YARMOUTH, Maine – If CMS decides to extend current competitive bidding contracts, a slight majority (53%) of respondents to a recent HME Newspoll say they would accept them—reluctantly.

“We currently have the contract and have provided the equipment and services, so it just makes sense to continue with it,” said one respondent to a recent HME Newspoll. “Either way, you lose.”

Contracts for both competitive bidding and the national mail-order contract for diabetes are set to expire Dec. 31, 2018, and 81% of poll respondents say there’s no longer enough time to complete the bid process by Jan. 1, 2019.

While CMS has the authority to extend contracts, several rounds of the flawed program have driven reimbursement rates to unsustainable levels, making the contracts extremely unattractive, say respondents.

“We would decline the offer because with all the cuts that have been made it is a big loser,” said Melody Amos, office manager at Quality Tem in Bakersfield, Calif. “You’re lucky if you can make your cost back and just break even.”

Other contract suppliers say they are committed to the bidding program for better or worse.

“We have invested a tremendous amount of resources to service many thousands of patients under the bid program,” said Robin Soblick, president of Michigan-based Specialty Medical and Texas-based AJT Diabetic, which hold national-mail order contracts for diabetes testing supplies. “It has taken years to develop an infrastructure capable of economically assisting patients under the bid program.”

With approximately 40% of suppliers closing their doors in just the past few years, access has become an issue. Some contract suppliers see extending their contracts as their moral duty.

“Accepting the extension would ensure timely and safe discharges from the hospital campuses in the community,” said one poll respondent. “Declining could increase length of stays and create unsafe conditions if access to equipment is decreased.”

Lack of access is, indeed, a concern—and an expensive one, says another respondent, a hospital-based provider that would also extend their contract.

“Independent suppliers take days if not weeks to deliver, which greatly increases our readmission rate,” said the respondent. “Those readmissions are a much greater cost overall to our system then the horrible reimbursement.”

CLEARWATER, Fla. – Lincare will pay $875,000 to settle a lawsuit filed by employees whose information may have been exposed in a “phishing attack.”

The lawsuit stems from an incident on Feb. 3, 2017, when a cyber-criminal posing as a high-level Lincare executive emailed a Lincare human resources employee and requested W-2 information for all employees. The HR employee responded with attached W-2 data for a certain number of employees of Lincare and its affiliates.

On Feb. 10, 2017, Lincare sent notice of the “phishing attack” to all impacted current and former Lincare employees, notifying them that their personally identifiable information may have been compromised. The company offered two years of complimentary credit monitoring, remediation services and identity theft insurance.

On Oct. 16, 2017, however, Andrew Giancola, Raymond Scott and Patricia Smith filed the lawsuit, alleging negligence, breach of fiduciary duty, breach of implied contract and violation of Florida’s Deceptive and Unfair Trade Practices Act.

Per the settlement, $550,000 will be used to compensate class action members who suffered an out-of-pocket loss and $325,000 will be reserved for members who experienced an “eligible incident,” like a fraudulent tax return.

Lincare has also implemented, or has agreed to implement, additional security measures, including an external HIPAA risk assessment every two years; an annual risk assessment of employees’ data; updated spam filter; and employee education.

As part of the agreement, Lincare admits to no wrongdoing.

Enteral nutrition, surgical dressings top error list

WASHINGTON – Enteral nutrition had the highest error rate (87%) from Targeted Probe and Educate audits in Jurisdiction D.

Noridian Healthcare Services, the DME MAC for Jurisdiction D, posted the error rates from TPE audits (see below) from Oct. 1 to Dec. 31, 2017.

AAHomecare has requested that all the DME MACs publish the error rates.

The error rates in Jurisdiction D are:

19%, ankle-foot/knee-ankle-foot orthosis

87%, enteral nutrition

35%, external infusion pumps

76%, glucose monitors

14%, hospital beds

9%, immunosuppressive drugs

77%, knee orthosis

57%, manual wheelchairs

3%, nebulizers

34%, spinal orthoses

80%, surgical dressings

13% therapeutic shoes

21%, urological supplies

VGM crafts comment template

WATERLOO, Iowa – VGM has created a template for suppliers to use when drafting their comments on the interim final rule. Providers are encouraged to hit on a few key points, including that future policy decisions must include providers in all non-bid areas that serve patients in “non-rural” areas; that the adjusted fee schedule is unsustainable; that the oxygen “double-dip” has pushed reimbursement rates below the single payment amount; and that CMS’s complaint and access monitoring is not capturing patient complaints. Comments are due to CMS by 5 p.m. EST on July 9. The downloadable template can be found here.

Study: Home infusion therapy can improve survival rates

BANNOCKBURN, Ill. – Inotropic home infusion therapy can help improve survival for patients with advanced heart failure, according to a new study from Option Care and the Keck School of Medicine of USC. Patients prescribed the therapy, which enables the patient’s heart to pump more efficiently, may experience a better quality of life, according to a press release. Option Care’s data suggest an average survival rate of more than two years for these patients. “Receiving this life-changing therapy in the comfort of home helps patients more fully enjoy their lives,” said Tess Artig-Brown, BSN, MN, co-author of the study and director of Option Care’s Heart Failure Program. “Home infusion is also much more cost effective than care provided in the hospital or long-term care centers and research has shown that with education and support, these patients are less likely to be readmitted to the hospital.”

Deadline extended for complex rehab sign-on letter

WASHINGTON – The deadline for collecting signatures for a congressional sign-on letter that asks CMS not to apply a provision in the 21st Century Cures Act to complex rehab technology has been extended to May 25. The original deadline for the letter, spearheaded by Reps. Bob Latta, R-Ohio, and Bill Johnson, R-Ohio, was May 17. A provision in the Cures Act requires CMS to limit federal contributions to Medicaid reimbursement to competitive bidding-influenced Medicare reimbursement. Stakeholders argue that, because complex rehab has been exempted from the bid program, the provision should not apply to that technology.

Medline launches online store

NORTHFIELD, Ill. – Medline has launched PersonalCareDirect.com, its first online consumer store offering products to residents of assisted living communities. PersonalCareDirect.com includes essential personal care products, such as incontinence supplies, skin health products, mobility aids, oral care necessities and nutritional supplements. The website also features education to help families select the correct products. “Families spend a great deal of time trying to find quality, reliable supplies for their loved ones,” said Shawn Scott, senior vice president of Post-Acute National Sales at Medline, in a release. “Any resident of a community offering PersonalCareDirect.com will have access to Medline's high quality, professional-grade personal care supplies through one online portal."

InfuSystem debuts mobile app

MADISON HEIGHTS, Mich. – InfuSystem Holdings has launched InfuSystem Mobile, a patient safety app that connects patients with the infusion provider’s products, expertise and registered nurses. Features include automated infusion safety alerts, patient education videos, secure two-way communications and paperless form submission. “InfuSystem Mobile will allow us to engage our patients directly,” said Richard Dilorio, CEO, in a release. “We believe this app represents an important step forward that will enable patients to more effectively manage their treatment.”

AABCP seeks achievers

HOUSTON – The American Association of Breast Care Professionals is seeking nominations for its 1st Annual Life Achievement Award to be presented at the AABCP Global Breast Care Summit & Expo July 12. The award committee will consider individuals who have demonstrated care, compassion and advocacy for the post-mastectomy care profession. The Summit takes place July 10-12 at Harrah’s New Orleans. Submit nominations here.

Golden’s contract renewed by VA

OLD FORGE, Pa. – Golden Technologies has been awarded its third consecutive five-year contract by the Department of Veterans Affairs to supply power scooters to veterans nationwide. “The Golden Companion GC230 and GC340 power scooters allow them to access medical care and to accomplish necessary tasks in home and community environments that are so important as they gain more independence in their daily lives,” said Rich Golden, CEO of Golden Technologies. This most recent contract ends April 2023. Golden was first awarded a national contract by the VA in 2003 for mid-size three-wheel and full-size three-wheel scooters. “For the past 15 years, the continuous effort and determination of the entire Golden team—from our VA Customer Service, VA Technical Service, Production, Research & Development, and Shipping departments—have demonstrated our dedication and commitment to the Department of Veterans Affairs and our nation’s veterans,” said Donna Payer, VA national account director for Golden.

AAH surveys providers on PMD demo

WASHINGTON – AAHomecare’s Complex Rehab & Mobility Council is collecting feedback from providers about the prior authorization demonstration project for power mobility devices currently taking place in 19 states. Responses to the council’s brief online survey are due by May 25. “The PMD prior authorization program has been a win-win for the HME industry and for CMS, and information from this survey will bolster our efforts in working toward a nationwide, permanent prior authorization program for PMDs,” said Nancy Froslie of Sanford Healthcare Accessories, who serves as chairwoman of the council. The demo is set to expire Aug. 31. The council is also preparing a white paper that articulates the positive results of the demo and outlines regulatory opportunities to expand prior authorization for PMDs beyond Aug. 31.

