NEW YORK – The majority of HME providers are reducing or delaying orders for oxygen and CPAP equipment, but that is likely to be temporary, according to a new survey for the fourth quarter of 2018 from Needham & Company.

Sixty three percent of respondents said they would reduce or delay orders for oxygen equipment in response to an any willing provider provision set to go into effect Jan. 1 for Medicare, according to the survey of 150 providers.

Respondents said they would also reduce or delay orders for CPAP devices (55%); mobility equipment (43%); non-invasive ventilators (36%); and other equipment (19%).

Analysts expect, however, any disruption to be temporary and only last one or two quarters.

“Since we expect patient volumes to remain steady, we believe that HMEs will ultimately have to reorder more equipment to catch up with demand in future periods,” according to Needham.

Other findings from the survey related to POCs:

·     Providers expect to see double-digit growth for POCs over the next twelve months, increasing from 22.3% of the ambulatory oxygen market to 30.4% during that time frame.

·     Applied Home Healthcare’s OxyGo was the highest-rated POC at 5.8 out of 7, followed by Applied Home Healthcare’s OxyGo Fit and Inogen’s G3, both at 5.4.

·     The two main factors limiting the use of POCs are the initial upfront investment and reliability.

·     Poll respondents believe that an average of 44% of their ambulatory oxygen patients are candidates for POCs, but Needham expects this increase as providers gain experience with POCs.

YARMOUTH, Maine – Despite the large number of unknowns for the year ahead, the majority of respondents to a recent HME Newspoll say they’re forging ahead with plans to grow their businesses.

Expanding their footprint topped the list of priorities for 2019 for 26% of respondents.

“We are going to be adding product lines and getting into new areas,” wrote one respondent.

Others say they’ll grow by delving further into other payer markets.

“Our main goal continues to be to increase hospice, retail and facility business to gain a larger share of our local market,” wrote one respondent. “Our territory continues to expand simply because patients can’t find suppliers closer to them.”

A number of respondents (17%) said they plan to ramp up marketing and social media to keep up with shifting trends in buying.

“Such platforms will influence 80% of buying decisions,” wrote one respondent.

Another 17% of respondents said they plan to increase their use of technology as a way to better serve their customers.

“Every need varies by patient and being able to fine tune offerings to meet their expectations in a meaningful way will bring greater satisfaction and deliver the intended results,” wrote John Specht, president of Specht & Associates in Ohio. “Staying current in trends and equipment will keep me on track.”

With reimbursement so low, 19% of respondents said they will prioritize reducing expenses.

“The only way to maximize profit is to control the things we can control,” wrote Jason Jones, president of Jones Medical Supply in Alabama. “We can’t do anything about reimbursement, so fix what we can.”

For some, reducing expenses means taking a hard line against unprofitable business.

“Getting more business is the easy part,” wrote one respondent. “Dealing with low reimbursement is the problem. We are starting to say no to more funding agencies.”

Another 17% said their top priority was selling their businesses.

WASHINGTON – Reimbursement rates for stationary and portable oxygen concentrators fare quite differently in the 2019 fee schedule, according to an analysis by AAHomecare.
The rural rate for stationary concentrators (E1390) will increase 10.9%, from $121.46 to $134.71, and the average regional rate will increase 4.4% from $69.31 to $72.32.
The rural rate for POCs (E1392) will decrease 5.2% from $46.77 to $44.32, and the average regional rate will decrease 6.5%, from $38.10 to $35.64.
Rates for portable gaseous contents (E0431) and portable gaseous 02 system (K0738) will also see decreases ranging from 3.8% to 6.5%, according to AAHomecare.
“These additional cuts for home oxygen therapy are certain to impact providers and patients in rural and other non-CBA areas,” stated AAHomecare in a bulletin. “Since CMS has repeatedly made it clear that they do not believe they have the statutory authority to address the budget neutrality offset, the HME community needs to make this a priority for advocacy efforts in the 116th Congress.”
A competitive-bidding related final rule released in November creates a new class for portable liquid oxygen equipment by splitting the existing class of portable gas and portable liquid oxygen, and changes the way budget neutrality is calculated by applying the offset to all oxygen and oxygen equipment classes beginning Jan. 1.
CMS’s 2019 fee schedule, released last week, provides a 2.5% increased to single payment amounts in former competitive bidding areas; a 2.5% increase to SPAs for diabetes supplies as part of the mail-order program; and a 2.3% increase for all other DME.

Brightree buys mobile delivery platform
ATLANTA – Brightree has acquired Apacheta, with an eye toward further innovating the company’s mobile delivery and cloud-based software platform, and increasing adoption among provider customers.
Brightree’s and Apacheta’s platforms have been integrated since 2015.
“Apacheta solves many of the business challenges HMEs face in managing deliveries, particularly eliminating missing, lost or incomplete delivery information,” said Matt Mellott, CEO of Brightree. “It has already helped Brightree customers save significant time and money, and we look forward to investing in its continued innovation and scalability.”
Apacheta and its Media, Pa.-based employees, including CEO Gregg Timmons, will join Brightree.
Apacheta is Brightree’s third acquisition in the past 18 months, following Conduit Technology and AllCall Connect.
ResMed, which owns Brightree, will continue to evaluate where else the company’s offerings could be integrated within its larger software-as-a-service ecosystem.
“Adding a reliable market-tested mobile delivery platform to ResMed’s SaaS portfolio helps our customers work more seamlessly and provide a better experience for their patients,” said Raj Sodhi, SaaS president for ResMed. “In addition to driving further innovation of this platform, we will explore bringing this solution to other care settings and platforms that would benefit by having a delivery solution.
ResMed has also acquired a number of companies recently—two in as many months: MatrixCare in November, and Propeller Health in December.
Terms of the Apacheta deal were not disclosed.

Providers hold off on ordering—for now
NEW YORK – The majority of HME providers are reducing or delaying orders for oxygen and CPAP equipment, but that is likely to be temporary, according to a new survey for the fourth quarter of 2018 from Needham & Company.
Sixty three percent of respondents said they would reduce or delay orders for oxygen equipment in response to an any willing provider provision set to go into effect Jan. 1 for Medicare, according to the survey of 150 providers.
Respondents said they would also reduce or delay orders for CPAP devices (55%); mobility equipment (43%); non-invasive ventilators (36%); and other equipment (19%).
Analysts expect, however, any disruption to be temporary and only last one or two quarters.
“Since we expect patient volumes to remain steady, we believe that HMEs will ultimately have to reorder more equipment to catch up with demand in future periods,” according to Needham.
Other findings from the survey related to POCs:
•    Providers expect to see double-digit growth for POCs over the next twelve months, increasing from 22.3% of the ambulatory oxygen market to 30.4% during that time frame.
•    Applied Home Healthcare’s OxyGo was the highest-rated POC at 5.8 out of 7, followed by Applied Home Healthcare’s OxyGo Fit and Inogen’s G3, both at 5.4.
•    The two main factors limiting the use of POCs are the initial upfront investment and reliability.
•    Poll respondents believe that an average of 44% of their ambulatory oxygen patients are candidates for POCs, but Needham expects this increase as providers gain experience with POCs.

PHS poised to go national
SAINT PAUL, Minn. – Pediatric Home Service has partnered with InTandem Capital Partners, a healthcare services-focused private equity firm, to expand its existing service lines. PHS offers a variety of services to pediatric patients throughout Minnesota and Wisconsin. “We selected InTandem as our investment partner because of their deep understanding of the healthcare services industry and their proven track record implementing successful growth strategies,” said CEO Mark Hamman. “As we work to establish PHS as a national leader in the pediatric home care industry, we are excited to leverage InTandem’s team of healthcare experts to assist us with accelerating our growth. ” InTandem believes PHS is “well positioned” for future growth. “We are eager to work with Mark and the entire leadership team to help take the business from a regional provider to a national leader,” said Micah Meisel, managing director.

KCI, Highmark forge performance-based deal
SAN ANTONIO – KCI, a provider of advanced wound management, and Highmark, an insurer, have entered into an agreement for the KCI iOn Progress Remote Therapy Monitoring Program. Used in conjunction with the Activ.A.C. Therapy System, the program provides monitoring, engagement and adherence, according to a press release. The agreement is the first of its kind for negative pressure wound therapy and creates a performance-based payment structure to reduce total wound care costs, according to a press release. “Our aim is to create value across the continuum of wound care and iOn Progress Remote Therapy Monitoring allows us to pursue that by better understanding each patient’s wound care journey,” said R. Andrew Eckert, president and CEO of KCI. “This unique insight allows us to engage patients and their caregivers like no other and better assist them through the healing process, which leads to better therapy adherence and ultimately, better outcomes and reduced costs.”

