WASHINGTON – Seema Verma, the new CMS administrator, is a relative unknown as far as HME is concerned, but stakeholders say having new leadership in place offers new opportunities to press forward on a host of issues.

“I’m excited to see that she’s been confirmed so we can get to work with her and the rest of the CMS staff to extend the interim relief for rural suppliers that was part of the Cures Act,” said Tom Ryan, AAHomecare president and CEO. “We also want to engage CMS on longer-term improvements for future rounds of the bidding program and other HME public policy priorities.”

The Senate on March 13 voted 55-43 to approve Verma’s nomination. Verma, the president, CEO and founder of SVC, an Indianapolis-based national health policy consulting company, will oversee a $1 trillion agency that serves more than 100 million Americans that access healthcare services through Medicare, Medicaid, CHIP and the Marketplace.

Verma’s biggest claim to fame: redesigning Indiana’s Medicaid program. She expanded eligibility but required recipients to pay premiums, contribute to health savings accounts and receive incentives for healthy behavior.

“Feedback from Indiana folks is that the system worked compared to the other systems that were failing,” said John Gallagher, vice president of government relations for The VGM Group.“It was a patient-centric approach, so that falls in line with Dr. Price’s approach.”

While Tom Price, the new Health and Human Services Secretary,is a long-time industry champion and outspoken critic of Medicare,Verma has little experience with the program. Still, her background with Medicaid should translate well to the HME industry, says Ryan.

“She’s certainly aware of the important role that HME plays in allowing patients to remain in their homes and avoid more costly clinical interventions,” he said.

At a Feb. 16 hearing before the Senate Finance Committee, Verma said that one-size-fits-all approaches to healthcare, like CMS’s competitive bidding program, don’t always work and that it’s important to understand how policies impact providers.

“We don't want to see that our policies and our programs are actually preventing providers—that we're losing providers and that they don't want to see Medicaid or Medicare beneficiaries anymore,” she said. “So, we'll be very careful with policies so that we're not pushing providers out of the system, but that we're actually attracting providers to the program.”

While stakeholders say they look forward to working with Verma and Price, that won’t happen right away, thanks to a mandate from President Trump that restricts federal agencies from communicating with the public, says Gallagher.

“They can’t have meetings,” he said. “We’re still really working through members of Congress to arm them with information, as they work with the bureaucracy within CMS.”

WATERLOO, Iowa – The VGM Group outlined three priorities that need “immediate action,” including relief for HME providers rural areas, in a March 20 letter to Health and Human Services Secretary Tom Price.

The top priority: speeding up six months of payments owed to HME providers as part of a retroactive delay of reimbursement cuts that went into effect in non-competitive bidding areas on July 1, 2016. A provision in the Cures Act delayed the cuts until Jan. 1, 2017. CMS in February notified the DME MACs that they could begin dispersing payments on May 1, with implementation by July 3.

“This delay is unnecessary as more suppliers are forced to close their businesses on a weekly basis while waiting for payments on services provided nearly one year prior,” VGM stated in the letter.

The other two priorities: delaying these cuts to non-bid areas indefinitely, until an impact analysis is released; and correcting CMS’s application of two different statutes to determine payment methodologies for oxygen concentrators.

Additionally, VGM called on Price to reform the overall competitive bidding program; implement a broader prior authorization program to reduce audits; establish a separate benefit for complex rehab; and work with Veterans Affairs and Tricare to match their reimbursement rates to Medicare’s fee schedule.

“With the implementation of these proposed regulatory recommendations to the administration, we firmly believe that home medical equipment suppliers across the nation will have a renewed ability to provide care to the most vulnerable patients in the healthcare system,” the letter states.

WASHINGTON – CMS does not have the authority to implement bundled bidding programs for CPAP or other HME, because it would jeopardize patient access to specific equipment, say industry stakeholders.

Bundling a CPAP device, consumable items, maintenance and service into a single monthly payment will cause disruption for suppliers and will provide an incentive to furnish inferior products and provide a lower quality of care to compensate for shrinking margins, said AAHomecare in its weekly newsletter.

Additionally, “it could substantially increase co-payments and out-of-pocket expenses for beneficiaries,” said Larissa D’Andrea, government affairs director for ResMed. “Plus, layering untested bundled payments on top of expanded competitive bidding program rates could compound existing access challenges caused by these other cuts.”

AAHomecare and industry groups like AdvaMed, the CQRC and The VGM Group are developing a unified response to Medicare’s proposal to bundle payment for CPAP in future rounds of competitive bidding. They plan to outline their response a forthcoming letter to CMS.

CMS on Jan. 31 announced it had added 10 new competitive bidding areas for the CPAP category. In five of those CBAs, payment for CPAP devices, related accessories, and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like all other existing CBAs.

WASHINGTON – From Martha’s Vineyard to the Pacific Northwest, rural HME providers are struggling to survive in a post-competitive bidding world, they told CMS officials during a call March 23.

CMS was mandated by the 21st Century Cures Act to take into account stakeholder input on future pricing in non-bid areas, which got their first taste of the program in 2016.

“We’ve been forced to dig into our personal savings to keep our business afloat this year and continue to provide much needed supplies and services in our area in anticipation that Medicare will right this wrong,” said Rebecca Erickson of Star Valley Medical Supply in Afton, Wyo.

Signed into law in December, the Cures Act rolled 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.

With that cut, and a first round of cuts that went into effect on Jan. 1, 2016, it’s unrealistic of Medicare to expect providers to be able to absorb cuts of 50% or more, say providers.

“It’s devastating to us, but, more importantly, the beneficiaries,” said one provider from Washington state. “When I tell them it will be billed on assignment, they walk out without the item and end up having further issues. CMS is forcing non-adherence. As a medical provider, I can’t even grasp where that makes sense.”

During the call, CMS sought input on: average travel distance and costs associated with furnishing items and services in an area; and average volume of items and services furnished by suppliers in the area.

Providers argue that, in rural areas, you can’t make up for reduced reimbursement with volume.

“One of the keystones of the program is that your volume goes up,” said Josh Shields of BetaMed in Bryan, Texas. “We are serving the same volume, but at a lower price.”

As a result, beneficiaries must wait longer for deliveries, and they have less choice in equipment, Shields said.

CMS also sought input on the number of suppliers in an area. Most callers said, in their area, they are it.

“I’m the sole provider of oxygen, CPAP and DME for Martha’s Vineyard,” said John Curelli of Island Home Medical. “We are hoping we don’t have to leave Martha’s Vineyard (located seven miles off the coast of Massachusetts) without a provider. The Cures Act needs to help cure this industry.”

While CMS has set an implementation date of July 3 to make repayments, that’s too long of a wait, say providers.

“Beds in central Virginia are down to $8.46 a month,” said Ronnie Rankin of Culpepper Home Medical in Culpeper, Va. “We can’t get out the door for that. We’d like to see a fast resolution to the Cures Act and definitely a better reimbursement rate based on a lot of factors that you deal with in a rural area.”

LIVERMORE, Calif. – Performant Recovery was officially up and running as of March 8, but the new national RAC for HME is taking its time ramping up its activities.

Peformant posted seven new reviews for everything from chest wall oscillation devices to complex Group 2 support surfaces in February. But it had not posted any additional reviews as of late March.

“I would expect that they would add one or two edits every seven days to staff up to where they were at previously with known issues,” said Andrea Stark, a reimbursement consultant with MiraVista. “They may be taking a slow and steadier approach.”

There are others signs that the RAC process under Performant will be a smoother and more manageable one for HME providers.

Right out of the gate, Performant opened a line of communication with providers by hosting two webinars in conjunction with the two DME MACs, Noridian and CGS.

“That’s the first time we’ve seen a RAC do any kind of outreach,” Stark said. “That kind of early communication can’t be undervalued.”