Coleman to receive advocate award

WASHINGTON – Doug Coleman, owner of Major Medical in Loveland, Colo., and president of the Colorado Association for Medical Equipment Services, will receive the AAHomecare/Mal Mixon Legislative Advocate Award at the Washington Legislative Conference on May 23. “Doug exemplifies the characteristics of this award, which honors AAHomecare members who inspire and motivate others to join the fight for better federal policy for the home medical equipment sector,” the association stated. “Serving as a catalyst for change at both the state and federal level for three decades, Coleman has tirelessly pursued policy change that will protect the integrity of the HME community.” Among Coleman’s accomplishments: working with AAHomecare to create the Grassroots Accountability Project, an effort to establish HME advocates to cover all 535 federal legislative offices. Coleman is the ninth recipient of the award, preceded most recently by George Kucka, president of Fairmeadows Home Health Center, in 2017.

MAMES wraps up successful conference

DES MOINES, Iowa – The Midwest Association for Medical Equipment & Supplies drew its largest crowd for its most recent spring conference since 2011. The conference, held April 25-27, also drew rave reviews from attendees (a perfect 4.0 rating) and exhibitors (100% rated it the best state or regional show), according to the association. At the conference, Frannie Green of Total Respiratory & Rehab in Nebraska, and Patrick Naeger of Healthcare Equipment & Supplies in Missouri won Provider of the Year Awards. Rose Schafhauser, executive director of MAMES, received the Excellence in Leadership Award. MAMES has now opened sponsor registration for the 2018 Fall Excellence in HME Conference, Oct. 3-5, in Welch, Minn.

Medtrade sign-ups heat up

ATLANTA ­– Several exhibitors have signed up for Medtrade, Oct. 15-17 at the Georgia World Congress Center, after successful appearances at Medtrade Spring, show organizers say. “We feel that being at Medtrade Spring in Las Vegas and Medtrade in Atlanta is a great way to capture as much coverage as possible and have conversations with providers across the United States,” said Kolby Wegener, marketing specialist with Mediware. Joining Mediware are Golden Technologies, Pride Mobility, VGM, Brightree, Philips Respironics, ResMed, Broda Seating, Fisher & Paykel, First Quality Products, Medforce Technologies, MK Battery, Precision Medical, Stander and more. Medtrade expects to open early registration for the show in mid-June.

Invacare appoints former Pfizer exec to board

ELYRIA, Ohio – Invacare has appointed Petra Danielson-Weil to its board of directors. From 2014 until her retirement in August 2017, Danielson-Weil was the regional president for Pfizer Essential Health-Europe, a maker of non-viral anti-infectives, biosimilars and sterile injectable medicines, and a unit of Pfizer, a research-based global biopharmaceutical company. Invacare says with more than 30 years of experience in the medical and pharmaceutical fields in Europe, Danielson-Weil offers deep industry and international expertise. The company now has eight directors, seven of whom are considered independent.

WASHINGTON – CMS should continue with its prior authorization programs and expand prior authorizations to include power wheelchair accessories, according to a new report from the Government Accountability Office.

The prior authorization demonstration project launched in seven states in 2012 and was expanded to an additional 12 states in 2014. Originally set to expire Aug. 31, 2015, the deadline was pushed to Aug. 31, 2018 and CMS has not announced plans to extend the deadline again.

The GAO estimates the prior auth program for power mobility devices saved nearly $608 million though March 2017.

Although the HME industry is largely in favor of prior authorizations, suppliers reported some challenges, such as obtaining the necessary documentation from referring physicians.

In addition, suppliers expressed concerns about whether PMD accessories are subject to prior authorization. CMS in 2017 said if an accessory is essential to the functioning of a K0856 or K0861 wheelchair, it would be considered part of the base and covered under the prior authorization process. 

CMS neither agreed nor disagreed with the GAO’s recommendations but said it would continue to evaluate the prior auth program and take the GAO’s recommendations into consideration in developing plans or determining next steps, according to the GAO.

WASHINGTON – Round 2 of Medicare’s competitive bidding program does not appear to have impacted access to oxygen or enteral supplies for most beneficiaries, according to two new reports from the Office of Inspector General.

The OIG analyzed claims data from three months before and six months after the July 1, 2013, kick-off of the program in both CBAs and non-CBAs.

For oxygen, the OIG found that Medicare payments continued for 86% of beneficiaries in CBAs and 89% of beneficiaries in non-CBAs. Those rates were consistent with payments being made for 88% of beneficiaries in 2012.

For enteral nutrition supplies, the OIG found that Medicare payments continued for 91% of beneficiaries in CBAs and 94% in non-CBAs, slightly lower than the 95% in 2012.

In both cases, the OIG said that the slightly higher percentages of beneficiaries in the CBAs “may or may not indicate disruptions,” and that the difference could also be attributed to the program reducing unnecessary equipment and supplies, as CMS has claimed in the past.

The OIG reports follow an interim final rule recently released by CMS that validates concerns raised by industry stakeholders about the significant reimbursement challenges and the decline of suppliers in certain areas.

A 2017 survey of beneficiaries, suppliers and discharge planners commissioned by AAHomecare found that 59% of oxygen patients reported access issues.

WASHINGTON – A major goal of the AAHomecare Washington Legislative Conference last week was determining whether or not Sen. John Thune, R-S.D., will continue to lead the HME industry’s bid relief efforts.

With a bill in the House of Representatives, but no bill in the Senate, the big question is: Is Thune satisfied with the relief outlined in the recently released interim final rule, which impacts rural states like the senator’s the most, or does he want to continue pushing for more widespread relief?

“Everyone’s looking at Thune,” said Jay Witter, senior vice president of public policy for AAHomecare. “If (he’s satisfied), we have other senators raring to go, but no one wants to move unless it’s blessed by Thune.”

Per the IFR, CMS will revert to the 50/50 blended reimbursement rates in rural areas from July 1, 2018, through Dec. 31, 2018. It will not revert to those rates in all non-bid areas.

Thune, who sits on the Finance Committee, has been key to the industry’s efforts in the Senate to date. He has introduced a bid relief bill in the past and, more recently, championed a provision, along with Sen. Heidi Heitkamp, D-N.D., in the 21st Century Cures Act that requires CMS to take into consideration provider costs and other factors when setting reimbursement in non-bid areas for future rounds of the program.

“We need to clear Thune,” said Tom Ryan, president and CEO of AAHomecare.

In the House, H.R. 4229, which would provide relief in all non-bid areas and retroactively from Jan. 1, 2017, to Jan. 1, 2019, has support from 145 lawmakers, including more than a dozen on the Ways and Means Committee. Discussions there are transitioning to how to move the bill through the committee process.

“We don’t need to introduce a new bill (in the wake of the IFR),” Witter said. “When the committee takes it up, they can mark it up and make modifications. If your member of Congress asks if the bill is still viable, it is.”

For CMS, AAHomecare has re-upped its retainer with law firm Foley Hoag, which has helped the association get meetings with high-level officials at the agency, as well as HHS, including Deputy Secretary Eric Hargan.

“When (former HHS Secretary Tom Price left), things came to a grinding halt, but we continued to pound away at it and with the energy and grassroots we generated, we’ve gotten access like never before,” Ryan said.

WASHINGTON – The ears of HME providers perked up during last week’s AAHomecare Washington Legislative Conference, when CMS’s Melanie Combs-Dyer said the agency was working on a documentation requirement lookup service for prescribing providers.

Combs-Dyer, the acting deputy director of the Center for Program Integrity, said CMS plans to pilot the service, which allows prescribing providers to look up documentation requirements at the time of service from their EHR or practice management system, in late 2018 or early 2019.

“This is wonderful news,” said Georgie Blackburn, vice president of government relations and legislative affairs at Blackburn’s in Tarentum, Pa., from the audience.

What’s more, looking at its pool of claims for high levels of utilization, errors and appeals, Combs-Dyer said CMS has tapped CPAP devices and oxygen therapy for two of the three pilots it will conduct.

As for the third? It probably won’t be DME-related, Combs-Dyer said.

“The other payers felt like I did, that DME was a good place to start,” she said. “But I have a feeling they’re going to want to move into other provider types, maybe home health or skilled-nursing, or maybe a certain hospital procedure.”

Asked why CMS is focusing the service on just prescribing providers, Combs-Dyers said, “They’re the ones whose documentation is at fault in a situation where we deny a claim. It’s rarely the (DME provider’s) documentation.”

Based on a schematic that Combs-Dyer shared, an exchange based on Fast Healthcare Interoperability Resources or FHIR will connect the prescribing provider’s EHR or practice management system with “rules libraries” built by payers—not only Medicare, but ideally, some Medicare Advantage plans and private payers, as well.

“We’re hopeful (this will improve documentation),” she said.

Making required paperwork easier to find is one of a number of strategies CMS has for reducing the burden on provider compliance, Combs-Dyer said. Others: simplifying paperwork (“There’s some stupid stuff that’s out there and we’re really trying to eliminate that stuff,” she said) and improving the audit process (“I believe the Targeted, Probe and Educate Program is quite promising,” she said).

WASHINGTON – Round 2 of Medicare’s competitive bidding program does not appear to have impacted access to oxygen or enteral supplies for most beneficiaries, according to two new reports from the Office of Inspector General.

The OIG analyzed claims data from three months before and six months after the July 1, 2013, kick-off of the program in both CBAs and non-CBAs.

For oxygen, the OIG found that Medicare payments continued for 86% of beneficiaries in CBAs and 89% of beneficiaries in non-CBAs. Those rates were consistent with payments being made for 88% of beneficiaries in 2012.