Inogen launches connected platform
GOLETA, Calif. – Inogen has launched Inogen Connect, a wireless connectivity platform for its Inogen One G4 through its direct-to-consumer channel. The platform is compatible with both Apple and Android, and includes patient features like oxygen purity status, battery run time, product support functions and notification alerts, according to a press release. A back-end database portal offers remote troubleshooting, equipment health checks and a location tracker to lower a provider’s total cost of serving oxygen therapy patients. Inogen expects to launch Inogen Connect in the domestic business-to-business channel in the first quarter of 2019.

WellSky acquires ‘entry point’ into new markets
LENEXA, Kan. – WellSky has acquired Consolo Services Group, a provider of fully integrated, web-based IT solutions for the hospice and palliative care industries. The deal offers WellSky, formerly Mediware, an entry point into the palliative, adult day care and memory care markets. “By combining our expertise in hospice software and services, WellSky Hospice and Consolo will enhance the experiences for our customers across both companies,” said Bill Miller, CEO of WellSky in a press release. The acquisition is the fifth this year for the TPG Capital-backed WellSky. Other buys include Rock-Pond Solutions and BlueStrata EHR, both in August.

Protech makes pair of buys
CINCINNATI – Protech Home Medical has acquired Riverside Medical and Central Oxygen, it announced Dec. 17. Riverside Medical, which focuses on home respiratory services in Tennessee and northern Mississippi, is Protech’s first entry into Tennessee. Central Oxygen, which also focuses on home respiratory, is located in Indiana. “I am pleased to continue to deliver on the strategy that we have articulated to the market place of rolling in strategic and well-priced assets when they make sense for the company,” said Greg Crawford, chairman and CEO of Protech, in a press release. Under the terms of the definitive purchase agreements, Protech acquired Riverside Medical and Central Oxygen for total consideration of about $871,000, which includes assumed debt and about 1.1 million common shares issued at a deemed price of $0.14 per share. The securities issued are subject to a four-month hold period.

Gaffney assumes vice president duties
ATLANTA – Medtrade Group Show Director Kevin Gaffney’s role will expand to include vice president duties. Gaffney has planned and executed more than 35 trade shows in a career spanning 25 years. In addition to Medtrade and Medtrade Spring, he is also group show director for four other shows: Environments for Aging; Construction SuperConference; HealthCare Design; and Hospitality Design. “People thought the Internet would kill trade shows, but it’s really made them more important than ever,” says Gaffney. “Social media and technology offer great ways to connect with people remotely and virtually, but people do business with people they know and like. You really can’t get to know somebody unless you spend time with that person, preferably in person.”

3B has new HQ
WINTER HAVEN, Fla. – 3B Medical has moved into a new corporate headquarters. The company, which experienced triple-digit growth in 2018, needed more space to hire more staff. “We selected Winter Haven as our corporate home because it is only 45 minutes outside of Orlando, easily accessible to both Tampa and Orlando, but still retains a slightly rural and small town flavor, which our employees love,” said Alex Lucio, CEO. “We are looking forward to another year of triple-digit growth in 2019.” The move coincides with several new products releases, and the expansion of 3B Medical’s global sales efforts into Canada, Australia and Europe.

VGM publishes tech playbook
WATERLOO, Iowa – VGM Group has released its latest playbook: “Technology Snapshots: Innovative Solutions for the Future.” This fourth edition of the playbook is a guide to helping providers and vendors understand both the threats and opportunities that make up the business technology ecosystem, the company says. “Technology is at the top of VGM’s list of priorities to help our membership community evolve and protect their business for the future,” said Clint Geffert, president of VGM & Associates. “From compliance to workflow to cybersecurity to the Internet of Things, this playbook was developed specifically to help businesses understand how technology can and should play a significant role in 2019 and beyond.” VGM called on in-house thought leaders and its vast network of experts in the technology space to build the content for the 26-page playbook. Seven of the articles in the playbook were written by the company’s vendor partners. The playbook is free to VGM members and vendor partners.

Graham-Field celebrates $10M facility
ATLANTA – GF Health Products joined 150 guests and state dignitaries in December to celebrate the grand opening of its new global headquarters at One Graham-Field Way in Atlanta. The 7.45-acre facility, which stretches across two counties in the Atlanta metro area, unites the company’s corporate headquarters, customer showroom and regional distribution center. It also serves as the company’s manufacturing hub for therapeutic support surface and specialty seating products. “With the 10-month construction process complete, the new space cements Graham-Field’s position as a prominent design, engineering and domestic medical equipment manufacturing facility,” said Ken Spett, president and CEO. The company invested $10 million in the new facility, which joins other facilities in Wisconsin, North Carolina, Missouri, Rhode Island and California.

Soleo opens location in Birmingham
MCKINNEY, Texas – Soleo Health has opened a specialty infusion pharmacy in Birmingham, Ala., expanding the company’s footprint to 19 locations nationwide, with licensure in all 50 states. The 4,000-square-foot location features a sterile pharmacy complex equipped with state-of-the-art compounding capabilities. It offers patients the flexibility of receiving their care in their homes or on-site in one of three ambulatory infusion suites. “We selected this area as a complement to our Mobile, Ala., location and (due to) the market demand for high quality specialty infusion services,” said Drew Walk, CEO. “From this location, we are reaching patients in Birmingham and extending service to the surrounding areas.”

PlayMaker, WellSky integrate
NASHVILLE, Tenn. – A new partnership between PlayMaker Health and WellSky combines EHR and business development data with market data and customer relationship management tools. “As we’ve worked with providers over the past 10 years, we know providers need a fully integrated growth solution that offers visibility across their market, their referral sources and their sales team, all in one place,” said John Griscavage, CEO of PlayMaker. “Our partnership with WellSky allows us to continue delivering on that promise.” In October, PlayMaker integrated with Brightree.

VMI buys Revability
PHOENIX – Vantage Mobility International, a manufacturer of wheelchair accessible vehicles, has signed a definitive agreement to acquire Revability, a division of REV Group. Revability designs and manufacturers wheelchair accessible vehicles for commercial and personal use, giving VMI a more diversified product line. “This is an important move as our organization continues to take steps to satisfy the needs of our retail and commercial customers,” said Mark Shaughnessy, CEO of VMI. The Revability deal follows VMI’s acquisition of AMS Vans, a company that provides economy priced wheelchair accessible van conversions for consumers, in October 2017. VMI will continue to operate Revability’s manufacturing plant in Clarkston, Mich., under the Revability name and will transition the remaining manufacturing to its plant in Phoenix.

Short takes: RESNA
Mary Ellen Buning, president of RESNA’s board of directors, joined a range of experts in London to serve as a judge for Toyota Mobility Foundation’s “Mobility Unlimited Challenge.” The $4 million challenge seeks to support “radical improvements in the mobility and independence of people with lower-limb paralysis through smarter assistive technology.” Five finalists will be announced in January with each receiving a $500,000 development grant. One winning team will be announced in September 2020, receiving a $1 million prize…RESNA has updated its procedures for the development and approval of position papers. “We hope this update encourages experts in the rehabilitation engineering and assistive technology field to submit a paper,” the organization says. Read about the procedures here.

 

NASHVILLE, Tenn. – National Seating & Mobility’s presence now extends into Canada. The complex rehab provider announced Jan. 3 that it has bought SelfCare Home Health Products in Vancouver, British Columbia, its first acquisition outside of the United States. “Investing in locations outside the U.S. not only allows us to reach more clients, but also fuels continued progress in the CRT industry, both here in the U.S. and worldwide,” said Bill Mixon, NSM CEO. SelfCare is a multi-site mobility equipment and home accessibility services provider serving the Lower Mainland of British Columbia. Darryl and Kim Mackie, who have owned SelfCare since its inception in 1993, will remain with the company in a leadership capacity. The company has 60 employees in four locations, with a fifth location planned for this year.

