chaired by Sen. Orrin Hatch, R-Utah, holds the official vote.

Industry stakeholders have cheered Price’s nomination. A longtime champion of the HME industry, he has introduced bills to replace the competitive bidding program with a market-pricing program.

WASHINGTON – AAHomecare is taking steps to make participation in its HME Audit Key survey easier in 2017.

The association and Brightree this month will begin beta testing a report that would give providers many of the answers to the “toughest” questions in the survey. It’s in discussions to do the same with Mediware.

“We hope to increase the motivation to participate in 2017,” said Kim Brummett, AAHomecare’s vice president of regulatory affairs.

AAHomecare expects to open its survey to the next round of data submissions—for the fourth quarter of 2016—in mid-January.

The association is also in preliminary discussions with The VGM Group’s complex rehab and O&P divisions to develop “mini-me” surveys specific to those markets.

“We want to gain momentum on rehab and O&P,” Brummett said. “We could have separate reports for each to make them feel like it’s specific to them, but then bring all the data together to say, ‘Here’s the bigger picture.’”

Additionally, AAHomecare has tweaked the survey to allow providers to pick the quarter for which they want to start entering data, instead of requiring them to start at Oct. 1, 2015, the date the survey officially launched.

“As we get further and further from that date, it gets harder and harder for suppliers to quantify the data,” Brummett said. “This also allows us to do more of an apples-to-apples comparison of the data.”

To date, providers with more than 1,500 locations have participated in the survey, Brummett said. She expects that number to rise this year, with audits likely to pick back up in 2017 due to the recent announcement of Performant Recovery as the new national RAC for DME.

“That’s going to put pressure on folks to participate after a relatively quiet 2016,” she said.

With legislation to curb audits a priority for AAHomecare in 2017, the impetus is there to have a robust set of data, Brummett said.

“If we want legislation this year, we need to state our case,” she said.

Data is currency on Capitol Hill, agreed Greg Packer, president of VGM’s U.S. Rehab.

“All decisions in D.C. are based upon, what can you give me that’s concrete to prove what you’re saying is true?” he said. “They want data-driven decisions.”

WASHINGTON – CMS held a Special Open Door Forum on Jan. 5 to discuss the third draft of its electronic clinical template for home oxygen therapy.

This newest draft of the template includes suggested clinical data elements and visual examples for the order, face-to-face encounter and lab test results.

CMS took into account comments to:

·      provide clear headings for related sets for data elements (e.g. beneficiary information);

·      provide a visual example of each data element and its value set;

·      add elements to the F2F encounter to capture text and specific conditions;

·      add an option to order for an oxygen conserving device;

·      and verify that the suggested elements will work for pediatric patients.

The suggested clinical data elements and visual examples are not a form, CMS says, but a tool that physicians or treating practitioners may voluntarily use to create electronic medical documentation.

CMS is pursuing an e-template for oxygen in response to the 48% improper payment rate for claims in fiscal year 2015. Of the claims in error, 86.2% were found to have insufficient documentation, mostly resulting from lack of documentation in medical records to justify Medicare coverage. The agency says the impact of these improper payments was more than $541 million.

CMS reviewed the second draft of the e-template in October.

WASHINGTON – The U.S. District Court for the District of Columbia stands firm that the Department of Health and Human Services must implement procedures to curtail a massive appeals backlog in a timely fashion.

Judge James Broasberg on Jan. 4 refused to rescind his previous order on Dec. 5 requiring the agency to eliminate the 650,000-claim backlog before 2021. HHS had argued that it would only be able to meet such a deadline by paying for claims without regard to merit.

The court was not unsympathetic to HHS’s plight, Broasberg wrote in his decision, but “(it) must follow the instructions of the D.C. Circuit and…conclude that equitable grounds existed for (relief) and that the reductions timetable was the most appropriate form of such relief.”

Prior to Broasberg’s Dec. 5 order, HHS had asked the court not to intervene in the appeals process, citing a number of administrative and legislative actions it was taking to eliminate the backlog by 2019. One of those actions: HHS recently offered to settle disputed claims for inpatient services—a large portion of the claims at issue—for 66 cents on the dollar. A similar offer in 2014 resulted in the settlement of 350,000 claims for about $1.5 billion.