For enteral nutrition supplies, the OIG found that Medicare payments continued for 91% of beneficiaries in CBAs and 94% in non-CBAs, slightly lower than the 95% in 2012.

In both cases, the OIG said that the slightly higher percentages of beneficiaries in the CBAs “may or may not indicate disruptions,” and that the difference could also be attributed to the program reducing unnecessary equipment and supplies, as CMS has claimed in the past.

The OIG reports follow an interim final rule recently released by CMS that validates concerns raised by industry stakeholders about the significant reimbursement challenges and the decline of suppliers in certain areas.

A 2017 survey of beneficiaries, suppliers and discharge planners commissioned by AAHomecare found that 59% of oxygen patients reported access issues.

GAO: Extend prior auth program

WASHINGTON – CMS should continue with its prior authorization programs and expand prior authorizations to include power wheelchair accessories, according to a new report from the Government Accountability Office.

The prior authorization demonstration project launched in seven states in 2012 and was expanded to an additional 12 states in 2014. Originally set to expire Aug. 31, 2015, the deadline was pushed to Aug. 31, 2018 and CMS has not announced plans to extend the deadline again.

The GAO estimates the prior auth program for power mobility devices saved nearly $608 million though March 2017.

Although the HME industry is largely in favor of prior authorizations, suppliers reported some challenges, such as obtaining the necessary documentation from referring physicians.

In addition, suppliers expressed concerns about whether PMD accessories are subject to prior authorization. CMS in 2017 said if an accessory is essential to the functioning of a K0856 or K0861 wheelchair, it would be considered part of the base and covered under the prior authorization process. 

CMS neither agreed nor disagreed with the GAO’s recommendations but said it would continue to evaluate the prior auth program and take the GAO’s recommendations into consideration in developing plans or determining next steps, according to the GAO.

CMS adds templates for enteral nutrition

WASHINGTON – CMS will host a Special Open Door Forum to allow feedback on draft templates and clinical data elements for parenteral nutritional therapy (order, progress note and lab test results) and enteral nutritional therapy (order and progress note). The forum is scheduled for May 31 at 2 p.m. EST. CMS recently released draft templates and CDEs for RADs, PAPs and vents; infusion pumps and nebulizers; and oxygen therapy. To participate in the forum call 800-837-1935 and use the ID 8778137.

Merits signs contract with Numotion

CAPE CORAL, Fla. – Merits Health Products has signed a contract with Numotion to become the Brentwood, Tenn.-based national complex rehab provider’s preferred provider for Group 2 power wheelchairs. The contract covers Merits’ full line of Group 2 power wheelchairs, including its popular Vision series and its new tilt-only Vision Ultra. “We are excited about this contract and happy to be partnering with one of the nation’s top providers,” said Chris Blackmore, vice president of sales and business development for Merits. “We feel this is a true testament of how far we have come with this company and product development.” Merits launched a complex rehab division called Avid Rehab in 2015, and a home access division called Pilot last year.

ResMed: Remote monitoring, resupply improve compliance

SAN DIEGO – Remote patient monitoring and resupply can improve patient adherence to PAP therapy, according to two studies presented by ResMed at the ATS 2018 International Conference. In the first study, medXcloud, a ResMed-assembled group of healthcare key opinion leaders, examined de-identified data of more than 2.6 million PAP users from its AirView network in the U.S. and found that 75% met the CMS compliance threshold. In the second study, ResMed and researchers found that over a one-year period patients who enrolled in a resupply program slept 5.6 hours on PAP each night, compared to 4.5 hours for those not enrolled. “These two studies demonstrate significantly effective ways to help patients achieve 90-day compliance with cloud-based remote monitoring and to keep them compliant over the long term with mask resupply programs,” said Adam Benjafield, researcher on both studies and ResMed’s vice president of medical affairs. 

ResMed: OSA affects more than previously thought

SAN DIEGO – Obstructive sleep apnea is more prevalent than previously estimated, with more than 936 million worldwide affected—according to a new data analysis from ResMed. Presented this week at the ATS 2018 International Conference, the study, “Global Prevalence of Obstructive Sleep Apnea (OSA)” was conducted by a group of international researchers seeking to provide a clear scope of the impact of the chronic sleep-disordered breathing condition. The previous estimate of OSA prevalence of 100 million came from a 2007 World Health Organization study. “This study should encourage physicians to talk with their patients about how sleep affects our overall health,” said ResMed Chief Medical Officer Carlos M. Nunez, M.D. “It should also cause more people to ask themselves, ‘Do I or my bed partner have this?’ Those who have sleep apnea don’t often realize they have it and, therefore, don’t realize they can do something to mitigate the resulting chronic fatigue or its more harmful long-term health risks.” 

More news from ATS 2018: Philips, ResMed back combined therapy

SAN DIEGO – Royal Philips announced new data at ATS 2018 that suggests combining home oxygen therapy with home non-invasive ventilation as treatment for chronically hypercapnic COPD patients is more effective and less expensive than HOT alone. Comparing the accumulated costs of devices, doctor visits, medication and hospitalizations using a U.S. economic model, HOT-HMV exhibited an average annual cost savings of $3,927 per patient. Results of the five-year, multi-center study were announced at ATS 2017 and published in the Journal of American Medical Association, but the potential health economic impact was previously unknown. The original trial data were used to develop an economic model from the U.S. payer perspective. This analysis indicated the base-case incremental cost per quality adjusted life year (QALY) gained was negative $50,856, suggesting HOT-HMV as a dominant strategy to both save costs and improve quality of life…ResMed announced the results of two studies at ATS 2018 that demonstrate the cost effectiveness of combining home oxygen therapy and home non-invasive ventilation therapy for patients with persistent hypercapnia following a life-threatening exacerbation of COPD. The ResMed-backed Home Oxygen Therapy – Home Mechanical Ventilation (HOT-HMV) health economic studies build on earlier data demonstrating the clinical and cost effectiveness of combined therapy. A U.K. study found that HOT-HMV treatment reduced exacerbation frequency and 28-day hospital readmissions. A U.S. analysis based on the U.K. study found a 58.3% reduction in 30-day readmissions for HOT-HMV patients and the ability to save patients money while improving their quality of life.

Aeroflow applauds vents decision

ASHEVILLE, N.C. – Aeroflow Healthcare will be able to provide even more support for its patients now that North Carolina Medicaid reimburses for home non-invasive ventilators. “For years, N.C. Medicaid patients with chronic respiratory failure, hypoventilation, neuromuscular disorders, and other diagnoses were unable to receive non-invasive ventilation (NIV) therapy, because Medicaid would not cover it,” said Rob Hunter, Aeroflow sales director. “Now that NC Medicaid will cover NIV, patients have access to a much greater level of care, such as with using the Trilogy ventilator, that will significantly reduce hospital readmissions.” The “Clinical Coverage Policy 5A-2, Respiratory Equipment, and Supplies” was updated to include policy guidelines for home and non-invasive ventilators and added HCPCS E0466 to the DME fee schedule as a continuous rental. Aeroflow says this means that Medicaid and North Carolina Health Choice will cover home ventilators with a non-invasive interface for qualifying patients. The devices must be necessary for the treatment of respiratory disorders other than obstructive sleep apnea (OSA).

Collaboration results in DMERT certification

WATERLOO, Iowa – The Durable Medical Equipment Repair and Training (DMERT) Group has been launched as a new certification body for the DME and complex rehab technology industry. The DMERT Group is a nonprofit organization meant to establish training guidelines and provide proper certification for repair technicians. U.S. Rehab, VGM Education and FIOS Repair Training collaborated to develop online tech training courses that are DMERT Group certified. The courses are designed to help prepare techs to take the DME RT challenge exams to earn certification. The group is guided by an executive oversight board that includes Greg Packer, president of U.S. Rehab, and Matthew Macpherson, ATP, director of FIOS DME Repair Training. “We’re excited to announce the addition of the DMERT Group as a resource to ensure quality standards which will further strengthen the credibility of repair technicians - who are intelligent, focused and repair-minded individuals,” Packer said. “This organization has a firm foundation and is advancing the certification for repair technicians that work in the DME and CRT arena.” 

United Spinal hosts outdoor enthusiast at Roll on Capitol Hill

NEW YORK – The United Spinal Association will host power wheelchair user Ian Mackay at its 7th Annual Roll on Capitol Hill, June 24-27 in Washington, D.C. Mackay, a California native, avid outdoor enthusiast and peer group leader, will attend the event for the first time to speak with legislators on issues that affect the independence and quality of life for people with spinal cord injuries and disorders and other pre-existing conditions. In 2016, he rode his wheelchair across the state to advocate for more accessible trails for wheelchair users and began hosting peer support groups. Last year, he rode more than 4,700 miles in four different states and won the national bike challenge in his area. Mackay now runs a nonprofit called Ian’s Ride to raise awareness of accessibility issues in his state.