Also, while providers have worried about whether or not Performant will apply the correct coverage policies—their reviews will span three years—that may not be an issue under the new RAC, stakeholders say.

“Initial discussions with the RAC do not indicate that this will be a concern,” said Wayne van Halem, president of The van Halem Group, a division of The VGM Group. “They’re aware of the fact that they must apply the rules in place on the date of service in question.”

Finally, providers have a more meaningful discussion period under Performant that will work in their favor. There’s always been a discussion period, but because previous RACs immediately signaled the MAC to start the overpayment process, the only way providers could hold onto their money was to file appeals. Now they have 30 days to work the process until anything is forwarded to the MAC.

“Oh yeah,” said Kim Brummett, vice president of regulatory affairs at AAHomecare, when asked whether or not she thinks providers will take advantage of the discussion period. “They should.”

Are you RAC ready?

Since it’s been so long since providers have had to grapple with a RAC, stakeholders offered these pieces of advice:

Be proactive.“Suppliers must have an internal quality assurance and compliance program that regularly monitors the claims that are being submitted,” van Halem said. “They should review the RAC website regularly to perform a risk assessment on their proactive audits. Suppliers can minimize the impact of these audits for themselves.”

Read carefully.“Some are medical necessity reviews and some are documentation reviews,” Brummett said. “Pay attention to your audit request letters and know which you are dealing with.”

Keep organized.“Use separator sheets to tell the auditors, this is where the face-to-face evaluation is, this is where the proof of delivery is,” Stark said. “They’re going to itemize the things they want you to send back to them, so make it as easy as possible on them. It predisposes you to a favorable opinion.”

WASHINGTON – AAHomecare has outlined several recommendations for fixing the competitive bidding program in a new letter to Health and Human Services Secretary Tom Price.

Those recommendations are:

• Use market clearing price to determine the single payment amount for any item included in competitive bidding.

• Use historical claims data to determine supplier capacity.

• Increase transparency of the competitive bidding program.

• Reform competitive bidding product categories.

• Apply uniform payment rules for transitioning DMEPOS competitive bidding beneficiaries.

• Remove CMS’s authority to move forward with bundled payments for CPAP and standard power wheelchairs.

“HME suppliers, patient groups and leading economists and auction experts have voiced concerns about major structural problems with the bidding program since it first took effect,” said Tom Ryan, president and CEO AAHomecare.  “With the next round of the bidding program set to consolidate the two rounds into one entity, the time is right for CMS to make these much-needed and common-sense changes.”

AAHomecare recommends CMS go through the formal rulemaking process to instate the proposed reforms.

This week’s letter follows a letter in February to Dr. Price requesting a repeal of the full phase-in of the Medicare adjusted fee schedule rates for non-competitive bidding areas that went into effect July 1, 2016.

VGM calls on Price to take action

WATERLOO, Iowa – The VGM Group outlined three priorities that need “immediate action,” including relief for HME providers rural areas, in a March 20 letter to Health and Human Services Secretary Tom Price.

The top priority: speeding up six months of payments owed to HME providers as part of a retroactive delay of reimbursement cuts that went into effect in non-competitive bidding areas on July 1, 2016. A provision in the Cures Act delayed the cuts until Jan. 1, 2017. CMS in February notified the DME MACs that they could begin dispersing payments on May 1, with implementation by July 3.

“This delay is unnecessary as more suppliers are forced to close their businesses on a weekly basis while waiting for payments on services provided nearly one year prior,” VGM stated in the letter.

The other two priorities: delaying these cuts to non-bid areas indefinitely, until an impact analysis is released; and correcting CMS’s application of two different statutes to determine payment methodologies for oxygen concentrators.

Additionally, VGM called on Price to reform the overall competitive bidding program; implement a broader prior authorization program to reduce audits; establish a separate benefit for complex rehab; and work with Veterans Affairs and Tricare to match their reimbursement rates to Medicare’s fee schedule.

“With the implementation of these proposed regulatory recommendations to the administration, we firmly believe that home medical equipment suppliers across the nation will have a renewed ability to provide care to the most vulnerable patients in the healthcare system,” the letter states.

Stakeholders question authority to bundle

WASHINGTON – CMS does not have the authority to implement bundled bidding programs for CPAP or other HME, because it would jeopardize patient access to specific equipment, say industry stakeholders.

Bundling a CPAP device, consumable items, maintenance and service into a single monthly payment will cause disruption for suppliers and will provide an incentive to furnish inferior products and provide a lower quality of care to compensate for shrinking margins, said AAHomecare in its weekly newsletter.

Additionally, “it could substantially increase co-payments and out-of-pocket expenses for beneficiaries,” said Larissa D’Andrea, government affairs director for ResMed. “Plus, layering untested bundled payments on top of expanded competitive bidding program rates could compound existing access challenges caused by these other cuts.”

AAHomecare and industry groups like AdvaMed, the CQRC and The VGM Group are developing a unified response to Medicare’s proposal to bundle payment for CPAP in future rounds of competitive bidding. They plan to outline their response a forthcoming letter to CMS.

CMS on Jan. 31 announced it had added 10 new competitive bidding areas for the CPAP category. In five of those CBAs, payment for CPAP devices, related accessories, and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like all other existing CBAs.

Brightree links to AirView, myAir

ATLANTA – Brightree has enhanced the integration between its HME billing and business management module and ResMed’s AirView and myAir. The enhanced capabilities include creating and updating patients in AirView, minimizing duplicate entry; receiving automatic patient compliance notifications from AirView, eliminating the need to check multiple systems; and inviting patients to register with myAir, helping to engage patients in their own therapy. “As the healthcare industry shifts to an outcomes-based model, Brightree and ResMed are working to provide innovative, seamless solutions to create greater visibility into performance and smarter decision making,” said Matt Mellott, Brightree’s president and CEO. AirView is a cloud-based sleep and respiratory care patient management platform; myAir is a patient engagement platform. ResMed bought Brightree in 2016.

Upstate HomeCare doubles down on specialty infusion

CLINTON, N.Y. – Upstate HomeCare now has a dedicated management team, strategic plan and sales force for its specialty infusion services business. The provider shifted away from retail pharmacy into specialty infusion services last summer. “We’re very excited to be expanding our services and aligning our strengths with our mission,” said Gregory LoPresti, CEO of Upstate HomeCare. “This shift builds upon our strength, which is home infusion services and associated core therapies.” Upstate HomeCare will be serving patients across New York from Albany to Buffalo. The company also provides a full line of respiratory therapies, from oxygen concentrators to CPAP devices to ventilators.

Spring time at the Capitol: NCPA, United Spinal plan events

The National Community Pharmacists Association has scheduled its 2017 Congressional Pharmacy Fly-In for April 26-27. As part of the event, hundreds of community pharmacists will visit the Capitol to advocate for their businesses and their patients. The fly-in will feature a legislative briefing with former Rep. Jim McCrery, now a partner at Capitol Counsel; and a breakfast keynote by Jayne O’Donnell, a healthcare reporter for USA Today. Register at www.ncpanet.org/flyin…The 6th Annual Roll on Capitol Hill Legislative and Advocacy Conference will take place June 11-14. The United Spinal Association hosts the event to advocate for the health, independence and quality of life of individuals with spinal cord injuries. Last year’s event drew more than 150 attendees from 33 states. FMI: www.unitedspinal.org.