Pacific Medical target of audit for braces

TRACY, Calif. – Pacific Medical did not always comply with Medicare requirements when billing for selected orthotic braces, according to an audit by the Office of Inspector General. For 89 of the 100 sampled claims, the company complied with requirements, but for the remaining 11 claims, it did not. Specifically, Pacific Medical billed for orthotic braces that were not medically necessary for nine claims and could not provide medical records for two claims, the OIG says. “The deficiencies occurred because the company did not always obtain sufficient information from the medical records of beneficiaries to assure itself that the claims for orthotic braces met Medicare requirements,” the audit reads. On the basis of sample results, the OIG estimates that Pacific Medical received at least $247,483 in unallowable payments. The agency recommends that Pacific Medical refund the DME MACs $247,493; exercise reasonable diligence to identify and return any additional similar overpayments outside of the audit period, in accordance with the 60-day rule, and identify any returned overpayments as having been made in accordance with this recommendation; and obtain as much information from medical records as necessary to assure itself that claims meet requirements. Pacific Medical did not concur with the first recommendation, but concurred with the second and third recommendations.

Aeroflow closes out big year

ASHEVILLE, N.C. – Aeroflow Healthcare says it has exceeded its goals for 2018 in sales, employee satisfaction and patient care. The launch of the Aeroflow Urology website and the Aeroflow Breastpumps Lactation Support Directory contributed to a 30% growth in revenue. Employee satisfaction increased 10%, while productivity increased 20%, according to a press release. “Aeroflow has surpassed expectations in reaching new levels of success with expansive growth and optimized patient care, all fueled by a fierce commitment to our patients and colleagues,” said Casey Hite, Aeroflow CEO and co-founder. “By investing in our team to inspire and grow talent, we’ve cultivated major ideas that have established us as a leader in health care throughout North Carolina and the rest of the country.”

Solera adds GemCare to network

PHOENIX – Solera Health has added Ohio-based GemCare Wellness to its national network of diabetes providers. Solera’s network is comprised of providers recognized by the Centers for Disease Control and Prevention as diabetes prevention program (DPP) providers. GemCare offers a personalized program focused on diet adjustments, increased physical activity and stress management. Since starting its program, most participants lost weight and 30% were no longer considered to have pre-diabetes at its conclusion, according to a press release. "One-third of adults in the U.S. have pre-diabetes, and some do not even know it," said James Piper, vice president and general manager at GemCare Wellness. "Solera shares our passion to make a difference in preventing diabetes, and through their connections with employers and health plans, we can broaden our outreach and meet patients that will realize real benefits from our program."

Contract switches to Palmetto GBA

COLUMBIA, S.C. – Palmetto GBA is taking over as the Pricing, Data Analysis and Coding (PDAC) contractor this month. The PDAC receives, evaluates and processes coding verification applications for DMEPOS; establishes, maintains and updates all coding verification decisions on the product classification list; provides coding guidance for manufacturers and suppliers on the proper use of HCPCS; maintains and publishes the NDC/HCPCS crosswalk and OACD pricing files; and conducts DMEPOS data analysis. Noridian Healthcare Solutions has held the PDAC contract since 2008. Palmetto GBA is also the National Supplier Clearinghouse and Competitive Bidding Implementation Contractor.

NHIA pushes for clarifications

WASHINGTON – The National Home Infusion Association has submitted comments to CMS asking the agency to issue sub-regulatory guidance that clarifies that home infusion services are reimbursed on any day a patient receives a professional service. The NHIA also asks the agency to establish a billing mechanism that distinguishes between professional services provided in the home by a nurse, and remote pharmacy services. “These changes would allow home infusion and homecare providers to collaborate to service patients with a homecare episode without interfering with the provision of either benefit, provide CMS with the data necessary to construct a permanent payment rate that reflects the complexity and duration of services necessary to deliver home infusion therapy, incentivize the delivery of safe, effective and high-quality care and inform future policy discussions as new and emerging medications become available,” the association states. The NHIA submitted comments in response to a final rule that CMS published in November detailing its plans to create a new home infusion therapy benefit and create a transitional payment for services.

InfuSystem’s board gets new leader

MADISON HEIGHTS, Mich. – InfuSystem Holdings has selected Scott Shuda as chairman of its board of directors. Shuda has been a member of the board since September 2015. He succeeds Gregg Lehman, PhD., who served as chairman since May 2015 and who will continue to serve on the board as vice chairman. Shuda, 53, is managing director of Meridian OHC Partners, a private equity firm that invests in small public companies, primarily in the healthcare and information technology sectors. In that capacity, he often serves as a member of the boards of directors of portfolio companies.

WASHINGTON – CMS on Dec. 31 implemented the “TPE 10-Claim Preview Pilot” to help reduce the burden for compliant DME providers, AAHomecare reports.

Per the pilot, the MACs may select 10 claims for review under Round 1, and if a provider is found to be compliant for a service/item, the NPI associated with those 10 claims will be exempt from reviews for about one year for that service/item. If errors are detected, a provider will go through the usual TPE process.

AAHomecare says information on the pilot will be available on CMS’s website soon.

In addition, CMS has also published a new transmittal instructing the MACs to review only services/items with dates of service after one-on-one education for Rounds 2/3, whereas they can review dates of service or dates of submission for Round 1. The MACs must allow 45-56 days between each education intervention to give suppliers time to improve.

The change applies to any new edits for Round 2/3 put in place after the Nov. 28 transmittal.

WASHINGTON – The number of DMEPOS suppliers furnishing rate-adjusted items in non-bid areas decreased 11% in 2017, according to a new study from the Government Accountability Office.

That decrease follows an 8% decrease in 2016—the first year rates were adjusted—compared to 2015 and continued a trend of annual decreases in non-bid areas that averaged 8% each year going back to at least 2011, according to the report, “Medicare Fee-For-Service: Information on the Second Year of Nationwide Reduced Payment Rates for Durable Medical Equipment,” released Dec. 21.

The number of beneficiaries receiving at least one rate-adjusted item in non-bid areas in 2017 decreased 2 percent compared to 2016. This followed a decrease of less than half of 1 percent between 2015 and 2016.

Since 2010, the number of suppliers furnishing rate-adjusted items has decreased by almost 45% and suppliers furnishing non-adjusted items decreased by almost 25%. 

The GAO’s findings are in line with AAHomecare’s supplier analysis, which shows an estimated decrease of 35% in suppliers between 2010 and 2018.

WASHINGTON – Industry stakeholders are focusing on CMS as they seek their footing in a bumpy start to the 116th Congress.

With Congress embroiled in shutdown negotiations, stakeholders continue to work with CMS to help shape the next round of competitive bidding, including the product categories.

“Discrete product categories and making sure like products are grouped together is really important,” said Cara Bachenheimer, chair of the government affairs practice at Brown & Fortunato, who, along with representatives from AAHomecare, met with CMS last week. “And then we’ve got all the other issues with the bidding program, like capacity, bona fide bids, licensure. We are putting together recommendations.”

As to when CMS will start releasing information on the next round of bidding, it’s anybody’s guess, but Bachenheimer anticipates it will be sooner rather than later.

“We are guessing within the next month or two, we will start to see CMS’s initial announcements about schedules of when things will be happening,” she said. “CMS had indicated they are committed to education, because this is such a different bidding process.”

With the government shutdown heading into a fourth week, there’s not a lot getting done in Congress, so stakeholders say it’s too soon to predict when any new HME-related legislation, including a new version of H.R. 4229, could get introduced. That bill, which would have delayed a second round of reimbursement cuts, garnered 158 co-sponsors.

“We’ve got our work cut out for us identifying what are the priorities and who are the champions that will carry the torch for us,” said John Gallagher, vice president of government relations for VGM.

In addition to the chaos of the shutdown, there are many new faces on Capitol Hill. Many committee assignments haven’t been identified yet, and newly elected lawmakers are still staffing their offices.

“That’s a big deal—that’s where we make a lot of our progress,” said Gordon Barnes, director of communications for AAHomecare. “A lot of things are still in flux with staffers and new people. It’s a challenge for everybody.”

WASHINGTON – CMS has updated its “Targeted Probe and Educate” program in two ways that could potentially make it easier and more fair for HME providers.

The agency on Dec. 31 implemented the “TPE 10-Claim Preview Pilot” to allow the MACs to select just 10 claims for review under Round 1. If a provider is found to be compliant, the NPI associated with those claims will be exempt from reviews for about one year for those services/items.