Breathe Grace Medical Supply opens

OAKLAND, W.Va. – Breathe Grace Medical Supply has opened here, with a focus on respiratory products and services, according to the Garrett County Republican. The company will offer CPAP/BiPAP equipment and supplies, and oxygen equipment and supplies, including portable oxygen concentrators. One of the company’s owners, Jackie Rodeheaver, previously worked for a large DME company that served the tri-state area but closed in 2015. “After its closure, the local area went without something that it needed,” she told the newspaper. “Durable medical equipment is a growing need in our country and in Garrett County, and people still want the hometown service that we have always been accustomed to.” Breathe Grace is in the process of becoming accredited, so it can bill Medicare and Medicaid, as well as private insurances. Right now, it’s offering products and supplies for cash. The company also offers bath safety products like shower chairs and commodes, and mobility products like wheelchairs, walkers, canes and rollators.

Wilson to leave NHIA

ALEXANDRIA, Va. – Tyler Wilson is stepping down as president and CEO of the National Home Infusion Association, effective July 17. Wilson will work with the Board of Directors and staff leadership to develop a transition plan while the association searches for a successor. “I have enjoyed my three years at NHIA,” said Wilson in a press release. “The association is stronger today with a dedicated Board of Directors and a staff that strives to always protect and promote the interests of the home and specialty infusion community. With recent achievements on Capitol Hill and the addition of new member benefits, NHIA has a great future. Wilson took the reins in August 2015. He is best known in the HME industry for his tenure at the American Association for Homecare, where he served as president and CEO from 2006 to 2013.

Short takes: NSM, Viemed, NCPA

Nashville, Tenn.-based National Seating & Mobility will serve as a preferred CRT and home access provider for the Visiting Nurse Service of New York Choice Health Plans. In January, NSM became an in-network provider with Geisinger Health Plan in Pennsylvania … Lafayette, La.-based Viemed Healthcare has received final approval from the Toronto Stock Exchange to graduate from the TSX Venture Exchange to the TSX after receiving conditional approval earlier this month. Common shares will be listed May 23 under the existing symbol VMD. The National Community Pharmacists Association has named Karry La Violette as senior vice president of government affairs and director of the association’s Advocacy Center. La Violette had previously led the association’s government affairs programs.

WASHINGTON – CMS last week published the adjusted reimbursement rates that will go into effect for seven months in rural areas.

The adjustments, called for in a recently released interim final rule, means reimbursement for oxygen concentrators, for example, will go from $77.16 to $121.46 per month from June 1 through Dec. 31 in rural areas.

Per the IFR, CMS is reverting to 50/50 blended reimbursement rates in rural areas, but not in all non-bid areas, as stakeholders had hoped.

Other examples include from $43.95 to $73.87 per month for CPAP devices; $703.16 to $1,184.12 for negative pressure wound therapy pumps; $36.73 to $66.62 for lightweight manual wheelchairs; and $205.41 to $438.56 for low-air loss mattresses.

VGM called the adjustments a step in the right direction, but pointed out they fall short of broader reform.

“VGM will continue to fight for CMS to implement sustainable rate methodologies and apply them to all non-bid areas, as well as high-level competitive bidding reforms to ensure that process are truly reflective of the market,” the company stated in a bulletin.

WASHINGTON – Two government agencies have widely differing estimates on a proposal to expand and reform Medicare’s competitive bidding program, according to Inside Health Policy.

The Congressional Budget Office estimates that the proposal, included in the president’s fiscal 2019 budget, would cost $1.3 billion over 10 years; The Department of Health and Human Services says it would save $6.5 billion over the same time period, according to the D.C. news service.

Under the proposal, CMS would expand the bid process to all areas of the country, including rural areas. The agency would also pay contract providers using their actual bid prices, not the median bid prices.

WASHINGTON – A huge variance in cost estimates for a proposal to expand the competitive bidding process to all areas of the country may be eye-catching, but industry stakeholders remain focused on the big picture.

The Congressional Budget Office estimates that the proposal, included in the president’s fiscal 2019 budget, would cost $1.3 billion over 10 years; The Department of Health and Human Services says it would save $6.5 billion over the same time period, according to an article in Inside Health Policy.

“This happens all the time,” said Jay Witter, senior vice president of public policy for AAHomecare. “The CBO is bound to Congress and the OMB is bound to the administration. They do it differently and they don’t communicate with each other.”

Under the proposal, CMS would expand the bid process to all non-bid areas, including rural areas. The agency would also pay contract providers using their actual bid prices, not the median bid prices.

The proposal, first announced in February, caught stakeholders off-guard, but they say, ultimately, they don’t think it has legs.

“At this point, we don’t believe there’s a huge appetite for it (among lawmakers),” said Cara Bachenheimer, chair of the newly formed Government Affairs Practice, Brown & Fortunato. “It’s our collective mission to make sure they maintain that lack of appetite.”

The industry’s strongest arguments against expanding the bidding process come from CMS’s own comments in the recently published interim final rule, where it acknowledged for the first time there are problems with the program.

“I think the IFR gave (us) tremendous credibility because lawmakers have been told for years and years that there are no problems and now finally the federal government has acknowledged the problems,” said Witter. “We’ll use the rest of the year to build on that.”

Stakeholders will continue to push H.R. 4229, a bill that would provide broader relief from the bid program. It picked up an additional four co-sponsors last week following the AAHomecare Washington Legislative Conference, for a total of 149.

“We still want to push H.R. 4229 and we need to have a Senate bill,” said John Gallagher, vice president of government relations for VGM. “There’s a realization that the can has been kicked down the road long enough and there needs to be a fix.”

WASHINGTON – CMS on May 25 published the adjusted reimbursement rates that will go into effect for seven months in rural areas.

The adjustments, called for in a recently released interim final rule, means reimbursement for oxygen concentrators, for example, will go from $77.16 to $121.46 per month from June 1 through Dec. 31 in rural areas.

Per the IFR, CMS is reverting to 50/50 blended reimbursement rates in rural areas, but not in all non-bid areas, as stakeholders had hoped.

Other examples include from $43.95 to $73.87 per month for CPAP devices; $703.16 to $1,184.12 for negative pressure wound therapy pumps; $36.73 to $66.62 for lightweight manual wheelchairs; and $205.41 to $438.56 for low-air loss mattresses.

VGM called the adjustments a step in the right direction, but pointed out they fall short of broader reform.

“VGM will continue to fight for CMS to implement sustainable rate methodologies and apply them to all non-bid areas, as well as high-level competitive bidding reforms to ensure that process are truly reflective of the market,” the company stated in a bulletin.

ResMed buys another software provider

SAN DIEGO – ResMed has entered into a definitive agreement to acquire privately held HEALTHCAREfirst, a provider of software solutions and services for home health and hospice agencies. HEALTHCAREfirst offers electronic health record software, billing and coding services, and advanced analytics that allow home health and hospice agencies to optimize their clinical, financial and administrative processes, ResMed says. “The home health and hospice segments are large and growing fast, due to the rising prevalence of chronic conditions and an aging population shifting to homecare and other lower-cost care settings,” said Raj Sodhi, president of ResMed’s SaaS business. “HEALTHCAREfirst’s solutions suite enables ResMed to help efficiently and effectively manage this growing population, benefiting patients, their families, agencies and payers.” HEALTHCAREfirst will complement the company’s existing software solutions offered by Brightree, a software provider for primarily the HME market, which it acquired in 2016.

CMS to implement O&P provisions

ALEXANDRIA, Va. – The American Orthotics & Prosthetics Association has received word that CMS has issued instructions to the DME MACs to immediately implement provisions that require the notes of orthotists and prosthetists to be recognized as part of the medical record. In early May, the MACs retired the “Dear Physician” letter for artificial limbs. The letter, originally published in 2011, dramatically changed the standards for approving a prosthetic claim, leading to higher denial rates. AOPA has been pressing CMS officials to implement the provisions, it said in a bulletin on its website.

Homecare Medical excels as small business

AUBURN, N.Y. – Homecare Medical Supply, Inc. has received a 20th Annual Small Business Excellence Award from the U.S. Small Business Administration for its “longevity, innovation, sales growth, increased employment, ability to overcome adversity or community contributions,” according to The Citizen and auburnpub.com. Homecare Medical Supply is a family owned business that offers home oxygen, CPAPs, nebulizers, hospital beds, wheelchairs, walkers, lift chairs urological supplies and orthopedic soft goods. Joseph and Joan Manning started the company in 1983 and their son Joe Manning purchased it in 1997 and now runs it with his wife Donna and their daughter Cynthia. Homecare Medical Supply received the award during a luncheon on May 2 during National Small Business Week.

Apria Healthcare salutes veterans

LAKE FOREST, Calif. – Apria Healthcare has launched Apria Salutes, a program that offers active duty military, veterans and other eligible family members an ongoing 25% discount and free shipping on qualifying purchases made on ApriaDirect.com, the company’s retail HME and supplies website. “We are proud to do our part to help the men and women who are actively serving or who have served our country by providing a convenient way to shop for over 7,000 health-related retail items, ranging from CPAP accessories to mobility devices,” said Dan Starck, CEO of Apria Healthcare. “These products help people improve their quality of life.” As part of the Blackstone Veterans Initiative, Apria, along with a portfolio of companies, has also adopted a goal to hire 50,000 veterans and spouses by 2022. This is in addition to the 50,000 veterans and spouses that were hired between 2013 to 2017 under the same initiative. Additionally, Apria belongs to the Department of Defense Military Spouse Employment Partnership, which works to connect military spouses with partner employers.