Governor recognizes GF Health Products for export excellence

ATLANTA – Georgia Gov. Nathan Deal, in conjunction with the Georgia Department of Economic Development (GDEcD), recently presented Graham-Field with the Georgia Launching Opportunities by Exporting (GLOBE) Award. “It is gratifying to know how well Graham-Field’s USA-manufactured medical equipment is respected throughout the world,” said President and CEO Ken Spett, who accepted the award. It is because of companies like Graham-Field that Georgia has earned a reputation as a leader in international trade, said the commissioner of the GDEcD. “With our strong international presence, Georgia is ready and able to support companies looking to achieve new levels of success,” Pat Wilson said. Graham-Field and its more than 300 employees make healthcare products for the acute care, extended care, homecare and primary care markets. Its brands include Basic American, American Medical Products, Everest & Jennings, Grafco, John Bunn, Labtron, Lumex and Lumiscope.

Sigvaris launches measurement system

PEACHTREE CITY, Ga. – Sigvaris has added an “initial pressure measurement system” to three of its inelastic compression wraps, the company announced March 21. The new system allows clinicians to prescribe a specific compression level (20-30mmHg, 30-40mmHg or 40-50mmHg) and patients to set the level themselves. “This product is going to change the market for inelastic wraps and finally give clinicians the confidence that patients will be able to accurately set their garment to the correct compression level at home,” said Scot Dubé, president and CEO of Sigvaris North America. The patent-pending Accutab system comes standard on Compreflex, Compreflex Lite and Compreflex NF.

Sleep therapy could help certain heart failure patients, ResMed study shows

SAN DIEGO – Further study is needed to determine how using adaptive servo-ventilation (ASV) therapy to treat sleep-disordered breathing helps people who have heart failure with preserved ejection fraction, according to a study published March 20 in the Journal of the American College of Cardiology. The overall results of the study were neutral, but they showed a statistical significant improvement in the primary endpoint for people with moderate to severe sleep-disordered breathing and this type of heart failure, ResMed stated in a press release. The primary endpoint was cardiovascular outcomes measured as a Global Rank Score that included survival free from cardiovascular hospitalization and change in functional capacity as measured by the six-minute walk distance. The study also assessed changes in functional parameters, arrhythmias, biomarkers, quality of life, and sleep and breathing. Leading cardiologists say the improvement for these patients signals a potential breakthrough in treatment, according to ResMed. "There are no recommended therapies specific for HFpEF patients, which accounts for half of all people living with chronic heart failure," said Dr. Christopher O'Connor, the study's lead investigator, a cardiologist and CEO of the Inova Heart and Vascular Institute. "These results from CAT-HF suggest we need to further study the role of whether addressing sleep-disordered breathing can help people who have heart failure with preserved ejection fraction." The study, the "Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure – The CAT-HF Trial," is a multicenter, randomized, controlled Phase II trial funded by ResMed to broaden the understanding of how best to treat diagnosed sleep apnea in patients that also have a particular form of heart failure.

ResMed-Brightree make Deal of the Year

SAN DIEGO – ResMed’s acquisition of Brightree was named Deal of the Year by Mergers & Acquisitions magazine. The deal underscores the ongoing shift in U.S. healthcare from a fee-for-service model to a value-based model, and the need for players across the healthcare continuum to use informatics and data analytics as tools to share information and deliver care more efficiently, said ResMed in a release. ResMed acquired Brightree for $800 million in February 2016.

WASHINGTON – AAHomecare has outlined several recommendations for fixing the competitive bidding program in a new letter to Health and Human Services Secretary Tom Price.

Those recommendations are:

• Use market clearing price to determine the single payment amount for any item included in competitive bidding.

• Use historical claims data to determine supplier capacity.

• Increase transparency of the competitive bidding program.

• Reform competitive bidding product categories.

• Apply uniform payment rules for transitioning DMEPOS competitive bidding beneficiaries.

• Remove CMS’s authority to move forward with bundled payments for CPAP and standard power wheelchairs.

“HME suppliers, patient groups and leading economists and auction experts have voiced concerns about major structural problems with the bidding program since it first took effect,” said Tom Ryan, president and CEO AAHomecare.  “With the next round of the bidding program set to consolidate the two rounds into one entity, the time is right for CMS to make these much-needed and common-sense changes.”

AAHomecare recommends CMS go through the formal rulemaking process to instate the proposed reforms.

This week’s letter follows a letter in February to Dr. Price requesting a repeal of the full phase-in of the Medicare adjusted fee schedule rates for non-competitive bidding areas that went into effect July 1, 2016.

ALBANY, N.Y. – New York and New Jersey are the two latest states to merge their HME associations.

The New York Medical Equipment Providers Association (NYMEP) and the Jersey Association of Medical Equipment Services (JAMES) formed the Northeast Medical Equipment Providers Association (NEMEP) in January.

“We wanted to broker on our already close involvement,” said Kim Voelker, executive director of NEMEP. “We also wanted to open up avenues for membership growth.”

For now, NEMEP has blended the leadership of NYMEP and JAMES, so for each officer role there are two providers, one from New York and one from New Jersey, Voelker says. Daniel DeSimone of NYMEP is president, and Dr. Kevin Saluck of JAMES is president-elect, she says.

Membership numbers for both associations have been down, especially in the wake of two Medicare reimbursement cuts in rural areas in 2016, acknowledges Anthony Cecere, president of Homecare USA in West Babylon, N.Y., and past president of NYMEP.

“We were able to hang on to more membership than we thought we would be able to, but there has been some contraction for both associations,” he said.

One association means being able to spread costs and share resources, Cecere says.

“We can be more efficient financially,” he said. “There is no duplication of efforts. Now we have one executive director; we have one publication.”

One association also means more power, says DeSimone, president and CEO of Continued Care of Long Island in Farmingdale, N.Y.

“It’s an awesome thing to pull off, because it definitely strengthens our membership and unifies our voice a bit more,” he said.

NEMEP is open to adding other contiguous states to further strengthen its base, Cecere says.

“We’re in talks and I see us expanding,” he said.

WASHINGTON – CMS has instructed the DME MACs to accept timely orders and medical documentation whether they come from a beneficiary’s treating physician or a transferring HME provider.

The change is a big deal for providers in competitive bidding areas, where transfers of beneficiaries from non-contract to contract providers are common.

“Industry (has) suggested that competition is bolstered and provider burden limited by allowing suppliers to accept medical documentation from other suppliers who previously held responsibility for that beneficiary,” CMS states in Change Request 9886 published on March 24.

The change goes into effect April 24, 2017.

Specifically, CMS instructs the DME MACs to:

• Accept documentation of the beneficiary’s need for an item, regardless of whether the supplier received the documentation directly from the beneficiary’s treating physician/practitioner or as transferred from his or her previous supplier.
• Contractors shall, in those instances in which the documentation is not transferred, continue to require a new order/documentation be received by the supplier from the treating physician/practitioner.
• Contractors shall describe any necessary workload changes in detail, including the rationale for these changes, to their Contracting Officer’s Representative and Medical Review Business Function Lead.

In an accompanying MLN Matters article, CMS put providers on notice that a new order is still required in the following situations:

• There is a change in the order for the accessory, supply, drug and so forth.
• On a regular basis (even if there is no change in the order) only if it is so specified in the documentation section of a particular medical policy.
• When an item is replaced.
• When there is a change in the supplier, if the recipient supplier did not obtain a valid order for the DMEPOS item from the transferring supplier.

ST. PAUL, Minn. – Minnesota could be the first state to introduce legislation to stave off a “pay for” in the 21st Century Cures Act that limits the federal portion of Medicaid reimbursement for DME to competitive bidding-influenced Medicare reimbursement starting Jan. 1, 2018.

Bills have been introduced in both the House of Representatives and the Senate that would direct the commissioner of the state’s Department of Human Services to make supplemental payments for DME that is impacted by the change. The bills state those payments should be no less than the difference between the payments before and after Dec. 31, 2017.