“In some ways it’s good,” said Kelly Grahovac, a senior consultant with the van Halem Group. “If you have everything that you need, it’s less of a burden, because you only have to respond to 10 files instead of 40 files.”

If the MACs detect errors during the pilot, a provider just goes through the usual TPE program.

But the pilot may put HME providers, whose documentation can sometimes be “subjective,” at a disadvantage, Grahovac says.

“Where I can see a problem is if you have one issue with your process, it affects every claim,” she said, “and it’s a smaller sample from which they’ll determine your compliance rate.”

CMS has also published a new transmittal instructing the MACs to review only services/items with dates of service after one-on-one education for Rounds 2/3 of the TPE program, whereas they can review dates of service or dates of submission for Round 1. The MACs must allow 45-56 days between each education intervention to give providers time to make improvements.

“The intent of the TPE is, targeting an issue, doing an audit or probe, then educating,” Grahovac said. “They need to give you time to fix it, then they can come back and see if you fixed it.”

Industry stakeholders had noted inconsistency across contractors and even reviewers on when an audit was “turned back on,” Grahovac says.

“I think enough folks said, ‘This doesn’t make sense, it needs to be date of service, not date of submission,’” she said.

Grahovac says she’s not surprised by the changes, as CMS considers the TPE program a work in progress. She expects more to come.

“I’d like them to be more consistent on product categories,” she said. “A supplier may get audited on a CPAP and pass, then get an audit for masks and pass, and then get an audit for another supply item. If you’re taking the time to review the main equipment and that documentation looks good, the likelihood is that it’s good for the supplies, too. It’s a bit beating a dead horse.”

WASHINGTON – The number of DMEPOS suppliers furnishing rate-adjusted items in non-bid areas decreased 11% in 2017, according to a new study from the Government Accountability Office.

That decrease follows an 8% decrease in 2016—the first year rates were adjusted—compared to 2015 and continued a trend of annual decreases in non-bid areas that averaged 8% each year going back to at least 2011, according to the report, “Medicare Fee-For-Service: Information on the Second Year of Nationwide Reduced Payment Rates for Durable Medical Equipment,” released Dec. 21.

The number of beneficiaries receiving at least one rate-adjusted item in non-bid areas in 2017 decreased 2 percent compared to 2016. This followed a decrease of less than half of 1 percent between 2015 and 2016.

Since 2010, the number of suppliers furnishing rate-adjusted items has decreased by almost 45% and suppliers furnishing non-adjusted items decreased by almost 25%. 

The GAO’s findings are in line with AAHomecare’s supplier analysis, which shows an estimated decrease of 35% in suppliers between 2010 and 2018.

Survey: Information on cost of sleep therapy needed

DARIEN, Ill. – Patients need better access to affordable sleep care, according to a new study from the American Alliance for Healthy Sleep.

Seventy eight percent of respondents reported that cost affects their decision to seek medical care; and 54% reported they were unaware of whether their insurance covered sleep services.

At the same time, 48% percent of respondents reported that their primary care physician never asked them about sleep.

“Millions of people in the U.S. have a sleep disorder that impairs their health, well-being, safety and performance,” said AAHS Chair Patti Van Landingham. “It is critical for people who have a sleep disorder to receive accurate health information, and they need convenient access to affordable, patient-centered medical care from knowledgeable health care professionals who understand the importance of healthy sleep.”

The survey included responses from 289 participants. Sixty-six percent were female; 43% indicated they have a diagnosed sleep disorder; and 17% of those with a sleep disorder reported being unable to afford medication or therapy.

Other findings from the survey: 75% of respondents said they have actively searched for sleep health information, but 59% reported that additional resources are needed, including more educational resources on sleep and improved education for medical professionals.

AAHS conducted the survey as part of its “Access to Information…Access to Care” awareness campaign, which seeks to establish how the organization can improve access to care.

An executive summary of the survey findings is available at www.sleepallies.org

Kansas proposes Medicaid rate cut

TOPEKA, Kan. – The Kansas Department of Health and Environment said in December it planned to submit an amendment to set the Medicaid fee schedule for DMEPOS items at 65% of the non-rural Medicare rates, effective Jan. 1. MAMES is working to set up a meeting with CMS to discuss the proposal, according to a bulletin. MAMES says that a legislative and regulatory approach may be needed to stop the cut from being implemented. Comments on the proposal are due Jan. 22.

CMS clarifies guidance on dual-eligibles

WASHINGTON – CMS has released updated guidance for state Medicaid programs on Medicare coverage for dual-eligible beneficiaries, clarifying that states do not need to require a Medicare denial for DMEPOS like incontinence supplies that the program routinely denies as non-covered, AAHomecare reports. The guidance also suggests that states consider creating a list of DMEPOS that are not covered by Medicare to expedite Medicaid coverage and payment for dual-eligibles. By doing so, states can avoid requiring providers to obtain a Medicare denial while still fulfilling their statutory requirement remaining the “payer of last resort.” Additionally, CMS suggests that states that develop such a list should also encourage their Medicaid managed care organizations to adopt the same list. “AAHomecare has been regularly engaging CMS over the last 18 months to help streamline the process for determining coverage for this patient population,” the association stated in a bulletin. “The new guidance has the potential to make it easier for suppliers to have claims processed for these services.”

ResMed’s Mobi now on the market

SAN DIEGO – ResMed’s Mobi portable oxygen concentrator is now widely available in the United States. The company says its POC offers an optimal balance of oxygen delivery, weight and battery life. “Simply put, Mobi keeps you mobile, which research shows is so important in terms of helping people with COPD lower their risk of hospitalization and early death,” said Richie McHale, president of ResMed Respiratory Care. “Mobi’s ideal balance of weight, battery life and oxygen output empowers people to stay active, and live their lives to the fullest.” ResMed is positioning its POC as one of a variety of solutions to help people manage their COPD at most stages: Mobi for people requiring oxygen therapy; and Astral and AirCurve 10 ST-A devices for cloud connected, in-home ventilation for people with severe COPD. The company plans to make Mobi available in other countries later this year, pending regulatory approval. ResMed first made a play to enter the oxygen therapy market in 2016, when it bought Austin, Texas-based Inova Labs. It introduced the Mobi in January of 2018, but the product has been under a controlled launch until now.

Ascensia partners with CGM maker

BASEL, Switzerland – Ascensia Diabetes Care is partnering with Zhejiang POCTech, Co., a manufacturer of continuous glucose monitoring systems, to serve as its exclusive distributor in 13 markets. As part of the agreement, Ascensia will commercialize a version of POCTech’s current CGM in these areas and will begin distributing product in the second half of 2019, according to a press release. The two companies have also entered into a development agreement to co-develop next generation products that build on POCTech’s existing technology. “This partnership will enable us to bring an approved CGM product to selected markets in 2019 and at the same time create novel CGM systems that build on POCTech’s existing technology to address some of the unmet needs of people with diabetes,” said Michael Kloss, CEO, Ascensia Diabetes Care.

Ritzman Pharmacies sells to CVS

MEDINA, Ohio – Ritzman Pharmacies will sell its 20 retail pharmacies serving primarily northeast Ohio to CVS Pharmacy, The Associated Press reports. CVS Pharmacy plans to operate in the same locations with the same staff in Ritzman’s Akron and Berlin stores, and close the remaining stores and transfer all files to nearby CVS Pharmacy stores, according to the AP. Ritzman will continue to manage Summa’s Home Infusion through a managing company called VAR. Eric Graf, president and CEO of Ritzman, told the AP that the company held out as long as it could. “This has been a lengthy process for Ritzman Pharmacy, including engaging the investment community, local and national chains, as well as private equity,” he said. “We have worked hard to sustain the independently operated community pharmacy model and are disappointed to bring it to a close, but it is time to pass our retail business to a company with more resources. While change is always difficult, especially after almost 70 years in business, customers and patients will benefit from having a wide range of products and services available and continued pharmacy care.” The deal is expected to be complete by the end of February.