Previously, in September, the court denied HHS’s request to put litigation with the American Hospital Association on hold until Sept. 30, 2017.

Senate eyes confirmation hearings for Price

WASHINGTON – A key Senate committee will reportedly hold a confirmation hearing for Rep. Tom Price, R-Ga., the nominee for secretary of the Department of Health and Human Services, ahead of President-elect Donald Trump’s inauguration.

An aide to Sen. Lamar Alexander, R-Tenn., chairman of the Senate Health, Education, Labor and Pensions Committee, says the hearing could be held Jan. 18, according to news reports.

The HELP Committee is one of two committees of jurisdiction for the confirmation process. The other, the Senate Finance Committee, has not officially released dates for the hearing. The Finance Committee, chaired by Sen. Orrin Hatch, R-Utah, holds the official vote.

Industry stakeholders have cheered Price’s nomination. A longtime champion of the HME industry, he has introduced bills to replace the competitive bidding program with a market-pricing program.

Lawmakers waste no time on repeal

WASHINGTON – Republicans in the House of Representatives have set Feb. 20 as a target date to get a bill repealing Obamacare to President-elect Donald Trump.

Trump himself plans to take executive actions to undo the Affordable Care Act on his first day in office, said Vice President-elect Mike Pence in an article on The Hill.com.

Healthcare experts have warned that repealing the program without an immediate replacement would create chaos. Twenty million people are covered under the act.

HME providers are no fans of the ACA. A recent HME Newspoll showed that 28% of respondents think repealing and replacing the program should be Rep. Tom Price’s top priority as secretary of the Department of Heath and Human Services.

ResMed launches new company

SAN DIEGO – ResMed has teamed up with Dr. Mehmet Oz and Pegasus Capital Advisors to launch SleepScore Labs, a new company focused on helping people understand and improve their sleep. SleepScore’s initial focus will be to compile and analyze consumer sleep data, starting with its national sleep study on sleepscore.com. It will also license SleepScore by ResMed technology for other consumer sleep devices, to update their tracking capabilities and improve their products, according to a press release. The company has already signed R&D contracts with several global leaders, including Lighting Science Group, which plans to leverage SleepScore technology to quantitatively measure the effectiveness of its GoodNight LED pre-sleep bulb. Dr. Oz will serve as the company’s brand ambassador and liaison to patients, as well as a board member and adviser, and a co-owner. ResMed and Pegasus will serve as equity partners. ResMed and Dr. Oz partnered in late 2016 to launch a national sleep survey.

Permobil doubles down on seating

LEBANON, Tenn. – Permobil has acquired custom molded seating manufacturer Prairie Seating. The acquisition provides Permobil with a platform for innovation and growth in the custom seating business, the company stated in a press release. It also complements Permobil’s existing portfolio of ROHO seating and positioning products, it says. “The timing of this acquisition is perfect, as it aligns with our growth ambitions and with our goal of adding premium product solutions to the already strong ROHO product portfolio,” said Tom Borcherding, president of Permobil Business Unit Seating and Positioning. Prairie Seating will continue to manufacture products from its Skokie, Ill., facility. Permobil’s initial focus for Prairie Seating will be U.S. sales, with an eye toward expansion opportunities in other countries, the company says.

Numotion expands reach in Carolinas

BRENTWOOD, Tenn. – Numotion has acquired the complex rehab division of Charlotte, N.C.-based BlueDot Medical, extending its reach and capacity in the Carolinas. BlueDot has been in business for more than 14 years, serving thousands of customers annually throughout North and South Carolina. “This acquisition will provide the disabled community in the Carolinas with greater access to mobility resources and an array of products and services,” said Mike Swinford, CEO of Numotion, in a press release. BlueDot’s 11 employees responsible for serving complex rehab customers have joined Numotion’s 25 employees at its Charlotte branch.