“Take the problems and attrition we’ve seen from the bid rates for Medicare and expand that to a whole other sector of the population—Medicaid,” said Sarah Anderson, vice president of sales and third party services for Key Medical Supply in Shoreview, Minn., and a board member of the Midwest Association for Medical Equipment Services. “It’s just unsustainable.”

Stakeholders suffered a setback in March, when omnibus bills were introduced in the House and Senate without language on supplemental payments for DME.

The omnibus bill in the House, however, includes what stakeholders call a “toehold” that keeps their efforts alive: a provision requiring DHS to study the impact of limited payment rates for DME on access. DHS must report on results by Feb. 1, 2018.

“The work is not over,” said Rose Schafhauser, executive director of MAMES, which is working on setting up meetings with Conference Committee members who are working to combine the two omnibus bills.

While cost is always a factor in getting legislation passed, stakeholders have so far successfully argued that the DME benefit has hit rock bottom. That’s something they’ll continue to argue.

“The bid rates don’t even cover the cost of acquisition,” Anderson said.

Also working in stakeholders’ favor is their good working relationship with DHS. They have worked with the agency to craft this most recent language, and they have worked with the agency in the past to prevent bid-influenced Medicare reimbursement from affecting Medicaid reimbursement for items included in the program.

“DHS and our legislature are very familiar with competitive bidding and the potential harm to providers and their patients,” Anderson said. “We’ve been working for years to continually separate (Medicaid and Medicare).”

MAMES has shared the language with other stakeholders, in the hopes that similar bills can be introduced in other states.

“We’re trying to be proactive,” Schafhauser said. “The general feedback we’re getting from state legislatures has been good. We’re not asking for an increase; we’re just asking not to go back.”

AMSTERDAM, the Netherlands, and SYDNEY – Royal Philips has signed an agreement to buy Australian Pharmacy Sleep Services, in a move that the company says will accelerate its home sleep testing offering through the pharmacy channel in Australia.

“With the addition of APSS to our sleep and respiratory care business in Australia, Philips will be able to provide better access to home sleep testing for those who need it, where and when they need it,” said Kevin Barrow, managing director at Philips Australia and New Zealand.

APSS, founded in 2011, offers a sleep apnea program for pharmacies that includes screening, home-based sleep studies based on CPAP therapy, training and services.

The retail pharmacy market provides a convenient and central local access point to offer simple and effective sleep screening, Philips says.

“This screening is aimed at assessing sleep quality and determining if subsequent sleep treatment may be required,” it stated in a press release. “APSS works closely with medical professionals for assessment and diagnosis of sleep problems, and subsequent sleep treatment.”

Philips expects to complete the transaction in the second quarter of 2017. It will not disclose financial details.

Roche sues pharmacies, supply companies

INDIANAPOLIS – Roche Diagnostics and Roche Diabetes Care have filed a lawsuit in the U.S. District Court of Indianapolis, claiming they have wrongfully paid millions of dollars in rebates and lost millions of dollars in legitimate sales for blood glucose test strips at the hands of an alleged scheme by six pharmacies and medical supply companies. The lawsuit, filed in the U.S. District Court of Indianapolis, charges the pharmacies and medical supply companies with allegedly obtaining test strips from Roche that were intended for reimbursement under DME plans but were sold for retail under pharmacy plans, according to the Indianapolis Business Journal. Test strips under pharmacy plans have a higher list price than strips under DME plans, but pharmacy plans receive larger rebates. “By purchasing strips from Roche at the lower DME list price and diverting them to sale in channels where they would be reimbursed at the much higher pharmacy plan rate, defendants and their co-conspirators made millions of dollars in illicit profits,” the lawsuit charges. Several defendants, including Binson’s Hospital Supplies of Centerline, Mich., and J&B Medical Supply of Wixom, Mich., had allegedly promised to sell the DME test strips only through DME channels, according to the lawsuit. The other defendants named in the lawsuit were Northwood of Centerline; Olympus Global of East Lansing, Mich.; Delta Global of Flint, Mich.; and Alpha XE of Cheyenne, Wyo.

CMS says CGMs cannot be used with other technology

WASHINGTON – Medicare beneficiaries using Dexcom’s G5 Mobile continuous glucose monitoring system cannot use smartphone apps or tablets to display glucose data if they want to have the CGM device reimbursed, according to recently released guidance from CMS. If a beneficiary uses a non-DME device (smart phone, tablet, etc.) as the display device, either separately or in combination with the CGM receiver classified as DME, the supply allowance is non-covered. CMS in January said it would classify certain CGMs as DME. Currently, only the Dexcom G5 meets criteria.

AAHomecare pulls together resources

WASHINGTON – AAHomecare hascollected resources and talking points for providers and state associations to use in discussions with payers. Providers can link to information on the CURES letter, pricing comparison by region, HME suppliers/locations by state and an HME cost study by Dobson DaVanzo to show the impact of drastic reimbursement reductions. Laura Williard, senior director of payer relations for AAHomecare,is working with several state/regional associations to support their meetings with payers. Links to the information can be found here.

Supreme Court sides with SCA

STOCKHOLM – SCA says it has won an important victory in its seven-year patent infringement case against First Quality Products. A six-year statutory period of limitations, during which a patent infringement claim must be commenced, cannot be shortened based on the equitable doctrine known as laches, the U.S. Supreme Court ruled in a 7-1 decision on March 21. The decision allows SCA to proceed with its claim for pre-suit damages, the company announced in a press release. “We are thrilled the Supreme Court ruled in our favor,” said Michael Freenan, vice president of sales and marketing for SCA Incontinence Care North America. “SCA can now pursue all of the damages to which it is entitled.” In 2010, SCA sued First Quality in the U.S. District Court for the Western District of Kentucky for infringement of a patent covering adult incontinence products. A lower court dismissed SCA’s claim for pre-suit damages in response to a petition by First Quality. Now that the Supreme Court has reversed that decision, the case returns to Kentucky for trial on both pre- and post-suit damages.

Medicare keeps coverage for wheelchair trays

WASHINGTON – Medicare made a clerical error when it said it considered wheelchair trays, tables or similar products convenience items. The agency said claims for E0950 would be denied as statutorily non-covered, no benefit, according to an LCD and policy article revision posted by the DME MACs on March 16. The article was corrected on March 30. The change was set to take effect retroactively on Jan. 1, 2017. Concerns with the change included the medical necessity of these items and the timing. “They made they change retroactively without any comment period,” stated the Midwest Association of Medical Equipment Services in a bulletin to members. Stakeholders planned to bring up the change at upcoming meetings with the DME MACs in April.

Apria offers payment options

LAKE FOREST, Calif. – Apria Healthcare has partnered with CarePayment, a patient financial engagement company, to provide financing to patients. The 0% APR payment program allows individual to pay over time for their medical supplies and care, according to a press release. “Americans are increasingly burdened by the rising out-of-pocket costs in our healthcare system,” said Dan Starck, CEO for Apria. “Unfortunately, extended illnesses often leave them struggling to make ends meet. We are so pleased to be able to offer our customers a solution that can help reduce the financial anxieties of managing medical conditions at home.”

Respiratory Services opens fourth location

ROCHESTER, N.Y. – Respiratory Services of Western New York has a new retail store at 535 Summit Point Drive in Henrietta, N.Y. The provider held a ribbon cutting ceremony at the store on March 23, with members of the community, local hospital representatives and employees in attendance. “There was a big need in the Rochester area for a company such as us to facilitate referrals from hospitals in a fast manner and provide the level of service that has differentiated us in the marketplace,” said Patti Capitani, vice president of sales, in a press release. During the ribbon cutting, Respiratory Services offered tours of its showroom, which features compression stockings, bath safety equipment, ambulatory devices, aides to daily living, sleep apnea equipment, oxygen equipment, diabetic shoes, lift chairs, scooters and more. Established in 1997, Respiratory Services also has locations in Cheektowaga, Dunkirk and Arcade.