Homecare nursing shortage leads to discharge delays

ST. PAUL, Minn. – A homecare nursing shortage is the primary cause of delayed hospital discharges for children being discharged to home care for the first time, according to a new study from Pediatric Home Service. Delayed discharge occurred in 68.5% of patients new to homecare with 46.3% due to not having available homecare nursing. The nursing shortage accounted for an average length of stay increase of more than 53 days for new patients. The study also shows that medical setbacks, not failed home care, account for 97% of 90-day readmissions. “Our findings clearly demonstrate the negative impact the shortage of home care nurses has on this population. Waiting for home care nurses to be hired prolongs hospitalization of technology dependent children,” said Dr. Roy Maynard, PHS medical director. “More must be done to attract caregivers to this profession, so these children have the opportunity to thrive at home with their family.”

NSM gets reaccredited

NASHVILLE, Tenn. – National Seating & Mobility has again earned The Joint Commission Gold Seal of Approval for Home Care Accreditation by demonstrating continuous compliance with performance standards. The Gold Seal of Approval is a symbol of quality that reflects an organization’s commitment to providing safe and effective care. NSM has been accredited by The Joint Commission since 2006, the only national complex rehab provider accredited by the organization. The company went through a month-long survey process at 20 locations across the country before receiving the reaccreditation. During the survey, its compliance with homecare standards reflecting key organization areas was evaluated, including the provision of care, treatment and services, emergency management, human resources, individual rights and responsibilities, and leadership.

YARMOUTH, Maine – It turns out a good chunk of the respondents to a recent HME Newspoll didn’t change their enrollment status by a Dec. 31 deadline because they’re already non-participating.

Industry stakeholders had been encouraging providers to enroll as non-participating providers so they can take assignment on a claim-by-claim basis.

“Always have been and always will be non-par,” wrote Sarah Cotner, a provider in Kokomo, Ind. “I want to be able to offer my patient the option of ‘good, better, best.’ If they want ‘good,’ we will accept assignment. If they want ‘better’ or ‘best,’ we will bill non-assigned, so they can at least get reimbursed the allowed amount.”

Sixty-six percent of the respondents who said they didn’t change their enrollment status for 2019 said they were non-participating.

Respondents say they need this flexibility primarily due to reduced reimbursement from Medicare’s competitive bidding program.

“I need the option to decide whether to go assignment or non-assignment depending on the item and what Medicare pays for the item,” wrote one respondent.

But even respondents who have been non-participating for years say they will be taking an even harder line about what Medicare business they accept.

“We have been non-participating for years, but almost always accept assignment,” said Lori Sears, a provider in Lapeer, Mich. “This year, we are going to try billing non-assigned on may purchases items and see how it goes with patients and referrals. If they don’t accept it, we will reject most Medicare referrals.”

If one respondent’s experience is any indication, patients and referrals will understand the position of providers.

“When I explain to a caller that we aren’t a participating Medicare provider, the answer is almost always the same: ‘I don’t blame you,’” wrote Brian Keith, a provider in Greensboro, N.C.

There is, however, one scenario in which providers might have their hands tied.

“We are part of a larger health system and we share the same tax ID number with our home health agency and by going non-participating we would impact them negatively with reimbursement,” wrote one respondent who is still a participating provider.

BALL GROUND, Ga. – CAIRE is now a wholly owned subsidiary of NGK Spark Plug Co., LTD, a Nagoya, Japan-based ceramics processing manufacturer.

Chart Industries had previously announced that it planned to divest its oxygen-related products business from its BioMedical division and sell it to NGK for $133.5 million.

“Over the last 15 years, NGK Spark Plug has been utilizing its unique sensing and ceramic technologies to develop leading solutions for the healthcare market,” said Earl Lawson, president of CAIRE. “Their sense of vision and planning to meet the healthcare needs of the future makes the acquisition of CAIRE a natural fit.”

CAIRE’s oxygen therapy portfolio includes liquid oxygen systems, and portable and stationary oxygen concentrators, marketed under the AirSep, SeQual and HELiOS brands.

In addition to Ball Ground, Ga., CAIRE’s global locations include Anjo, Japan; Buffalo, N.Y.; Chengdu, China; Padova, Italy; Wokingham, U.K.; and Wuppertal, Germany.

OIG: Handful of strips dominated Medicare mail-order market

WASHINGTON – The top two strips accounted for 53% of the Medicare mail-order market, and the top 10 strips accounted for 98% of the market, according to a new report from the Office of Inspector General.

Overall, suppliers in Medicare’s national mail-order program provided 17 types of test strips during the three-month period between April 1, 2018, and June 30, 2018, the OIG found.

To conduct the report, the OIG sampled 1,210 claims from a population of 313,704 claims.

Suppliers must comply with a rule outlined in the Medicare Improvements for Patients and Providers Act (MIPPA) requiring them to provide at least 50% (by volume) of the types of test strips provided to beneficiaries.

The budget for the Department of Health and Human Services for fiscal year 2019 included a provision that would strengthen the 50% rule by requiring bidders to attest to their ability to maintain an inventory of strips consistent with their bid, and requiring CMS to establish and maintain a surveillance program to ensure suppliers are complying with the rule.

All competitive bidding contracts expired Dec. 31, 2018.

The Compliance Team celebrates 25 years

SPRING HOUSE, Pa. – It’s been 25 years since Sandra Canally, RN, formed The Compliance Team to accredit Medicare Part A and Part B providers. Canally considers The Compliance Team to be the only certified woman-owned organization to be authorized to accredit providers. She considers as highlights over the past two decades: plain language Safety-Honesty-Caring Quality Standards and Evidence of Compliance; a patient satisfaction reporting and benchmarking web portal; and a Medicare-approved Exemplary Provider accredited status. The Compliance Team plans to introduce “new transformative accreditation programs” later this year, according to the release. The company today offers 17 operations-based accrediting programs for clinics, PCMH, pharmacy services, DMEPOS and private duty. Each year, it accredits thousands of providers based in all 50 states, Puerto Rico and the U.S. Virgin Islands.

Triple W wins award at CES

SAN DIEGO ­– Triple W won a “Best of CES Award” for the Digital Health and Fitness Category at International CES 2019. The company and its DFree wearable device for urinary incontinence was chosen from thousands of companies appearing at CES, standing out based on its level of innovation, quality of design, overall efficiency and market demand, according to a press release. Engadget editors announced the winners following a competition Jan. 8-11 at the Las Vegas Convention Center. DFree uses ultrasound technology to monitor bladder fullness and notifies the user on their smart phone or tablet when it’s time to go to the bathroom. The product also earned second place in the Innovative HME Retail Product Awards at Medtrade in October.

People news: Permobil, RESNA, United Spinal

Catharina Modahl Nilsson has been appointed executive vice president, research & development, for Permobil Group. She will oversee innovation, product development and cost position within power wheelchairs, manual wheelchairs, seating solutions and power assist devices, overseeing the newly formed Global Research and Development function. Nilsson joins Permobil following a long career from the Scania Group and most recently the Traton Group, where she held various senior management positions within R&D, as well as product and project management…Andrea Van Hook has joined RESNA as interim executive director, the organization’s board of directors has announced. Van Hook was RESNA’s membership, marketing and communications manager from 2011-16. She also has experience working in healthcare operations and management at Smithbucklin, an association management company, and in marketing, communications and public relations at L.A. Care Health Plan, a Medicaid HMO and public agency in Los Angeles…Danielle Corazza, an experienced military and veteran advocate, has been appointed vice president of the VetsFirst program at the United Spinal Association. The program assists thousands of veterans and actively serving military personnel annually through an online help desk, Ask VetsFirst, and ongoing advocacy work. Corazza formerly served as the first national outreach coordinator for the Center for Women Veterans in the Office of the Secretary of the Department of Veterans Affairs, leading strategy, program management, public affairs and digital outreach initiatives.

DreamWear mask hits mark

AMSTERDAM – Royal Philips has sold its 10 millionth DreamWear CPAP mask and cushion. The mask, which features a modular frame system that works interchangeably with nasal, pillow and full-face cushions, launched three years ago. “The invention of the DreamWear mask was not just an incremental improvement on existing CPAP mask designs, but a generational leap forward in terms of comfort and usability,” said John Frank, business leader of Sleep & Respiratory Care at Philips.

Medline eyes southeast distribution center

WINSTON-SALEM, N.C. – Medline wants to open a 660,000-square-foot warehouse distribution center here that could ultimately employ 400 people, according to the Winston-Salem Journal. “It will be essentially a healthcare supply-chain center,” Dmitry Dukhan, vice president of real estate for Medline Industries, told the newspaper. If approved, construction is expected to start in the third quarter of 2019 and finish in mid-2021. Medline has more than 20,000 employees worldwide and a portfolio of more than 550,000 products. It had sales of more than $10 billion in 2017.