Growth was off for F&P Healthcare’s masks

IRVINE, Calif. – Fisher & Paykel Healthcare reported operating revenue grew 10% to a record NZD 980.8 million, or 9% in constant currency terms, for fiscal year 2018. Split up, that’s 13% constant currency growth in the company’s hospital product group and 4% growth in its homecare product group. F&P reported that its operating profit grew 12% to NZD 269.8 million and its net profit after tax few 12% to NZD 190.2 million in FY 2018 vs. 2017. In the homecare product group, OSA mask constant currency revenue growth was 5% for the first half of FY2018, and 2% for the second half. “This is lower growth than we have experienced over the last few years as competitors introduced new masks to market,” said Lewis Gradon, managing director and CEO. F&P says it plans to expand its range of masks later this year. OSA flow generator revenue declined 8% for the full year, but it saw 10% growth in constant currency terms for the second half of the year.

ADA: Improve insulin access, affordability

ARLINGTON, Va. – The American Diabetes Association on May 24 released a public policy statement outlining both long- and short-term recommendations for improving insulin access and affordability. The recommendations in “ADA Public Policy Statement: Insulin Access and Affordability” include increasing transparency across the entire insulin supply chain; streamlining the approval process for biosimilar insulins; lowering or removing patient cost-sharing for insulin; and increasing access to healthcare coverage for all people with diabetes. The statement follows a white paper, “Insulin Access and Affordability Working Group: Conclusions and Recommendations,” published on May 8 in Diabetes Care. The ADA’s Chief Scientific, Medical & Mission Officer William T. Cefalu, M.D., also testified that day before the U.S. Senate’s Special Committee on Aging to share the findings and conclusions in the white paper. A recent survey by the ADA confirmed that individuals who face high out-of-pocket costs for insulin are not adhering to their diabetes care plan by either rationing or forgoing insulin doses to reduce costs. The statement is the latest milestone in the ADA’s Make Insulin Affordable strategic initiative, which launched in November 2016 and includes a petition that has been signed by nearly 350,000 individuals.

Option Care nurses receive infusion certification

BANNOCKBURN, Ill. – Option Care, a provider of home and alternate treatment site infusion therapy services, recognizes 19 of its nurses for passing the Certified Registered Nurse Infusion (CRNI) examination this spring. The bi-annual exam, facilitated through the Infusion Nurses Certification Corporation, is the only accredited and nationally recognized certification for infusion nursing. Option Care says its newly certified clinicians make up nearly 20% of the total number of clinicians to receive the credential this March and will join an elite group of only 3,000 active certified clinicians worldwide. The exam tests the knowledge and expertise of nurses in eight core areas of infusion therapy practice: technology and clinical applications, fluid and electrolyte balance, pharmacology, infection prevention and control, special populations, transfusion therapy, antineoplastic/biologic therapy, and parenteral nutrition.

CQRC questions OIG findings

WASHINGTON – The Council on Quality Respiratory Care criticized a recent report from the Office of Inspector General, saying it underestimates the negative impact of the competitive bidding program on access for oxygen patients. The CQRC states that the “limitations in the report’s methodology signal significant flaws in the OIG’s conclusions.” It points out that the OIG, itself, acknowledges that continued Medicare payment “is not a direct measure of continued access to oxygen equipment and contents” and that “the response rate for our survey was too low to project the results to all beneficiaries for whom claims did not continue.” The CQRC in March released its own report citing lost or limited access due to the bid program. “It is past time for CMS to correct the competitive bidding methodology with a set of rules that ensures access to oxygen and home therapies for Medicare patients in need of respiratory care as well as adequate reimbursement to providers dedicated to the delivery of high quality home oxygen care,” said Dan Starck, chairman of the CQRC. 

NSM goes in-network with MedCost

NASHVILLE, Tenn. – National Seating & Mobility has a new provider agreement with MedCost, a Winston-Salem, N.C.-based benefit solutions company. As an in-network provider, NSM’s branches in North Carolina and South Carolina are authorized to provide rehab solutions to MedCost members with mobility challenges. NSM currently operates branches in Charlotte, Asheville, Valdese and Raleigh, N.C.; and Charleston, Greenville and Columbia, S.C. MedCost, jointly owned by Carolinas HealthCare System and Wake Forest Baptist Medical Center, helps employers lower their health plan costs and provider more affordable benefits for their employees, according to a press release. NSM also has provider agreements with Geisinger Health Plan and the Visiting Nurse Service of New York Choice Health Plans.

Lisa Wells launches Naturally Able

LAS VEGAS – There’s a new website for people with disabilities that aims to provide free resources and news to them lead healthier lives. Naturally Able, published and founded by Lisa Wells, also offers a free magazine vie email subscription signup and an online discussion group. “By offering these resources, Naturally Able is serving an existing need for more natural, healthy lifestyle options in the disability community,” said Wells, who is also the vice president of marketing at Cure Medical, a manufacturer of intermittent catheters and closed catheter systems. “We received more than 2,000 visitors in our first week of service online with no paid advertising and that speaks to the ongoing desire for more help in this area from our audience.” Some of the resources on the website include financial planning for parents and caregivers; Amazon Prime perks; ways to explore the great outdoors on wheels; the risk of sleep apnea for quadriplegics; and low-cost hacks for better home accessibility. Naturally Able also aims to financially support non-profits within the disability community by donating 10% of all net income received from advertising to local chapters of the United Spinal Association and the Spina Bifida Association. Wells is the founder of several social communities for wheelchair users, including Wheel:Life, which she sold to Comfort Medical in April 2016.

VGM, HME News join forces on benchmarking survey

WATERLOO, Iowa – The VGM Group and HME News have partnered to administer one HME Financial Benchmarking Survey, rather than two separate surveys. The two entities say the move will mean an increase in responses and more consistent data. “We’re excited to work with our friends at VGM on this project,” said Rick Rector, publisher of HME News. “We look forward to increased participation and can’t wait to dig into the data and share it with the respondents, as well as HME Business Summit attendees.” Businesses that complete and submit the online survey by July 13 are eligible to win a free registration to the Summit, scheduled for Sept. 16-18 in Savannah, Ga.

WASHINGTON – Part of the Medicare Trust Fund will run out of money three years earlier than expected, according to a new report from the Medicare Board of Trustees.

The report says Medicare’s Hospital Insurance Trust Fund will become insolvent in 2026 and will no longer be able to fully cover inpatient care.

The report also says the Supplementary Medical Insurance Trust Fund, which covers Medicare Parts B and D, is expected to be adequately financed in all years, because premium income and general revenue incomes are reset annually to cover expected costs. The fund had $88 billion in assets at the end of 2017. The report warns, however, that an aging population and rising healthcare costs are causing SMI projected costs to increase from 2.1% of the gross domestic product to 3.6% in 2037.

The report projects that total Medicare costs (including both HI and SMI expenditures) will grow from approximately 3.7% of GDP in 2017 to 5.8% of GDP by 2038, and then increase gradually thereafter to about 6.2% of GDP by 2092.

The report notes that CMS continues to enact policies to strengthen the Medicare program and lower costs for Medicare recipients. Those policies include creating a patient-driven healthcare system with greater price transparency and interoperability; and removing outdated regulations.

CMS is also increasing choice in Medicare Advantage programs, and is working to lower the cost of drugs for seniors.

WASHINGTON – CMS should take steps to mitigate program risks in managed care, according to a new report from the Government Accountability Office.

About 0.3% of the $171 billion that Medicaid paid managed care organizations for 2017 was improper, the GAO found.

CMS’s estimate of improper payments for managed care has limitations that are not mitigated by current oversight efforts, the GAO says. One component of the Payment Error Rate Measurement measures the accuracy of capitated payments made to MCOs. However, the managed care component of PERM doesn’t include medical review of services delivered to enrollees or reviews of MCO records or data.

Overpayments and unallowed costs that are not identified and removed from the cost data used to set capitation rates may allow inflated MCO payments and minimize the appearance of risks, the GAO says.

The GAO found 10 of the 27 federal and state audits and investigations conducted identified about $68 million in overpayments and unallowable MCO costs that were not accounted for by PERM estimates. Another investigation resulted in a $137.5 million settlement.

These audits and investigations were conducted over more than 5 years and involved a small fraction of the more than 270 MCOs operating nationwide as of September 2017, the GAO says.

TALLAHASSEE, Fla. – Fearing another Univita debacle, the Florida Alliance of Home Care Services has retained legal counsel to ensure that the state’s Medicaid managed care contracts are aboveboard.

In April, the Agency for Health Care Administration awarded contracts to 12 health plans in 11 regions, effective Jan. 1, 2019. Of concern to FAHCS and its members: Who will act as the third-party administrators, if any, for the health plans, and who will provide DME equipment and services?

“We want to work closely with the Agency for Health Care Administration to gain transparency on entities that are accepting contracts,” said Chris Townsend, FAHCS president. “Our concern is a monopoly could be formed.”

That’s what stakeholders say happened back in 2014, when Univita gained control of a huge share of the managed care market, contracting with 10 of 14 health plans to administer their HME programs, even though they were an HME provider themselves.

Univita’s model proved unsustainable. AHCA terminated the company’s contracts in July 2015 and the company filed for bankruptcy shortly thereafter.