Sigvaris completes expansion

PEACHTREE CITY, Ga. – Sigvaris celebrates the grand opening of its expanded corporate headquarters today. As part of the festivities, the manufacturer is offering plant tours, and the opportunity to meet with corporate executives and members of the founding family from Switzerland. The 40,000-square-corporate headquarters now houses office, manufacturing and warehouse space, all under one roof. The grand opening at the corporate headquarters follows a ribbon cutting at a second new manufacturing facility in Holland, Mich., on March 28. Sigvaris focuses on the development, production and distribution of medical compression garments, including hosiery, socks and inelastic compression garments.

Convaid revamps website

TORRANCE, Calif. – Convaid has launched a new website to provide a more user-friendly experience and optimized functionality. The website makes it easy to explore the company’s line of pediatric wheelchairs, with how-to videos, customer insights, industry resources, an educational portal and an interactive community section. It also helps users “geo-locate” dealers anywhere in the world. The website is compatible with all browsers and mobile devices.

Conference updates: AAH, Medtrade, CRT

AAHomecare has shortened and slashed the price of its Washington Legislative Conference this year. The conference will take place at the Washington Court Hotel on May 24 and 25, but events will conclude at 2 p.m. on May 24, giving attendees more time to conduct meetings on Capitol Hill. “Whether you’re an experienced, regular attendee of the conference or this is your first time attending, your direct, in-person engagement with legislators and their staff members is the most effective means to advocate for better public policy for HME,” the association stated in a press release. AAHomecare is offering a rate of $49 for members and $99 for non-members this year, half the cost of last year’s conference. To increase the buzz around the conference, the association is encouraging stakeholders to share why they feel attending is so important on social media using #AAHWLC17. Register here…Show organizers have locked in Oct. 23-26 as the dates for this year’s Medtrade in Atlanta. “We believe Medtrade 2017 can be a huge focal point as the industry rebounds from very difficult times,” said Kevin Gaffney, group show director, Medtrade, in a press release. Organizers have also set Feb. 26-28, 2018, as the dates for the next Medtrade Spring in Las Vegas…Among the sessions at the upcoming National CRT Leadership and Advocacy Conference will be a panel presentation providing an overview of the healthcare issues, options and politics in Washington, D.C. Participating in the panel will be Eric Gascho, vice president of government affairs at the National Health Council; and Amy Cunniffe, principal, and Sarah Egge, senior manager, of the Washington Council at Ernst & Young. NCART says the session will be a “great primer” for the congressional visits on April 27 that will follow educational sessions on April 26. The conference takes place at the Hyatt Regency Crystal City in Arlington, Va.

Short takes: Medforce, Circadiance, AOPA, FODAC

Medforce Technologieshas joined the National Association for Home Care and Hospice. “We have experienced solid growth in the home health sector over the past several years,” said Esther Apter, Medforce CEO. “Joining NAHC was a logical choice to help us stay in tune with the latest challenges and continue to learn how to best serve this industry”…Circadiance has launched the SleepWeaver 3D Soft Cloth CPAP Mask in the U.S., following its recent 510(k) clearance from the U.S. Food and Drug Administration. The cloth mask provides an interface for CPAP or BIPAP therapy and is intended for single patient re-use…The American Orthotic & Prosthetic Association (AOPA) has announced that the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) will sponsor the Presidential Papers at the 2017 AOPA World Congress. The Presidential Papers represent the top 10 clinical education submissions of original research backed by a full manuscript and will be published in a special supplement of the Journal of NeuroEngineering and Rehabilitation. ABC will also be an official partner of the Congress, Sept. 6-9 in Las Vegas…Friends of Disabled Adults and Children (FODAC) will hold its 17th Annual Run Walk n’ Roll at Stone Mountain Park in Stone Mountain, Ga., on May 6. The 5-mile race and 2-mile walk is one of FODAC’s main fundraisers. Participants can run, walk or roll through the course—wheelchairs, strollers and walkers are all welcome.

WASHINGTON – Industry stakeholders had a meeting with Seema Verma, the new CMS administrator, on April 4, and they were impressed.

The top topic at the meeting: industry efforts to fix the competitive bidding program.

“Administrator Verma demonstrated impressive familiarity with HME industry concerns about the bidding program, and others in attendance were well-acquainted with the proposals in letters regarding the bidding program (that) AAHomecare recently sent to HHS Secretary Price, which provided a good baseline for discussions,” AAHomecare stated in a bulletin to members.

Tom Ryan, president and CEO of AAHomecare; Jay Witter, senior vice president of public affairs for the association; Cara Bachenheimer, senior vice president of public relations for Invacare; and Thomas Baker, an attorney recently engaged by the association, met with Verma and Deputy Administrator Demetrios Kouzoukas, as well as several HHS and CMS staffers.

At the meeting, stakeholders also discussed their support for protecting reimbursement for accessories for complex wheelchairs and for oxygen therapy.

“We believe both the tone and substance of the discussion shows that the new leadership at HHS and CMS understands industry concerns,” AAHomecare stated. “In particular, we’re encouraged by Administrator Verma and her colleagues expressing their interest in working with us to come up with solutions on these issues that will allow us to continue to meet the needs of the millions of individuals who depend on home medical equipment and related services.”

In March, AAHomecare sent a letter to HHS Secretary Price with several recommendations on how to fix the bid program, including using market clearing pricing to determine the single payment amount for any item included in the program, and using historical claims data to determine supplier capacity.

PHILADELPHIA – SCA will split its global hygiene and health products into a new company, Essity.

The forest products division will remain under the SCA name.

As of 2016, 86% of the company is in hygiene and health, with 14% in forest products. Synergies between the operations have diminished over time, SCA said in a press release.

Essity will develop, produce, market and sell personal care and tissue products, including the BSN Medical brands, which SCA acquired in December for $2.9 billion. Essity stems from the words “essentials” and “necessities.”

“Hygiene and health are necessities for better lives and our products and solutions play an essential role in improving well-being for everybody, everywhere,” said Magnus Groth, president and CEO of SCA.

Groth will transition to president and CEO of Essity.

SCA had sales in about 150 countries under global brands like TENA for incontinence products and Tork for Away-from-Home tissue products. The acquisition of BSN Medical added brands like Leukoplast, Cutimed, JOBST, Delta Cast, Delta Lite and Actimove.

The split will be completed no later than the second half of 2017.

SCA forms separate hygiene company

PHILADELPHIA – SCA will split its global hygiene and health products into a new company, Essity.

The forest products division will remain under the SCA name.

As of 2016, 86% of the company is in hygiene and health, with 14% in forest products. Synergies between the operations have diminished over time, SCA said in a press release.

Essity will develop, produce, market and sell personal care and tissue products, including the BSN Medical brands, which SCA acquired in December for $2.9 billion. Essity stems from the words “essentials” and “necessities.”

“Hygiene and health are necessities for better lives and our products and solutions play an essential role in improving well-being for everybody, everywhere,” said Magnus Groth, president and CEO of SCA.

Groth will become president and CEO of Essity.

SCA had sales in about 150 countries under global brands like TENA for incontinence products and Tork for Away-from-Home tissue products. The acquisition of BSN Medical added brands like Leukoplast, Cutimed, JOBST, Delta Cast, Delta Lite and Actimove.

The split will be completed no later than the second half of 2017.

ResMed, ATS partner on NIV grant

SAN DIEGO – ResMed has funded a new $100,000 two-year grant with the American Thoracic Society to research non-invasive ventilation for COPD patients. COPD affects 65 million people worldwide and is the third leading cause of death, according to a press release. “Through this award, the field of respiratory medicine stands to gain more valuable knowledge about the use of NIV for the treatment of COPD with the ultimate goal of improving the lives of patients and the efficiency of our health care system as a whole,” said Carlos Nunez, MD, chief medical officer for ResMed.