NHIA promotes two execs

ALEXANDRIA, Va. – The National Home Infusion Association has promoted Jennifer Charron to COO and Bill Noyes to senior vice president of reimbursement policy. Charron joined NHIA in 2017 as vice president for clinical services, focusing on education. Noyes joined NHIA in 2012 as vice president of information policy, focusing on reimbursement and regulatory issues. “Jennifer and Bill have made significant contributions to the home and specialty infusion industry and to NHIA in their previous roles,” said NHIA President and CEO Connie Sullivan. “I look forward to working with Jenn and Bill as they transition to their new positions to help achieve the legislative and operational goals of NHIA.”

CRT conference registration opens

ARLINGTON, Va. – Registration is now open for the 2019 National CRT Leadership and Advocacy Conference, scheduled for May 1-2 at the Renaissance Arlington Capital View Hotel. This year’s program will provide updates on healthcare trends, updates on CRT policies, and updates on Medicare, Medicaid and managed care, as well as an advocacy day. The conference is a partnership between NCART and NRRTS. To register: www.ncart.us/crtconf.

Lifeway Mobility expands Midwest presence

HARTFORD, Conn. – Lifeway Mobility has acquired Home Safe Homes, a provider of accessibility equipment and home modification services. Home Safe Homes, which serves central Indiana, was founded by Kent McCool in 2011, according to a press release. McCool will stay on as general manager of the Lifeway Mobility Indiana market. “We are looking forward to working with Lifeway’s team of experienced professionals, and to having access to various systems and tools that allow us to serve our clients with a holistic set of solutions,” said McCool. Lifeway Mobility provides ramps, lifts and bath safety solutions throughout Connecticut, Massachusetts, Rhode Island, Illinois, northwest Indiana, Minnesota and western Wisconsin.

Royal Philips broadens sleep portfolio

LAS VEGAS and AMSTERDAM – Royal Philips has expanded its SmartSleep suite of solutions in America. The product portfolio aims to offer consumers with solutions that can address a wide range of sleep issues from insomnia to snoring, according to a press release. Those solutions, introduced at CES 2019 in Las Vegas, include the SmartSleep Snoring Relief Band, SmartSleep Better Sleep Program, SmartSleep Analyzer, SmartSleep Deep Sleep Headband, and SmartSleep Sleep and Wake-Up Light (Somneo Connected). Royal Philips also announced strategic alliances with the American Sleep Association, American Well, SleepRate and WebMD to create further awareness and education on sleep issues.

Accreditation University starts ‘new chapter’

CARY, N.C. – The Accreditation Commission for Health Care has rebranded its Accreditation University as ACHCU. The move is part of ACHCU’s efforts to expand its service menu domestically and internationally, and will allow it to remain closely identified with ACHC, according to a press release. “We are excited to align our image and brand essence to the support we provide our customers,” said Greg Stowell, ACHCU’s senior manager of education & consulting. “We are excited for this new chapter with our brand, and look forward to providing our customers the education that will empower them to improve their avenues of health care.” The nonprofit ACHC, which was formed in 1986, is a CMS deemed accrediting organization for home health, hospice and DMEPOS.

Ki Mobility forms Canadian division

STEVENS POINT, Wis. – Ki Mobility, a manufacturer of ultra-light manual wheelchairs and complex rehab seating and the North American distributor for Leckey, has acquired NuVision Rehab Group and Western Home Medical in Canada. The acquisition creates Ki Mobility Canada LTD. NuVision Rehab Group represents rehab, mobility and home accessibility manufacturers from around the world. Its sales team, led by Rick Nori, has been representing Ki Mobility for the last four years and has been a vital part of the company’s success in the Canadian market, according to a press release. “Forming Ki Mobility Canada LTD allows us to better support our products and services to the dealers in Canada and is an essential part of our overall growth strategy of becoming the leading provider of complex rehab seating in North America,” said Doug Munsey, president of Ki Mobility. NuVision Rehab Group will continue to represent and distribute its existing product lines, including Special Tomato, Silvalea, Essential Medical Products and others, and will continue to manufacture products through its Western Home Medical division.

Parachute Health integrates with Altruista Health

NEW YORK – Parachute Health has partnered with Altruista Health to help healthcare providers reduce costs and errors associated with ordering DME. By integrating Parachute Health’s ePrescribing solution into Altruista’s GuidingCare platform, the companies have developed and implemented a new function that matches patients with DME based on care provider recommendations and complicated insurance requirements. Once the function identifies and selects the correct equipment, orders are automatically approved and processed, the companies say. “By partnering with Altruista, we’ve taken another step toward improving the care delivery process,” said David Gelbard, CEO and founder of Parachute Health. “With the integration of Parachute’s solution into Altruista’s GuidingCare platform, we expect to see reductions in spending and readmissions, and increases in patients satisfaction.” Altruista’s GuidingCare platform is used by health plans and provider organizations to streamline care management workflows; facilitate coordination among clinical, behavioral and community resources; accelerate quality improvement; and promote engagement for more than 38 million members. The new function will be introduced by Visiting Nurse Service of New York. "Since VNSNY CHOICE’s Select Health program began utilizing Parachute in December members are receiving their medical supplies quicker and the lines of communication are excellent," said Sal Bastardi, vice president of corporate administrative services. "The Select Health team can check the system at any given time to determine the status of the order."

Medtrade Spring is workshop ready

LAS VEGAS – Medtrade Spring has scheduled four workshops for April 16, the first day of the show. The workshops, which are available as add-ons to conference or expo passes, are: An Introduction to the Certified Durable Medical Equipment Specialist (CDME), HME Master Sales Training, Industry Insights: Forecasting 2019 and Best Practice Checklist for Productivity and Management. Fees vary per workshop. “If you’re going to make the trip to Medtrade Spring, workshops are a great way to hit the ground running and experience in-depth learning on day one,” said Kevin Gaffney, vice president and group show/publication director, Emerald Expositions. “In 2019, we will have some familiar experts from BOC, VGM, Brightree and Mike Sperduti from Emerge Sales—all sharing new and relevant information.” Medtrade Spring takes place April 16-18 at the Mandalay Bay Convention Center in Las Vegas.

OLYMPIA, Wash. – Only physicians can now order medical equipment for Medicaid recipients, says the Health Care Authority in Washington state.

Advanced nurse practitioners (ARNPs) or physician assistants (PAs) ordering medical equipment must have a physician’s signature on their requested orders, the Medicaid director says.

“I wouldn’t say the majority of the prescriptions we receive are from ARNPs or NPs, but there are certain clinics where they are the primary practitioners,” said Ryan French, home health director at Jim’s Pharmacy & Home Health in Port Angeles, in December, ahead of the new rule going into effect Jan. 1. “I just sent 12 faxes about the change to clinics where they are the prescribers. We don’t want our patients to have a lapse in getting their equipment and supplies.”

In a Nov. 14 letter to stakeholders, the Medicaid director says the state’s making the change “to align with federal regulations published by CMS on Feb. 2, 2016.”

The change, however, came as a surprise to providers, who noted how, back in 2015, Congress required CMS to expand who can conduct the face-to-face exams required for DME prescriptions to include PAs, NPs or clinical nurse specialists.

“We saw the change coming, but we thought the uproar that happened when Medicare made a similar announcement on the face-to-face would also happen in this case, but no one seems to be discussing it or complaining,” said Dawn Rolph, office manager for In Home Medical in Pasco. “It’s strange, because it’s going to be a huge problem.”

The biggest problem: reduced, or at least delayed, access to equipment and supplies, providers say.

“It’s not frantic right now,” Rolph said in December, “but it’s going to be when we can’t provide people’s equipment and they ask, ‘Why not,’ and we say, ‘Because the state changed the rules.’”

TOPEKA, Kan. – A proposal to drastically reduce Medicaid rates for DMEPOS, published just before the holidays, came as a surprise to stakeholders, they say.

The Kansas Department of Health and Environment said it planned to submit an amendment to set the Medicaid fee schedule for DMEPOS items at 65% of the non-rural Medicare rates.

“We have no idea what the rationale behind this is,” said Rose Schafhauser, executive director of MAMES. “We met with them in February of last year and made them aware then that even going to the Medicare allowable would be problematic.”