“One thing that causes heartburn is we are seeing the trend of the different plans all beginning to use the same network manager,” said one provider. “With Univita, it was referring to itself. That really locked out the DME business for other providers.”

As the new contracts are implemented, FAHCS wants to make sure AHCA honors a requirement whereby health plans must identify all subcontractors, and those subcontractors must identify any further subcontractors, the association stated in a bulletin to its members.

“FAHCS is working on a formal inquiry to assure that the ‘non self referring subcontractor’ language survives in the contract,” it stated.

WASHINGTON – AAHomecare’s latest analysis shows a 33% decrease in the number of unique traditional DME suppliers since the beginning of competitive bidding and a 31% decrease in the number of traditional DME supplier locations.

The states with the biggest reductions in the number of unique traditional DME suppliers from November 2010 to January 2018 are Florida (52%), California (45%), Illinois (42%) and Texas (39%).

AAHomecare says its analysis doesn’t include big merchandisers like Walmart—only what it considers “traditional suppliers.” The association defines “traditional suppliers” as those that provide at least two of the following product categories: oxygen, CPAP, NPWT, RAD, hospital beds, wheelchairs and accessories, urological supplies, enteral supplies and ostomy supplies.

AAHomcare obtained the data for its analysis through a Freedom of Information Act request.

Previously, AAHomecare was conducting its analysis using a supplier directory on CMS’s website. Last year, however, after the association published its July 2017 analysis, it was notified of changes to the directory that resulted in “new numbers not corresponding to previous analysis.”

AAHomecare now plans to release an analysis each quarter, via a FOIA request.

Medicare’s finances get shakier

WASHINGTON – Part of the Medicare Trust Fund will run out of money three years earlier than expected, according to a new report from the Medicare Board of Trustees.

The report says Medicare’s Hospital Insurance Trust Fund will become insolvent in 2026 and will no longer be able to fully cover inpatient care.

The report also says the Supplementary Medical Insurance Trust Fund, which covers Medicare Parts B and D, is expected to be adequately financed in all years, because premium income and general revenue incomes are reset annually to cover expected costs. The fund had $88 billion in assets at the end of 2017. The report warns, however, that an aging population and rising healthcare costs are causing SMI projected costs to increase from 2.1% of the gross domestic product to 3.6% in 2037.

The report projects that total Medicare costs (including both HI and SMI expenditures) will grow from approximately 3.7% of GDP in 2017 to 5.8% of GDP by 2038, and then increase gradually thereafter to about 6.2% of GDP by 2092.

The report notes that CMS continues to enact policies to strengthen the Medicare program and lower costs for Medicare recipients. Those policies include creating a patient-driven healthcare system with greater price transparency and interoperability; and removing outdated regulations.

CMS is also increasing choice in Medicare Advantage programs, and is working to lower the cost of drugs for seniors.

GAO: MCOs need more oversight

WASHINGTON – CMS should take steps to mitigate program risks in managed care, according to a new report from the Government Accountability Office.

About 0.3% of the $171 billion that Medicaid paid managed care organizations for 2017 was improper, the GAO found.

CMS’s estimate of improper payments for managed care has limitations that are not mitigated by current oversight efforts, the GAO says. One component of the Payment Error Rate Measurement measures the accuracy of capitated payments made to MCOs. However, the managed care component of PERM doesn’t include medical review of services delivered to enrollees or reviews of MCO records or data.

Overpayments and unallowed costs that are not identified and removed from the cost data used to set capitation rates may allow inflated MCO payments and minimize the appearance of risks, the GAO says.

The GAO found 10 of the 27 federal and state audits and investigations conducted identified about $68 million in overpayments and unallowable MCO costs that were not accounted for by PERM estimates. Another investigation resulted in a $137.5 million settlement.

These audits and investigations were conducted over more than 5 years and involved a small fraction of the more than 270 MCOs operating nationwide as of September 2017, the GAO says.

Mobility movers: NSM makes pair of acquisitions, Numotion expands in Midwest

NASHVILLE, Tenn. – National Seating & Mobility has acquired the custom rehab division of The Medical Store in South Burlington, Vt., and its home access division, AccessNSM, has acquired Home Safe in Tampa, Fla.

The Medical Store’s custom rehab division broadens NSM’s footprint across the region, adding statewide coverage in Vermont and supplementing the reach of existing branches to extend services into New Hampshire.

“Expanding with new locations allows us to positively impact the lives of more individuals with mobility challenges,” said Bill Mixon, CEO. “We look forward to partnering with healthcare providers to serve clients in these communities.”

Four ATPs from The Medical Store will transition to NSM.

Chris Henry, the owner of The Medical Store, will continue to grow the company’s sleep therapy business, as well as its line of retail HME.

Home Safe, a national full-service home modification and accessibility provider, accelerates NSM’s growing position as a national provider in the market, according to a press release.

“This acquisition not only significantly expands our footprint, but also enhances our nationwide network of branches and mobility experts with the addition of a team of experience home accessibility experts,” Mixon said.

Home Safe’s co-founder Ward Farley will stay on board with NSM, continuing to lead the Tampa operation; and Ferenc Moricz, an ATP, will join NSM there to provide support through “a CRT lens to ensure a clinically holistic approach to accessibility within the home.”

Home Safe is a preferred provider for many third-party payers, including workers’ compensation administrators and Veterans Affairs facilities.

Numotion extends reach in Nebraska, Iowa

BRENTWOOD, Tenn. – Numotion has acquired the rehab division of Omaha, Neb.-based Midwest Respiratory & Rehab, extending its reach into Nebraska and Iowa.

“We are excited about expanding in Nebraska and Iowa,” said Mike Swinford, CEO, Numotion. “We are always looking for ways to better serve customers and provide them with innovative mobility solutions. Midwest’s reach, coupled with our product and service offerings, provides the disabled community with the best resources available in the market.”

Midwest’s rehab employees will be integrated into Numotion’s north central team. They will gain access to a larger product offering and support infrastructure to increase efficiency, according to a press release.

The acquisition does not include Midwest’s non-complex rehab product lines.

“We are pleased to continue to serve our vent and respiratory customers, as well as continue our services with hospice and nursing home equipment rental throughout the Midwest,” said Mick Hall, vice president, Midwest.

Reliable Respiratory buys Mount Auburn Hospital DME

NORWOOD, Mass. – Reliable Respiratory has acquired Mount Auburn Hospital DME in Cambridge, Mass., and will open a new facility there, it announced June 6. “We are honored that the folks at Mount Auburn have trusted us with their patients, and we are glad to welcome them, and their providers, into the Reliable family,” said Eric Mongeau, vice president of sales & marketing. “With the new facility, we will continue to provide the best sleep medicine products and top-notch service to our new members to ensure they receive the best care and adherence to therapy plans.” In addition to its headquarters in Norwood, Reliable Respiratory has locations in Springfield and Worcester, Mass.; Merrimack, N.H.; White River Junction, Vt.; and South Portland, Maine.

Solara Medical Supplies receives PE investment

CHULA VISTA, Calif. – Solara Medical Supplies has received an investment from Linden Capital Partners, a Chicago-based healthcare private equity firm. Solara is a direct-to-consumer provider of continuous glucose monitors, insulin pumps and other diabetes supplies. Ron Labrum, Linden operating partner, and Keith Crawford, Linden adviser, have been named chairman and CEO, respectively. “Solara founder Tod Robinson and his team have built an extraordinary business,” said Crawford, in a press release. “I look forward to working with Tod and carrying on the company’s strong employee culture and commitment to providing exceptional service to patients, manufacturers and payers.”

Bengt Thorsson named new CEO at Permobil

LEBANON, Tenn. – Bengt Thorsson will succeed Jon Sintron as CEO at Permobil, when Sintron steps down Aug. 31, after nine years at the helm. “Jon Sintorn has led Permobil during nine years of fast growth and transition,” said Martin Lundstedt, chairman of the board of directors, in a press release. “I am grateful for Jon’s valuable contribution and the outstanding progress Permobil has achieved during his time as CEO.”In the past decade, Permobil has grown from a niche player to a global leader in advanced rehab technology. Thorsson is currently president EMEA at Dometic and has held various positions at Scania.

Motivo receives funding

MILWAUKEE – Motivo has completed a $950,000 Series A round of financing, bringing the personal mobility device manufacturer’s total funding to $4.8 million, it announced in a press release today. The new round of funding will help the company further develop and scale its new in-house manufacturing capabilities, and support the national launch and advertising campaign for its 2018 Motivo Tour Walker. “This funding represents an important growth milestone for Motivo,” said Jeremy Knopow, Motivo co-founder. “With this Series A complete, our team has been able to scale up manufacturing with new equipment, hire new employees and has allowed us to solidify our go-to-market strategy for the national launch of the new 2018 Tour this summer.”