Study: ASV improves compliance

SAN DIEGO – Patients with obstructive sleep apnea who develop central sleep apnea are more compliant when they switch from CPAP to adaptive servo-ventilation, according to a new study. The study, sponsored by ResMed, analyzed anonymous, aggregated data from the devices of 198,890 telemonitored patients. It showed that patients who switched from CPAP to ASV went from 62.7% compliance to 76.6% compliance. “Achieving compliance through proper therapy usage is a well-recognized clinical goal in sleep apnea management, and one that is often hard to achieve, particularly in difficult-to-treat patients who may have untreated central sleep apnea,” said Carlos Nunez, M.D., ResMed’s Chief Medical Officer. “These findings underscore the importance of continuously monitoring central sleep apnea and rethinking the conventional wisdom on therapeutic options based on each patient’s disease severity.”

Option Care earns perfect accreditation score

BANNOCKBURN, Ill. – Option Care earned a perfect score on its URAC Specialty Pharmacy accreditation for its corporate as well as three specialty pharmacy centers of excellence in Chicago, Los Angeles and Panama City, Fla. The perfect accreditation score applies to all specialty areas, including immunoglobulin (IG), bleeding disorders, enzymes and infliximab. Option Care was audited on more than 200 standards, nearly 90 of them mandatory., according to a press release. “We are proud and gratified to earn independent accreditation with this unprecedented demonstration of quality,” said Paul Mastrapa, CEO of Option Care. “A perfect score is significant for us as a national healthcare services organization, as well as for the patients and providers who rely on our care.” Option Care is a leading national provider of home and alternate site infusion services.

Familiar faces, ‘fresh blood,’ encouraged to submit proposals

ATLANTA – Time is running out to submit presentation ideas for Medtrade. Potential speakers must submit presentations for review by April 27. Medtrade 2017 takes place Oct. 23-26 at the Georgia World Congress Center in Atlanta. The Medtrade educational advisory board is also on the lookout for HME providers to share their stories. “Medtrade always has the best speakers in the industry,” says Kevin Gaffney, group show director, Medtrade. “Similar to last year, we will also be on the lookout for new blood, so feel free to pass along our ‘Call for Presentations’ to suitable candidates.” Go here for more information or to submit a proposal.

AAHomecare calls for audit data

WASHINGTON – The next submission round for AAHomecare’s HME Audit Key opens April 17. The association is asking providers to use the online survey to submit their audit activity for the first quarter of 2017. To complete the survey, providers will need their NPIs and zip codes. AAHomecare reminded providers that Brightree customers now have the option of printing a report that will help them answer many of the operational questions in the quarterly survey. It also reminded them that they do not have to submit data on individual claims, only cumulative counts of pre- and post-payment audits and appeal claim outcomes under DME MAC, RAC and SMRC reviews.

NHIA publishes survey questions

ALEXANDRIA, Va. – The National Home Infusion Association has published “Uniform Patient Satisfaction Survey Questions for Home Infusion Providers.” The 12 questions will enable providers to collect consistent data to be used for research and benchmarking. “With the current focus on value-based purchasing, the delivery of high-quality home infusion care requires providers to carefully consider the patient’s experience more than ever before,” said Connie Sullivan, RPh, NHIF vice president of research. The new publication is the latest step in a multi-year initiative to establish demographic, operational, and quality benchmarks that will advance home infusion patient care.

MassHealth moves toward preferred manufacturer model

BOSTON – MassHealth has published a request for response for a preferred manufacturer/distributor for incontinence products, according to the Home Medical Equipment Services Association of New England. Tom Lane, the director of MassHealth’s Fee-for-Service Programs, told HOMES, however, that the preferred manufacturer/distributor would be required to work with the HME provider network. The bid opening date is scheduled for May 1. A number of states have explored similar models for incontinence supplies, including Illinois and South Carolina. Last year, TwinMed snagged a five-year preferred vendor contract worth $225 million to provide incontinence supplies to Medicaid beneficiaries in New York.

Short takes: Coram, Coloplast

Coram CVS Specialty Infusion Serviceshas made Functional Formularies feeding tube and oral meal replacement formulas available to its customer base. Liquid Hope and Nourish, adult and pediatric certified organic, whole foods formulas, will be available through Coram, making them even more accessible to thousands of individuals and families coping with a wide-range of challenging health conditions, from cancer to ALS, Parkinson’s and MS. “Our new partnership with Coram shows the industry, which has historically been built on sugar-filled formulas, has been flipped on its head,” said Robin Gentry McGee, founder and CEO of Functional Formularies…Coloplast’s Biatain Silicone sizes and shapes has been awarded a Red Dot award for user experience and aesthetics. The Biatain Silicone products are soft, flexible, absorbent foam dressings with a silicone adhesive used for treating chronic and acute wounds. This year, Red Dot received 5,500 submissions from 54 countries. An independent and international jury of experts assessed all products entered…B. Braun has introduced an app that offers educational content to clinicians and patients for its Easypump ST/LT Elastometric Infusion Pump System. The Easypump app, for Apple and Android devices, offers simple menus and navigation, giving infusion therapy nurses a table-top tool for teaching patients how to properly use and manage the small, lightweight pump… Quantum Rehab has launched enhancements to its iLevel technology, including 12 inches of lift and LED fender lights, to further increase the independence of users. As of May 1, the iLevel technology available on the Q6 Edge 2.0 will have two inches more lift. The iLevel technology on the Q6 Edge 2.0 will also come standard with LED headlights and tail lights integrated into the fenders.

People: Joe Lewarski, John Graham

Joseph Lewarski, vice president of Global Respiratory and Sleep for Drive DeVilbiss, will speak at the American Association for Respiratory Care’s 70th Anniversary Conference at the Dittrick Museum of Medical History April 22. He will discuss the history and evolution of home respiratory care, the impact that reimbursement challenges have on the delivery of care, the current status of respiratory homecare, therapists’ current challenges and the future of homecare respiratory therapy…John Graham, a senior fellow of the National Community Pharmacists Association, has been appointed assistant principal deputy assistant secretary for Planning & Evaluation at the Department of Health and Human Services. Graham has a record of accomplishment in many areas of health policy, including payment reform, and regulation of drugs and devices, according to a press release.

WASHINGTON – When AAHomecare officials met with Seema Verma for the first time last week, they were pleased to find the new CMS administrator up to speed on key industry issues like competitive bidding.

“We had a very productive meeting,” said Tom Ryan, president and CEO. “We still have a long way to go on the road to meaningful fixes on competitive bidding and other HME policy priorities, but I’m convinced a strong working relationship with new leadership at CMS and Health and Human Services is going to help the process a great deal.”

It’s a small step forward after several months of feeling like things in Washington, D.C., are moving at a snail’s pace. Ryan says he feels providers’ pain.

“It’s April already and they want to know what’s going on,” he said.

Part of the problem is that the Trump administration’s transition has been slow and chaotic, with hundreds of key positions currently unfilled, according to a recent Washington Post article.

But that’s slowly changing at HHS, which on April 4 announced 11 new political appointments, including for its Office of General Counsel.

“There are still a number of unfilled positions, but they are moving along,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “That’s all necessary to go to the next steps to work with career staff.”

In the meantime, AAHomecare has been busy laying out its strategy. Letters in February and March asked HHS SecretaryTom Price to freezerates in non-bid areas at the 50/50 blended rate that took effect Jan. 1, 2016; and outlined several recommendations to fix the competitive bidding program.

While AAHomecare is hopeful that it can get bid relief through regulatory measures, the association is prepared to take up its fight legislatively, says Ryan.