States around the country have been adjusting fee schedules to comply with the 21st Century Cures Act, which sates that the federal portion of Medicaid reimbursement for HME cannot exceed what Medicare allows. States can base their Medicaid rates on Medicare’s lowest fee schedule or they can gather aggregated data using their Medicaid and utilization rates for 2018.

What Kansas is proposing is untenable, says Robert Clock, the state representative to MAMES and CEO of Winfield-based Clock Medical Supply.

“I think for most providers this is well below their product costs,” he said. “As people assess where they are with their goods and services, to receive a 35% reduction on the Medicare non-rural rates is unacceptable.”

That’s of particular concern in the large swathe of the western half of the state, which is largely rural and already underserved, says Clock.

“Patients will have to stay wherever they receive their primary service, usually a rural hospital, which is way too costly,” he said.

Complicating matters: the transition to a new administration. The Medicaid director is leaving, new lawmakers are being seated, and a newly-elected Democratic governor replaced the outgoing Republican, said Clock.

“It’s a whole new learning curve,” he said.

Providers had until Jan. 22 to submit comments on the proposal.

Fighting that fear factor

VGM’s Ronda Buhrmester spent the last two weeks of 2018 taking frantic calls from HME providers wondering whether or not they should change their Medicare enrollment status for 2019.

Her general advice: If you’re a participating provider, change to non-participating.

“There’s a fear factor, because it’s a change in enrollment status for a lot of providers, and they’re afraid of how it’s going to affect their patients and their referrals,” said Buhrmester, director of reimbursement. “But it gives them the most options.”

Providers had until Dec. 31, 2018, to change their enrollment status for 2019 with Medicare’s National Supplier Clearinghouse.

Non-participating status means providers can take assignment on a claim-by-claim basis. With an any willing provider provision allowing all Medicare-enrolled providers to provide DME to beneficiaries expected to shake up the landscape, they need that flexibility.

“They may want to wait a month or the first quarter before deciding what they want to do,” Buhrmester said.

If non-participating gives providers more options, why have providers traditionally enrolled as participating?

“That’s a good question,” Buhrmester said. “Back in the day, the rates were reasonable, so it didn’t matter.”

Participating status also puts a provider in the supplier directory. But most providers already have established relationships with the referral sources in their communities and Buhrmester guesses most of those sources use Google, anyway, if they want to search for providers.

“I think we’re going to see an increased number of providers that went non-participating in 2019, I really do,” she said.

Luddites no more

If Miriam Lieber has one thing she wishes providers would embrace in 2019, it’s technology—current and future technology.

“The notion of a patient being able to tap into their iPhone to know if they had a leak in their CPAP mask, that goes so far in the patient managing themselves and the provider managing the patient,” said Lieber, president of Lieber Consulting LLC. “That’s really where it’s at and it’s here now.”

Lieber says providers also need to jump on technology that’s not exactly here now, like an automated intake process using artificial intelligence.

“Checking and verifying eligibility is not straightforward today,” she said. “We need a more robust and automated intake process to find out who the payer is and how you can marry the payer with the authorizer, and what the documentation requirements are, etc.”

Providers have one thing pushing them toward technology, Lieber says: tight margins.

“They’re realizing they can’t do it alone and it’s too expensive to hire more people,” she said.

CHICAGO – Pritzker Private Capital has acquired KabaFusion, a provider of acute and specialty home infusion services. The Cerritos, Calif.-based KabaFusion was founded in 2010 and serves patients in more than 40 states, specializing in IVIG and home infusion therapies. “We are committed to providing our patients with the highest quality of specialty home infusion treatments and are thrilled to partner with Pritzker Private Capital,” said Dr. Sohail Masood, KabaFusion CEO and founder. “We selected Pritzker Private Capital because of their deep experience in healthcare services and differentiated long-term approach to building world-class businesses.” Terms of the deal were not disclosed.

NSM adds 10th branch in Texas

NASHVILLE, Tenn. – National Seating & Mobility has acquired First Care Medical Equipment in Fort Worth, Texas, further strengthening its growing presence in the state.

Formerly owned and operated by industry veteran Robby Halcomb, First Care Medical Equipment has served the Forth Worth area since 1998. Halcomb, along with his entire team of complex rehab professionals and ATP Ray Deshazer, will transition to the NSM team and continue to serve clients from the branch at 5470 E Loop 820 South.

With this acquisition, NSM now operates 10 branches in Texas. Forth Worth joins existing branches in Dallas, Austin, Midland, Abilene, Houston, San Antonio, Beaumont, Waco and McAllen.

Kelley Medical received unallowable payments for orthotics, OIG says

WASHINGTON – Kelley Medical received at least $4 million in unallowable Medicare payments for orthotic braces, according to a new report from the Office of Inspector General. For 24 of the 100 sampled beneficiaries from Jan. 1, 2015, through March 31, 2017, Kelley Medical complied with requirements, but for 76 beneficiaries, it did not. Specifically, Kelley Medical billed for orthotic braces that were not medically necessary for 67 beneficiaries and could not provide medical records for nine beneficiaries. The OIG recommends that Kelley Medical refund to the DMEMACs $4 million in estimated overpayments for orthotic braces, exercise reasonable diligence to identify and return any additional similar overpayments outside of our audit period, and obtain as much information from beneficiary medical records as it determines necessary. Kelley Medical disputed the OIG’s findings and recommendations. The OIG, which maintained its findings, notes that its recommendations don’t represent final determinations by Medicare but are recommendations to HHS.

Shutdown and HME: StripSupply, AvaCare Medical offer help

BOSTON – StripSupply will be waiving monthly subscription fees for both diabetes test strips and lancets for federal employees affected by the government shutdown. The company says with one in 10 people living with diabetes and with the cost of supplies often more than $500 out-of-pocket per month, “StripSupply does not wish for any federal employees living with diabetes to suffer from any additional stress, while they attempt to maintain their physical health and to cover expenses for housing and nutrition without pay.” … Lakewood, N.J.-based AvaCare Medical, and its sister companies, MSC and Murse World, sent an announcement offering assistance to customers affected by the shutdown. “We know that many of our customers struggle to pay their bills and living with their medical supplies just isn’t an option,” the company stated in the announcement. There are 800,000 federal employees affected by the shutdown.

Quality Biomedical, Brightree integrate service

BOULDER, Colo. – Quality Biomedical has integrated with Brightree to streamline workflows for HME companies managing the service and deployment of biomedical equipment. HME companies that manage large equipment fleets can now self-generate RMAs, arrange for pick-ups of defective equipment, view the status of equipment undergoing service, approve all service estimates and retrieve service records instantly. “This integration is a key aspect of our strategy to build a nationwide service network to support distributed healthcare industries such as home medical companies,” stated PK Bala, CEO of Quality Medical. “By eliminating the need for paper-based records, phone calls and emails needed to manage biomedical equipment services, the productivity savings for our HME customers will be quite significant.” Quality Biomedical provides integrated logistics, warehousing, service/repair, document management and other related services through a technology platform called Q-Connect.

GAMES taps new executive director

ATLANTA – GAMES has hired Devin Krecle as its new executive director, according to a bulletin from AAHomecare. Krecle is part of Association Strategy Group, a firm that specializes in association management. He also serves as executive director of the North Carolina Academy of General Dentistry, Georgia Medical Directors Association and the Georgia Society for Respiratory Care. "Devin brings a decade of experience and a strong team to assist us in the operation and growth of GAME,” said Tyler Riddle, president of GAMES and CEO of MRS Homecare. “As we recognize the increasing importance of state legislative issues as it relates to DME, we look to Devin’s experience and connections in Atlanta to help promote a more favorable atmosphere for our members and the customers we serve." 

Rehab Medical revamps website

INDIANAPOLIS – Rehab Medical has launched a new website with a customer-focused design. The new site, rehabmedical.com, organizes the provider’s product offerings into four frequently searched categories: manual wheelchairs, power wheelchairs, pediatric wheelchairs and wound care. It also features a new blog and a page detailing the process of obtaining equipment through insurance.