FDA clears Omnipod DASH

BILLERICA, Mass. – Insulet Corp. has received clearance from the U.S. Food and Drug Administration for its Omnipod DASH Insulin Management System. The Omnipod DASH features an easy-to-read, touch-screen PDM; user-friendly steps to manage basal rates; and a food library. Bluetooth technology allows for connectivity between the device and the Pod, as well as the Omnipod Display and View apps. It also allows users to monitor their data on their smart phones. “Omnipod DASH was inspired by Podders and embodies what users on multiple daily injections have been asking for in a diabetes management system,” said Patrick Sullivan, chairman and CEO. “Our No. 1 priority is to continue to minimize the daily strain on those impacted by diabetes and we are confident this system, and eliminating the system’s upfront cost, do just that.” The DASH is free with the purchase of Pods.

Bridge Connector gets startup funding

PALM BEACH GARDENS, Fla. – Bridge Connector, an integration platform as a service that delivers streamlined solutions for healthcare organizations, has received $4.5 million in startup funding, led by Axioma Ventures. The financing will be used to hire developers and bolster its support, sales and management teams. “We are excited to back Bridge Connector, which has created an innovative ‘industry-first’ for healthcare organizations to automatically transfer data between disparate systems," said Howard Jenkins, co-founding partner of Axioma Ventures and former CEO of Publix Super Markets, who has also joined Bridge Connector as chief strategy officer and a board member. "It's a great example of thinking outside the box and leveraging the value of existing healthcare systems, rather than being disruptive for the sake of it.”

Parachute Health attracts second round of funding

NEW YORK ­– Parachute Health has attracted $9.5 million in new funding to expand its e-prescribing platform into key markets across the United States. Parachute provides a seamless, all-digital solution for ordering home medical equipment and services after patients are discharged from hospitals. The new funding was led by Harley Miller and Dan Ahrens of Insight Venture Partners, and includes investment from GNYHA Ventures, the business arm of the Greater New York Hospital Association, and Anthony Welters, formerly of UnitedHealth Group. Parachute previously raised $5.5 million in funding from a group of investors that includes Loeb Holding Corp. Parachute is already being used by healthcare facilities across the country, including the Hospital for Special Surgery, Visiting Nurse Service of New York and Stanford Hospital.

ResMed: Bi-level therapy can save adherence

BALTIMORE – A ResMed-sponsored study shows that shifting patients who are struggling with adherence to a PAP device to a more advanced bi-level device in the first 90 days of treatment is an effective tool in more than half of cases. In the study, ResMed compared 1,496 non-compliant patients who switched to bi-level therapy and found that compliance was achieved by 58.5% of patients who switched before day 60, 54.2% of patients who switched between days 60-90, and 56.8% of patients overall. “Finding the right mode of therapy made all the difference to those patients who are struggling with initial adherence to therapy,” said ResMed Chief Medical Officer Carlos M. Nunez, M.D. “This strongly suggests that bilevel devices provide a powerful alternative therapy that physicians and HMEs can utilize to help improve non-compliant patients’ treatment experience and outcomes.” The study was presented this week at SLEEP, an annual joint meeting of the American Academy of Sleep Medicine and the Sleep Research Society. A bi-level device delivers two distinct pressures, one for inhalation and one for exhalation, and can be prescribed for patients who are pressure intolerant or have continued evidence of apnea at higher pressures.

Medtrade starts Smart Saver rates

ATLANTA – SmartSaver rates (formerly Early Bird rates) for this year’s Medtrade, Oct. 15-17, at the Georgia World Congress Center, go into effect June 11. SmartSaver rates last 18 days, ending June 29. Under SmartSaver rates, an Expo-only pass costs $25; and a conference pass, which includes full access to the Expo, costs $109. Click here to register.

Aeroflow donates to Nicaraguan mission

ASHEVILLE, N.C. – Aeroflow Healthcare has donated four pediatric nebulizers and 30 inhaler spacers to treat Nicaraguan children suffering from respiratory disorders like asthma or chronic bronchitis. The company made the donation after learning that Dr. Teresa Herbert of Park Ridge Hospital in Hendersonville, N.C., was joining her daughter on a mission in Nicaragua and needed respiratory equipment. "It is such a privilege to both work with and contribute to an organization with such a great cause," said Brice Rowland, a patient care coordinator at Aeroflow. "Dr. Herbert's passion for child care in such an impoverished area is very inspiring and humbling. It is an honor for Aeroflow to give back and be able to make a difference so far away from home."

Short takes: Brightree, Uni-flo2, Sunrise Medical

Atlanta-based Brightree has been ranked No. 71 in Healthcare Informatics Magazine’s listing of the Top 100 healthcare information technology companies for 2018. It’s the fifth consecutive year the company has appeared on the list. The Healthcare Informatics 100 is a compilation of the top HIT companies based on revenues from the most recent fiscal year…The Uni-flo2 single-nasal cannula system reports positive responses from a patient satisfaction survey, with 98% finding the system to be more comfortable, stable and secure. The Uni-flo2 ensures continuous oxygen flow equivalent to the low flow dual-pronged cannula but with half the skin contact…Fresno, Calif.-based Sunrise Medical supports the theme for this year’s World Environment Day: “Beat Plastic Pollution.” As an example of its support, the company noted that its U.K. operation has achieved zero waste to landfill, replaced their fleet of forklift trucks with ones that are 27% more energy efficient and introduced a formalized e-learning environment tool for employees.

State news: Connecticut Medicaid drops requirement

HARTFORD – HME providers will no longer have to retain the original signature on prescriptions and proof of delivery for Medicaid patients for claims on or after July 1, 2018, according to HOMES. “This is a huge win for our Connecticut members,” said Karyn Estrella, president and CEO of the association. “We’ve been fighting this for years. With the strain of continuing reimbursement cuts, our members need regulatory relief.” Gov. Dannel Malloy signed S.B. 243, “An Act Concerning Audits of Medical Assistance Providers,” into law on June 1. The lobbying group TCORS Capitol Group helped providers get the bill introduced and passed in the state legislature. Stakeholders were anticipating a bulletin from Connecticut Medicaid in the next few weeks.

WASHINGTON – AAHomecare’s latest analysis shows a 33% decrease in the number of unique traditional DME suppliers since the beginning of competitive bidding and a 31% decrease in the number of traditional DME supplier locations.

The states with the biggest reductions in the number of unique traditional DME suppliers from November 2010 to January 2018 are Florida (52%), California (45%), Illinois (42%) and Texas (39%).

AAHomecare says its analysis doesn’t include big merchandisers like Walmart—only what it considers “traditional suppliers.” The association defines “traditional suppliers” as those that provide at least two of the following product categories: oxygen, CPAP, NPWT, RAD, hospital beds, wheelchairs and accessories, urological supplies, enteral supplies and ostomy supplies.

AAHomcare obtained the data for its analysis through a Freedom of Information Act request.

Previously, AAHomecare was conducting its analysis using a supplier directory on CMS’s website. Last year, however, after the association published its July 2017 analysis, it was notified of changes to the directory that resulted in “new numbers not corresponding to previous analysis.”

AAHomecare now plans to release an analysis each quarter, via a FOIA request.

YARMOUTH, Maine – Fewer than half (36%) of providers say they keep a credit card on file for customers but that may be changing, say respondents to a recent HME Newspoll.

“A Plus Medical Equipment has not pursued credit cards on file in the past,” said Jerry Roberts in Cape Girardeau, Mo. “Given the number of patients with past due balances, this is under review.”

In fact, 60% of the total amount owed by patients is never collected, and 30% of all patients have a past due balance of 60 or more days, according to Brightree.

Many respondents cited security as their reason not keep the information on file.

“It’s for the customer’s safety that we do not keep them on file,” said Rachel Ward, AlternaCare Home Medical in Great Bend, Kan. “If a customer wants to call in a number over the phone, we will do a payment that way and then we shred that information.”

Others fear losing customers.

“We have actually had several patients transfer from other suppliers to us as a result of other suppliers implementing this policy,” said one poll respondent. “It’s one of the only things holding me back from trying to implement it myself.”

It’s a chance some are willing to take, says one respondent who has just begun requiring credit card information for all patients without secondary insurance coverage.

“It has really gone smoother than expected,” said Lori Valentine, of Memorial Medical Equipment in Springfield, Mo. “A handful of customers leave, but are not sure if they are changing providers yet.”

It’s important to have policies in place, she added.

“There is a release that is signed by the customer and kept on file,” she said. “The policy does include a service fee of $35 if their card is denied. Once they provide a new payment form, the fee is revoked.”

With some patient groups, requiring credit information is a necessity.

“I try to get them on CPAP clients,” said one respondent. “They’re the worst to pay the ongoing bills. You could take a rocket scientist and explain what the deductible is and they call with the first bill and ask why the insurance did not pay.”

No need to split hairs, says one provider.

“Policy: no card, no service,” said Woody O’Neal, in Birmingham, Ala.

WASHINGTON – CMS has agreed that states can process claims using the higher fee schedule amounts for claims in rural areas from June 1-Dec. 16, 2018, according to a bulletin from AAHomecare. Previously, the agency had said that any fee schedule adjustments would not impact 21st Century Cures Act reconciliation as they would be using the Jan. 1, 2018 rates. The agency also agreed that states that are not simply basing their rates on Medicare rates can present their utilization for reconciliation on area- of-service and for dates from Jan. 1 through May 31, 2018, and for June 1 through Dec. 31, 2018. CMS will then use the higher rates for the rural areas in the reconciliation process. “I am happy we were able to influence CMS to utilize the rates that offered relief to many rural areas," said Laura Williard, vice president of payer relations for AAHomecare.