Capitala Finance exits investment in Drive Medical

CHARLOTTE, N.C. – Capitala Finance Corp. has exited its investment in Medical Depot, doing business as Drive Medical, netting a realized gain of about $5 million with a cumulative cash-on-cash return of 4.7x, it has announced. “Our investment was a great opportunity to work with an excellent management team that was passionate about their mission, fully knowledgeable of their market space and was able to effectively execute multiple, complex, international acquisitions in a short timeframe,” stated Joe Alala, chairman and CEO of Capitala, in a press release. Drive and Clayton, Dubilier & Rice announced in August that the New York-based private equity firm would be making a “significant investment” in the company. Previously, Ferrer Freeman & Co., another New York-based PE firm, was a minority stakeholder in Drive. Capitala is a provider of capital to lower and traditional middle market companies. Since 1998, its managed funds have participated in more than 138 transactions, representing more than $1.3 billion of investments in a variety of industries in North America.

PSP Homecare makes ‘short list’

RANCHO CUCAMONGA, Calif. – Proto Script Pharmaceutical Corp., doing business as PSP Homecare, announced Jan. 6 that it is a contract supplier for standard mobility equipment and general home medical equipment and related supplies and accessories as part of Medicare’s competitive bidding program. PSP is authorized to provide these bid items in 12 areas in California and Nevada, encompassing a total population of about 32.4 million people, it says. The contract runs from July 1, 2016 to Dec. 31, 2018. “The CMS contract places us on a short list of authorized Medicare approved suppliers in our competitive bid areas,” said Michelle Rico, CEO and president of PSP, in a press release. “(It) gives PSP Homecare a strong foothold in California and Nevada, two of the largest and fastest growing mobility products markets in the country. We anticipate building our existing business within these current areas and look forward to expanding into new markets supported by a comprehensive marketing program in the near future.” PSP has specialized in power wheelchairs and orthotics since 2011. It files reports with the Securities and Exchange Commission.

AAHomecare forms tech workgroup

WASHINGTON – AAHomecare has formed a Hi Tech Work Group to explore new technology and payment models. The group, chaired by Maura Toole, director of field marketing for Philips Healthcare, will focus on how the industry can bring new technology to the market, promote operational efficiencies and make sure providers are paid appropriately for these technologies. The work group’s initial focus will be on examining new and emerging technologies that can deliver measurable benefits for both HME patients and payers, such as reduced readmissions, and strategizing how to get payer to consider increased reimbursements or new payment models that take these improved outcomes into account.

CD&R closes deal on Drive

NEW YORK – Clayton, Dubilier & Rice has completed its equity investment in Drive DeVilbiss Healthcare, it announced Jan. 4. The deal allows Drive to continue its organic growth strategy, as well as provide the company with additional capital for future acquisitions. Drive has made 25 acquisitions since 2002, including the 2015 acquisition of DeVilbiss Healthcare. The deal was first announced in September. CD&R replaces Ferrer Freeman & Co., which has been a minority stockholder of Drive since 2008. Terms of the deal were not disclosed.

GF Health Products welcomes congressman

ATLANTA – GF Health Products (Graham-Field) hosted Rep. Glenn Grothman, R-Wis., to its Fond du Lac manufacturing facility here in December. Kurt Hellman, senior vice president of manufacturing operations, led a brief tour of the plant to highlight the facility's product lines and plant capabilities. Grothman is an advocate of bringing manufacturing back to the U.S.A., a goal of GF Health Products’ “Made in USA” initiative. GF Health Products makes healthcare products for the acute care, extended care, homecare and primary care markets.

ResMed logs major milestone

SAN DIEGO – ResMed has downloaded one billion nights of sleep data on its AirView remote patient monitoring platform. “This unprecedented amount of data enables predictive analytics to help physicians and providers better manage patients’ sleep apnea and COPD therapy, and ultimately improve their overall health,” said Mick Farrell, ResMed CEO, in a press release. “Reaching one billion nights is about more than just big data; it’s a testament to how the adoption and meaningful use of technology benefits patients, physicians and providers everywhere.” ResMed first made remote monitoring of CPAP patients available in 2004.