“We think we can get legislation dropped quickly and we have the commitment from a leader who thinks that strategy makes sense,” he said. “How quickly that would move through chambers and how quickly we’ll get a Senate companion remains to be seen.”

In the meantime, HME providers need to keep up the noise, said Ryan.

“Be vocal, be loud,” he said. “CMS keeps saying there are no access issues, but I am hearing there are access issues and we’ve got to get that message out loud and clear.”

ALBANY, New York – Just months after New York and New Jersey decided to combine their state HME associations, they have announced new leadership.

The board of directors of the Northeast Medical Equipment Providers association (NEMEP) has chosen Beth Bowen, who already leads state HME associations in Florida, North Carolina, Tennessee and Virginia, as their new executive director.

“NEMEP is very lucky to have such a distinguished and energetic professional at its helm,” Kim Voelker, the former executive director of NEMEP, wrote in a letter to members on April 11.

Earlier this year, Voelker led efforts to combine the New York and New Jersey state HME associations.

Most recently, Bowen led efforts to combine the North Carolina and Virginia state HME associations.

“I look forward to serving with the board and the members of NEMEP beginning next week,” she wrote in an email on April 11.

WASHINGTON – AAHomecare reiterated it concerns about the structure of the competitive bidding process, including CMS’s use of median bid prices instead of market clearing prices, in recent comments submitted to the agency.

CMS was mandated by the 21st Century Cures Act to take into account stakeholder input on future pricing in non-bid areas, which got their first taste of the program in 2016.

In its comments, AAHomecare also asked for more comprehensive evaluation of the bidding program’s effects on beneficiary access and the quality of equipment furnished.
 

The comments also noted significant reductions in the number of HME suppliers in recent years and echoed the feedback shared by many suppliers on a March 23 call with providers.


“The stories told by suppliers and referral sources all had the same theme: the cuts are too severe, suppliers cannot exist on the current regional SPAs, Medicare beneficiaries are not being serviced at the level they need,” AAHomecare stated. “There was a sense of urging CMS to reconsider what has been done as part of the requirement in the Cures Act.”
 


AAHomecare closed its comments by asking what process CMS will follow to respond to industry feedback from the call and the written comments provided by stakeholders, and reiterated the association’s commitment to working with the agency to arrive at a workable payment solution.

AAH makes recommendations on SMRC contract

CMS requested that AAHomecare’s Regulatory Council provide suggestions on what should be included in the next statement of work for the SMRC contractor. Strategic Health Solutions’ contract is set to expire this year. Some of AAHomecare’s suggestions are:

• Change the time frame for response by a supplier from 30 days to 45 business days. 

• Limit the number of claims per letter to 20.

• Require the SMRC contractor to publicly publish error rates and overturn rates through all levels of appeal.

• Require the SMRC contractor to only look at new setups and not the random dates of service as they do now.

AAHomecare says it has previously worked with CMS on SMRC audit issues and appreciates the opportunity to continue to be involved in the process.  

WASHINGTON – AAHomecare reiterated it concerns about the structure of the competitive bidding process, including CMS’s use of median bid prices instead of market clearing prices, in recent comments submitted to the agency.

CMS was mandated by the 21st Century Cures Act to take into account stakeholder input on future pricing in non-bid areas, which got their first taste of the program in 2016.

In its comments, AAHomecare also asked for more comprehensive evaluation of the bidding program’s effects on beneficiary access and the quality of equipment furnished.
 

The comments also noted significant reductions in the number of HME suppliers in recent years and echoed the feedback shared by many suppliers on a March 23 call with providers.


“The stories told by suppliers and referral sources all had the same theme: the cuts are too severe, suppliers cannot exist on the current regional SPAs, Medicare beneficiaries are not being serviced at the level they need,” AAHomecare stated. “There was a sense of urging CMS to reconsider what has been done as part of the requirement in the Cures Act.”
 


AAHomecare closed its comments by asking what process CMS will follow to respond to industry feedback from the call and the written comments provided by stakeholders, and reiterated the association’s commitment to working with the agency to arrive at a workable payment solution.

AAH makes recommendations on SMRC contract

CMS requested that AAHomecare’s Regulatory Council provide suggestions on what should be included in the next statement of work for the SMRC contractor. Strategic Health Solutions’contract is set to expire this year. Some of AAHomecare’s suggestions are:

• Change the time frame for response by a supplier from 30 days to 45 business days. 

• Limit the number of claims per letter to 20.

• Require the SMRC contractor to publicly publish error rates and overturn rates through all levels of appeal.

• Require the SMRC contractor to only look at new setups and not the random dates of service as they do now.

AAHomecare says it has previously worked with CMS on SMRC audit issues and appreciates the opportunity to continue to be involved in the process.  

Association forms Retail Work Group for complex rehab

WASHINGTON – AAHomecare has formed a new Retail Work Group within the Complex Rehab & Mobility Council. The work group will hold monthly phone calls for suppliers and manufacturers to discuss retail layouts, operational strategies, legal aspects of marketing and promotions and more. “This Work Group is a collaboration of CRMC members who are trying to supplement their cuts in reimbursement with retail cash sales,” says Work Group Chairwoman Nancy Froslie of Sanford HealthCare Accessories. “Tapping in on a solid retail sales revenue is a great way for providers to increase sales and improve their cash flow.”



Georgia passes licensure requirement

ATLANTA – Georgia’s House of Representatives and Senate have passed a bill that establishes a licensure requirement for DME suppliers. Under the requirement, a supplier must submit the appropriate forms as prescribed by the Georgia State Board of Pharmacy, submit the requisite license fee, and maintain an office or place of business within Georgia. The supplier must also meet safety standards, including ensuring all personnel engaged in delivery, maintenance and repair of DME receive annual continuing education; provide instruction to the patient or patient’s caregiver on how to use DME; receive and respond to complaints from patients; maintain patient records for all patients receiving DME; and properly manage, maintain and service DME. The bill also establishes a definition for DME that specifies it is equipment requiring a prescription, including repair and replacement parts. To be considered DME, equipment must be able to withstand repeated use; have an expected life of at least three years; be primarily and customarily used to serve a medical purpose; be generally not useful in the absence of illness or injury; and should be appropriate for use in the home. The bill now sits before Gov. Nathan Deal, who has 30 days to sign or veto it.

Rowheels names new CEO

FITCHBURG, Wis. – Rowheels, the makers of pull-based geared wheels for manual wheelchairs, has named a new CEO: Fred Mindermann. Previously, Mindermann has held executive positions at Siemens Medical and AGA Linde HealthCare, according to the Wisconsin State Journal. He replaces Rimas Buinevicius, who co-founded the company in 2011. Last year, Rowheels used $1.5 million in funding to launch a more general-purpose wheel.

Board taps Bowen to lead NEMEP

ALBANY, New York – Just months after New York and New Jersey decided to combine their state HME associations, they have announced new leadership.

The board of directors of the Northeast Medical Equipment Providers association (NEMEP) has chosen Beth Bowen, who already leads state HME associations in Florida, North Carolina, Tennessee and Virginia, as their new executive director.

“NEMEP is very lucky to have such a distinguished and energetic professional at its helm,” Kim Voelker, the former executive director of NEMEP, wrote in a letter to members on April 11.

Earlier this year, Voelker led efforts to combine the New York and New Jersey state HME associations.

Most recently, Bowen led efforts to combine the North Carolina and Virginia state HME associations.

“I look forward to serving with the board and the members of NEMEP beginning next week,” she wrote in an email on April 11.

ARJ moves headquarters

LENEXA, Kan. – ARJ Infusion Services held an open house at its new headquarters here April 13. The new location features a state-of-the-art pharmacy with compounding area; a modern infusion suite with a relaxed environment for patients and continuing education programs for clinicians. “ARJ has a lot to celebrate—a new headquarters, ranking nationally in the top 10% in home health patient satisfaction, and continued revenue growth year after year," said Lisa Sackuvich, president and owner, in a press release.