CMS changes course on CGM policy

WASHINGTON – CMS will allow Medicare beneficiaries to use smart phone technology with their continuous glucose monitors, it announced.

The announcement reverses guidance issued in March 2017 in which the agency said beneficiaries could not use a non-DME device, such as a smart phone or tablet as the display device—in conflict with how many use their CGMs.

“CMS heard from numerous stakeholders who shared their concerns that Medicare’s CG coverage policy limited their use of CGMs in conjunction with their smartphones, preventing the from sharing data with family members, physicians and caregivers,” the agency stated in a bulletin.

CMS in January 2017 approved certain CGMs as durable medical equipment if they were approved by the Food and Drug Administration for use in place of a blood glucose monitor when making treatment decisions.

The DME MAC contractors will issue a revised policy article in the near future, at which tie the change will be effective.

Currently, only the Dexcom G5 and the Freestyle Libre are approved.

CMS overpaid for CPAP supplies, says OIG

WASHINGTON – Most Medicare claims for CPAP supplies did not comply with Medicare requirements, according to a new report from the Office of Inspector General. Out of 110 sample claims that Medicare paid in 2014 and 2015, 24 complied with Medicare requirements while 86 claims with payments totaling $13,414 did not. The OIG estimates CMS made overpayments of almost $631.2 million as a result. CMS’s oversight is insufficient to ensures Medicare suppliers meet requirements. Without period claim reviews, contractors were unable to identify suppliers that consistently billed claims that did not meet requirements. The OIG recommends that CMS recover the portion of the overpayments of $13,414 associated with the 86 sample claims that are within the four-year reopening period; and work more closely with the four Medicare contractors. CMS concurred.

ActivStyle boosts catheter biz

MINNEAPOLIS – ActivStyle has launched Catheter Express, a new catheter and urology brand within the ActivStyle portfolio, a move that will the provider to grow its catheter division, according to a press release. ActveStyle is primarily known as a direct-to-consumer provider of incontinence supplies. "Customers have a lot of choices for catheters and related urology supplies, but ActivStyle's years of experience in medical supplies, customer information systems, and distribution platform help set us apart from the competition,” said Gayle Devin, CEO. “We are uniquely positioned to provide superior, compassionate, and reliable service to the catheter customer.”

Brightree offers new integrated solution

ATLANTA – Brightree has launched eReferral Integration with athenahealth network, a provider of network-enabled services for hospitals and ambulatory clients. Now, any office can refer patients to HME providers the same way they refer to other healthcare settings. “With this new innovative solution, HME providers are integrated into the digital referral process that has been in place for other health providers for years,” said Nick Knowlton, Brightree vice president of business development. “By digitizing the process, we are greatly improving efficiencies for both physicians and HME providers while helping to improve the overall patient experience. We’re excited to bring this level of interoperability to the HME market and look forward to the positive impact it will have on the delivery of healthcare.”

NSM signs deal with Fallon Health

NASHVILLE – National Seating & Mobility has finalized an agreement with Worcester, Mass.-based Fallon Health to provide complex rehab solutions to its customers, it announced in a press release. NSM has branches in Franklin, Natick, Woburn and Chicopee, Mass. Fallon Health has 270,000 members. “We are committed to continue to reach more individuals in need of mobility solutions,” said Bill Mixon, NSM CEO. “As an approved Fallon Health CRT provider, we look forward to providing customized products and services to members who need them.” The provider has inked several other provider agreements, including in May, with MedCost, a Winston-Salem, N.C.-based benefit solutions company.

SleepScore labs launches app

CARLSBAD, Calif. – SleepScore Labs has released the SleepScore mobile app, a free app that can turn any smartphone into a standalone sleep tracker. The SleepScore app accesses a smartphone’s microphones and speakers to detect users’ sleep patterns. Each morning users receive a score of how they slept with a breakdown of what affected their sleep. The app also features a seven-day sleep history, goal setting, a smart alarm that can be set to wake the user at the ideal moment in their sleep cycle and personalized product recommendations. “Sleep affects all facets of people’s health, and yet there has been no easy way to accurately measure or track it everywhere we sleep—until now,” said Colin Lawlor, CEO of SleepScore Labs. “We’ve been developing this technology longer than the iPhone has existed. We’re excited that for the first time, virtually everyone can get a truer picture of their sleep health for free and make smarter decisions about how to get a more restful night’s sleep.” SleepScore Labs is a joint venture between ResMed, Dr. Mehmet Oz and Pegasus Capital Advisors.

Bonafide taps Zendesk for better solution

THOUSAND OAKS, Calif. – Bonafide Management Systems has completely integrated with Zendesk’s customer service cloud solution, it announced June 14. The integration will allow Bonafide to offers its customers fast response times and exemplary customer support, according to a press release. The solution also features extensive reporting capabilities and an integrated knowledge base. Bonafide’s “significant” customer growth in the past two years made the change necessary, said Wayne Bailey, director of customer service at Bonafide. “We needed a better solution, fast. Zendesk met all of our needs, and we were able to train our agents quickly.”

Rely Medical launches rewards program

MINNEAPOLIS – Rely Medical Supply has launched a new customer loyalty program. Customers are automatically enrolled when they create an account at www.relymedical.com. Customers earn one point for each dollar they spend; every 20 points earned is equal to $1 that can be used toward purchases in the store. "Online marketplaces are very competitive, and it is extremely costly to acquire new customers, that's why we want to reward our loyal customers at Rely Medical Supply,” said Devon Dougherty, marketing director. “Rewarding them for their loyalty and purchases is one small thing we can do to help increase their satisfaction with our shop and keep them coming back.”

Pride gets 10K ‘likes’

EXETER, Pa. – Pride Mobility Products’ Facebook page has reached 10,000 followers, the company announced today. The page focuses on both products, like launches, overviews and product news, and lifestyle, with posts featuring users living active lives. “Delivering a complete product experience online is important,” said Rhonda Perko, senior director of marketing. “We want consumers to know about the products, but we also want them inspired by stories of how actual consumers are living active lives with the products.” Approximately 80% of seniors and baby boomers are on the Internet.

HOMES honors VGM

WATERLOO, Iowa – VGM Group has received the 2018 Outstanding Volunteer Award from the Home Medical Equipment and Services Association of New England (HOMES). The award recognizes a person, company or associate member who promotes the interest of the HME industry. “The members of HOMES share the same passion for the HME industry that VGM has, and our collective knowledge and expertise allow us to work together to support common goals and interests, which allows them to do what they do best…service their patients,” said Margo Colarossi, regional account manager for VGM in a press release. The award was presented in May at the HOMES annual meeting in Portsmouth, N.H.   

WASHINGTON – MedPAC’s June 2018 report to Congress recommends that CMS include more DMEPOS products in the competitive bidding program as a way to improve Medicare’s payment policies and reduce fraud and abuse.

“The CBP has successfully driven down the cost of DMEPOS products for the Medicare program and beneficiaries,” the report states. “Compared with payment rates in the year before the CBP, Medicare’s payment rates for some of the highest expenditure products have fallen by an average of roughly 50%.”

At the same time, MedPAC says expenditures for products not included in the program have continued to grow, making them good candidates for competitive bidding.

“By 2015, nearly half of all Medicare expenditures on DMEPOS products were for products excluded from the CBP,” the report states. “Medicare’s payment rates for the top 10 non-CBP products in 2015 were one-third higher, on average, than private-payer rates for comparable products, and some non-CBP products continue to generate high rates of improper payments and utilization growth and to exhibit patters of potential fraud and abuse.”

MedPAC points out that CMS has the authority to include some additional products in the program, including chest wall oscillation devices, ventilators and off-the-shelf orthotics.

The commission even describes products that CMS is statutorily prohibited from including in the program, like parenteral nutrition, as “likely good candidates…because multiple suppliers furnish the products, and Medicare’s payment rates appear to be substantially higher than private-payer rates.”

In the case of parenteral nutrition, MedPAC found that Medicare’s payment rate for the highest expenditure parenteral nutrition product was 24% higher compared with private-payer rates in 2015.

MedPAC also points out that CMS’s authority to include some additional products in the program, like ostomy, tracheostomy and urological supplies, is “unclear” but worth pursuing.

WASHINGTON – The Department of Health and Human Services is asking for feedback on the physician self-referral law, known as the Stark Law.

In a request for information scheduled to be published in the Federal Register on June 25, HHS asks for feedback on “how to address any undue regulatory impact and burden of the physician self-referral law.”

The agency has made the request as part of efforts “to help accelerate the transformation to a value-based system that includes care coordination.” It says removing unnecessary government obstacles to care coordination is one of its key priorities.

“Through internal discussion and input from external stakeholders, CMS has identified some aspects of the physician self-referral law as a potential barrier to coordinated care,” the RFI reads.

Specifically, HHS is requesting information in 20 different areas, including “What, if any, additional exceptions to the physician self-referral law area necessity to protect financial arrangements between HHS entities and referring physicians who participate in the same alternative payment model”; and “Please share your thoughts on the role of transparency in the context of the physician self-referral law.”

HHS noted that the RFI is a request for information, not a request for proposal.

The agency will accept comments for 60 days after the date of publication of the RFI.