UnityPoint at Home cracks Excelera contract

URBANDALE, Iowa ­ – UnityPoint at Home, an integrated home health services provider, has joined the specialty pharmacy network of Excelera. The network provides members with a nationally scaled infrastructure and support to help them develop best practices and gain access to limited-distribution drugs and biologics and restrictive payer agreements so they can provide continuity of care for their patients with complex and chronic conditions. “We are delighted to welcome UnityPoint at Home into our national network,” said Jim Fox, CEO of Excelera, in a press release. “UnityPoint at Home is an example of an integrated health system looking to improve continuity of care for complex patients to lower costs and advance clinical and financial outcomes.” Excelera will partner with UnityPoint at Home to develop key specialty pharmacy capabilities, including training, operations, data aggregation, reporting for drug manufacturers and payers, and revenue cycle management. UnityPoint at Home’s services include adult and pediatric nursing care, rehabilitation therapy, personal care and home support, infusion therapy, respiratory therapy, palliative care, hospice and home medical equipment services. It serves patients and communities in Iowa, Illinois and Wisconsin.

Strategic Healthcare Programs enters home infusion market

SANTA BARBARA, Calif. – Strategic Healthcare Programs, a provider of data analytics and benchmarking to home health agencies and hospice providers, has expanded its offerings to home infusion providers. SHP’s Home Infusion Pharmacy Solution allows providers to capture daily trends and insights from their clinical, financial, demographic and utilization data. “Pharmacies need these comprehensive reports to manage performance and demonstrate value as home infusion providers will need to compete based on quality outcomes and pay-for-performance reimbursements,” the company stated in a press release. The solution follows data standards recently published by the National Home Infusion Association that bring consistency to the industry and enable comparisons of outcomes and quality metrics. SHP partnered with Managed Health Care Associates (MHA), which owns The MED Group, to develop the solution.

Short takes: Pride, Etac, US Healthcare Supply

Pride Mobility has named Micah Swick director of sales. Swick was formerly national sales director for Mega/Windermere Motion, a leading supplier of power recline/lift chairs and mobility scooters. Joe Showfety has replaced Swick at Mega/Windermere…Etac CEO Torben Helbo will serve as interim president of North American sales and Convaid Products. Chris Braun, who previously held the position, departed the company this week. Convaid sold to Etac in 2015. A search is underway to replace Braun…US Healthcare Supply has received DMEPOS accreditation by the Accreditation Commission for Health Care. The Milford, N.J.-based provider offers diabetes and other medical supplies.

WASHINGTON – The U.S. District Court for the District of Columbia stands firm that the Department of Health and Human Services must implement procedures to curtail a massive appeals backlog in a timely fashion.

Judge James Broasberg on Jan. 4 refused to rescind his previous order on Dec. 5 requiring the agency to eliminate the 650,000-claim backlog before 2021. HHS had argued that it would only be able to meet such a deadline by paying for claims without regard to merit.

The court was not unsympathetic to HHS’s plight, Broasberg wrote in his decision, but “(it) must follow the instructions of the D.C. Circuit and…conclude that equitable grounds existed for (relief) and that the reductions timetable was the most appropriate form of such relief.”

Prior to Broasberg’s Dec. 5 order, HHS had asked the court not to intervene in the appeals process, citing a number of administrative and legislative actions it was taking to eliminate the backlog by 2019. One of those actions: HHS recently offered to settle disputed claims for inpatient services—a large portion of the claims at issue—for 66 cents on the dollar. A similar offer in 2014 resulted in the settlement of 350,000 claims for about $1.5 billion.

Previously, in September, the court denied HHS’s request to put litigation with the American Hospital Association on hold until Sept. 30, 2017.

WASHINGTON – CMS held a Special Open Door Forum on Jan. 5 to discuss the third draft of its electronic clinical template for home oxygen therapy.

This newest draft of the template includes suggested clinical data elements and visual examples for the order, face-to-face encounter and lab test results.

CMS took into account comments to:

• provide clear headings for related sets for data elements (e.g. beneficiary information);
• provide a visual example of each data element and its value set;
• add elements to the F2F encounter to capture text and specific conditions;
• add an option to order for an oxygen conserving device;
• and verify that the suggested elements will work for pediatric patients.

The suggested clinical data elements and visual examples are not a form, CMS says, but a tool that physicians or treating practitioners may voluntarily use to create electronic medical documentation.

CMS is pursuing an e-template for oxygen in response to the 48% improper payment rate for claims in fiscal year 2015. Of the claims in error, 86.2% were found to have insufficient documentation, mostly resulting from lack of documentation in medical records to justify Medicare coverage. The agency says the impact of these improper payments was more than $541 million.

CMS reviewed the second draft of the e-template in October.