Philips launches travel CPAP device

AMSTERDAM, the Netherlands – Philips has released a compact, travel-ready CPAP device called the DreamStation Go. The device weighs just 1.86 pounds and comes in two models: a fixed-pressure unit called the Pro; and an Auto CPAP that is auto-titrating. “The new DreamStation Go is perfectly suited for every-day therapy, as well as for active, traveling lifestyles,” said Chris Vasta, president of The CPAP Shop, which began selling the device on April 10. DreamStation Go, which retails for $849, features a Federal Aviation Administration-approved automatic battery backup, a color swipe screen, and an integrated USB port, among others. It also connects to the DreamMapper sleep monitor app. ResMed, a competitor of Philips, received clearance from the U.S. Food and Drug Administration for its AirMini travel CPAP device in January. During a conference call that month to discuss its latest financial results, the company said it plans to launch the device some time before June 30. Human Design Capital, which is owned by private investment firm PBM Capital, launched a portable CPAP device called the Z1 in 2013.

VOCSN: ‘Not just another ventilator’

BOTHELL, Wash. – Ventec Life Systems has received FDA 510(k) clearance of its VOCSN, a unified respiratory systems for ventilator patients. VOCSN combines five respiratory therapies—ventilation, oxygen, cough, suction and nebulization—and is designed to improve care for patients with neuromuscular disease, impaired lung function, spinal cord injury and pediatric development complications. The system is designed for use in hospital institutional, transport and home settings, and enables caregivers to spend less time managing machines and more time caring for patients. “I’ve seen firsthand how improved ventilator technology can enhance the quality of life for patients and caregivers,” said Doug DeVries, founder and CEO of Ventec, in a press release. “Our team didn’t want to create just another ventilator, we spent the past five years focused on building a truly integrated solution.”

Smith & Nephew begins distributing patient monitoring system

LONDON – Smith & Nephew has signed a distribution agreement with Leaf Healthcare, a developer of a wireless patient monitoring system for pressure ulcer/injury prevention. “Smith & Nephew is focused on providing not just products to treat conditions, but also supporting customers through technologies designed to support prevention, as well as treatment,” said Glenn Warner, president U.S., Smith & Nephew. “The Leaf Patient Monitoring System is complementary to Smith & Nephew’s existing portfolio in this area, such as ALLEVYN Life prophylactic dressings and SECURA skin care products.” The monitoring system is comprised of a small, lightweight, wearable sensor that wirelessly monitors a patient’s position and movement, and uses that data to automate and document the management of prescribed turn protocols for patients at risk for ulcers/injuries. As a result of the agreement with Smith & Nephew, the system, which is currently in use in a limited number of hospitals, now has the opportunity to reach a nationwide customer base.

Oklahoma considers steep cuts for Medicaid

OKLAHOMA CITY, Okla. – The Oklahoma Health Care Authority has had to map out budget scenarios for the upcoming fiscal year based on a 5% to 15% reduction in state appropriations, according to Tulsa World. A cut of 15% would mean eliminating some optional benefits and reducing provider rates by up to 25%. Benefits being evaluated for elimination include pharmacy, behavioral health and DME, according to the newspaper. Past budget shortfalls have resulted in eliminating or reducing sleep studies, perinatal and dental care, and DME purchases, the newspaper reports. The authority is in charge of the state’s Medicaid program, called SoonerCare.

Action DME goes with CareTend

LENEXA, Kan. – Action DME has purchased Mediware’s CareTend Software for its durable medical equipment business. Owner Hunter Cook likes the software’s all-in-one solution. “I really look forward to using the workflow management tools in CareTend that are very intuitive to how my business operates each day-with the bonus of tracking output in real-time in a single dashboard,” he said in a press release.

WASHINGTON – AAHomecare is asking lawmakers for relief from a “double-dip” oxygen cut in the 2017 Medicare fee schedule for stationary oxygen.

The move reinforces a letter that the association sent to previous leadership at CMS in December, asking the agency to recalculate its rates, which have dipped below competitive bidding rates in rural and non-bid areas.

“We would like to reinforce these efforts by generating congressional interest and support on the issues, as well,” the association states.

AAHomecare is also engaging the new leadership at CMS and the Department of Health and Human Services.

The association is calling HME providers to action, asking them to contact their members of Congress to educate them about the issue and have them contact CMS.

AAHomecare argues that CMS has improperly reduced payments for E1390 by applying a regulation introduced in 2006—called the budget neutrality offset—that only should be applied to unadjusted fee schedules. The association says the 2017 fee schedule for stationary oxygen must be consistent with those based on regional single payment amounts from competitive bidding areas.

YARMOUTH, Maine – A whopping 65% of respondents to a recent HME Newspoll say they can sustain their businesses for less than a year, if they don’t get reimbursement relief.

Thirty-six percent of respondents say they can sustain their businesses for up to six months, and 29% say they can sustain their businesses for six to 12 months.

“I have laid off long-time employees and cut benefits like health care, but there is no way to make up for 50%-plus cuts in Medicare,” wrote Don Chrysler of National Home Health Care in Amarillo, Texas.

CMS’s decision to apply competitive bidding reimbursement rates to non-bid areas in two waves in 2016 has sent ripples throughout the HME industry, forcing many providers to make drastic changes to their businesses.

The largest number of respondents—37%— says the biggest impact of the cuts on their businesses has been dropping certain products and services. It’s a tough decision that has made some providers more financially viable but has put patients in a bind.

“The biggest impact for us has been to drop certain categories, i.e. nebulizers, hospital beds, walkers, and only bill them unassigned for Medicare beneficiaries,” wrote Jim Lehan of Lehan’s Medical Equipment in Rockford, Ill. “We do enough cash business and non-Medicare business to most likely stay in business, but the patients have suffered as no one will take assignment on a lot of Medicare business.”

Twenty-eight percent of respondents say the biggest impact of the cuts has been going into debt, both professionally and personally, to keep their businesses afloat.

“We have debt now of $100,000, when we were debt free before the price reduction,” wrote Diane Friend of Valley Home Health Care in Roanoke, Va. “I have not received a salary for more than 11 months as an owner. We still cannot pay for our equipment and have to continue to finance. With rent, utilities, payroll, insurances, bonds, we still cannot pay the bills.”

Sixteen percent of respondents say the biggest impact has been cutting staff, 11% say closing locations, and 8% say putting growth plans on hold.

For many respondents, the impact spreads across their businesses.

“We have laid employees off, and we have had to borrow money to say open,” wrote Lana Cochrane of Personal Medical Equipment in Anna, Ill. “If things keep going as they are we will not be able to provide equipment to our customers much longer, and we service a very rural, impoverished area.”

For some providers, diversity has been a lifeline, whether it’s an accompanying retail business or other homecare-related business.

“We have survived by the skin of our teeth due to the fact that we also provide pharmacy services and state bid contract medications,” wrote Melissa Hammett of Professional Care Pharmacy in Monroe, La. “Had it not been for these private contracts, we would certainly be in a much different situation.”

But even after making changes to their businesses and leveraging diversity, it’s not enough for some providers. For them, the sense of despair is palpable.

“It’s been a slow, painful death, but they’ve gotten what they wanted: the shutdown of an industry of small, service-oriented businesses,” wrote Kathleen Weir Vale of HOPE Medical in San Antonio. “Another fiendish arrow in their quiver has been the bureaucratic documentation requirements. Those alone made our services marginally profitable, without even considering the first fee cuts, not to mention the auction. They’ve won. We all need to face it, close up shop and get a life.”

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