CEUs return to Medtrade Spring

LAS VEGAS – Pride Mobility Products and Quantum Rehab will once again offer courses for continuing education units (CEUs) at Medtrade Spring this year. Attendees can choose from “Clinically Speaking – A Practical Guide to Evaluation and Documentation for Power Seat Options” and “The Case for Wheels – Selecting the Clinically Appropriate Base.” Each course, worth .20 CEUs, is free but requires an expo pass and registration with Pride/Quantum. The courses are back this year after debuting at the show last year. “The CEO classes were reintroduced at Medtrade last year,” said York Schwab, an account executive with Medtrade Spring. “Thanks to our fantastic partner Quantum Rehab, we were able to offer two free sessions that were almost full. We will be offering the same opportunity for our Medtrade Spring 2019 audience.” The courses will take place on the second day of the show. Medtrade Spring takes place April 16-18 at the Mandalay Bay Convention Center in Las Vegas.

ResMed goes to the top

SAN DIEGO – ResMed has introduced its first top-of-head-connected nasal CPAP mask, the AirFit N30i, in the United States. The top-of-head connection keeps tubing out of the wearer’s way, letting them move and sleep in any position. The mask also features a nasal cradle cushion that sits just under the wearer’s nose, reducing facial markings and irritation. Additionally, ResMed says the mask fits 96% of CPAP users with just two frame sizes and four cushion sizes, making it convenient for HME providers and sleep labs. The AirFit N30i is also available in Canada, Australia, New Zealand and most of Europe, with other countries planned to follow later this year.

Companion Medical launches insulin pen app

SAN DIEGO – Companion Medical has launched the Android version of its InPen App, a smart insulin pen system that helps users manage dosages and provides reports that display aggregated glucose, insulin and meal data. "Our mission is to empower people living with diabetes and their healthcare providers with easy-to-use connected solutions that improve outcomes at a lower cost,” said CEO Sean Saint, in a press release. “InPen's dose calculator, insulin-on-board tracking, and dose reminders do all the tracking, monitoring, and complex calculations for users, while also providing healthcare professionals with the data they need." An iOS version of the app, which is approved by the Food and Drug Administration, has been available since December 2017.

People: Zacharias

OWINGS MILLS, Md. – Claudia Zacharias, president and CEO of BOC, has been appointed to serve on the Certified Association Executive Commission. The CAE, an independent body of the American Society of Association Executives, is responsible for setting policy and standard related to the CAE program. Zacharias earned her CAE credential in 2008.

WASHINGTON – CMS has launched a new app that allows beneficiaries to see whether Medicare covers a specific medical item or service.

The “What’s Covered” app allows beneficiaries to more easily get accurate, consistent Original Medicare coverage information in the doctor’s office, the hospital or anywhere else they use their mobile devices.

“The new app is the next in a suite of products designed to give consumers more access and control over their Medicare information,” said CMS Administrator Seema Verma.

CMS’s eMedicare initiative, launched last year, also includes online decision support to help beneficiaries better understand and evaluate their coverage options and costs between Medicare and Medicare Advantage; an online service that lets beneficiaries quickly see how different coverage choices will affect their estimated out-of-pocket costs; price transparency tools that let beneficiaries compare the national average costs of certain procedures between settings, such as hospital outpatient department vs. ambulatory surgical center; a webchat option in the Medicare Plan Finder; and surveys across Medicare.gov so beneficiaries can share what they want.

The “What’s Covered” app is available for free in both Google Play and the Apple App Store.

WASHINGTON – CMS has launched a new app that allows beneficiaries to see whether Medicare covers a specific medical item or service.

The “What’s Covered” app allows beneficiaries to more easily get accurate, consistent Original Medicare coverage information in the doctor’s office, the hospital or anywhere else they use their mobile devices.

“The new app is the next in a suite of products designed to give consumers more access and control over their Medicare information,” said CMS Administrator Seema Verma.

CMS’s eMedicare initiative, launched last year, also includes online decision support to help beneficiaries better understand and evaluate their coverage options and costs between Medicare and Medicare Advantage; an online service that lets beneficiaries quickly see how different coverage choices will affect their estimated out-of-pocket costs; price transparency tools that let beneficiaries compare the national average costs of certain procedures between settings, such as hospital outpatient department vs. ambulatory surgical center; a webchat option in the Medicare Plan Finder; and surveys across Medicare.gov so beneficiaries can share what they want.

The “What’s Covered” app is available for free in both Google Play and the Apple App Store.

New legislation would repeal preferred provider program

ST. PAUL, Minn. – A bill that would repeal Minnesota Medicaid’s preferred provider program for incontinence supplies was introduced Jan. 24 in the state senate. SF 491 is similar to a bill that was passed as part of an omnibus bill in 2018 but that was ultimately vetoed by the governor. In August 2018, MAMES obtained a temporary restraining order to delay the state’s plans to create a preferred provider program that would award a single contract to provide the supplies. Also at issue: the reimbursement was calculated at 20% above acquisition cost. A companion bill is expected soon in the state House of Representatives.

RAC targets pneumatic compression devices

ATLANTA – Performant Recovery, the national DMEPOS RAC, added pneumatic compression devices to its approved issues list on Jan. 23, the van Halem Group reports. Performant will perform complex reviews to determine if the pneumatic compression device is reasonable and necessary for the patient’s condition based on the documentation in the medical record. Claims that do not meet the indications of coverage and/or medical necessity will be denied. The audit will cover E0651 and E0652 for claims having a “claim paid date” that is more than three years prior to the additional development request (ADR) date and prior to Dec. 1, 2015.

One Drop eases self-management

NEW YORK – One Drop has launched Personal Diabetes Assistant, a new approach, it says, to supporting people with diabetes in their day-to-day self-management. One Drop iOS users select their recurring health management tasks, such as blood glucose checks, medication doses, meals, physical activity and blood pressure measurements, and One Drop delivers a personalized daily schedule based on their unique needs. The company has also announced integration with Health Records on iPhone, allowing One Drop iOS users to seamlessly share their electronic health records with their personal coaches through the One Drop platform. Together, these new additions represent important steps toward alleviating the burden of living with diabetes, and facilitating the seamless exchange of health data between patients, care teams and healthcare institutions, One Drop says.

Quantum launches online community for iLevel users

DURYEA, Pa. – Quantum Rehab has launched lifeatilevel.com, a consumer-focused website for people who use iLevel wheelchairs or who want to learn more about them. The site features videos, blogs and photos, and consumers are invited to submit their personal stories about how iLevel has improved their lives. "We wanted to create a dedicated website for consumers,” said Megan Kutch, Director of Quantum Marketing. It’s not a typical website you’d expect for a product, but a place where we will share the stories of those who use life-changing iLevel technology.” In October, the iLevel passed the 20,000 mark of wheelchair users who have adopted the technology, a power adjustable seat height system.

Rowheels to make TV pitch

MADISON, Wis. – Rowheels, a developer of manual mobility technology, has been chosen to appear on “Project Pitch It,” a local TV show in which entrepreneurs pitch their startup companies “Shark Tank”-style and compete for weekly awards valued at a total of $30,000, according to a press release. Rowheels has *developed a patented technology that allows wheelchair users to pull rather than push when they want to move forward, preventing repetitive stress injuries of the shoulder. "Rowheels is thrilled to be appearing on ‘Project Pitch It’ season 3,” said Chief Executive Gaurav Mishra. “All the companies selected to appear are outstanding, and we are honored to have been chosen." The episode airs Feb. 9 at 6:30 pm on WISN-TV Channel 12. http://www.hmenews.com/article/rowheels-pulls-not-pushes

Triple W wins another CES honor

SAN DIEGO – Triple W has received the iPhone Life Best of CES 2019 Award for DFree, a wearable device for urinary incontinence. DFree uses ultrasound technology to monitor bladder fullness and notifies the user on their smart phone or tablet when it’s time to go to the bathroom. “We’re honored to be selected by iPhone Life as an innovative and useful solution for people who have a loss of bladder control or are caregivers for a loved one facing a challenge,” said Atsushi Nakanishi, president and CEO in a press release.The company also won a “Best of CES Award” for the Digital Health and Fitness Category at International CES 2019; and earned second place in the HME Retail product Awards at Medtrade in October.

Solera Health adds health department to roster

PHOENIX – Solera Health has added the Johnson County Department of Health and Environment in Olathe, Kan., to its network of diabetes providers. Solera’s network is comprised of companies recognized by the Centers for Disease Control and Prevention for their diabetes prevention program (DPP).

Johnson County's DPP emphasizes that even small changes in diet and exercise can lead to significant lifestyle changes and prevent the onset of Type 2 diabetes. "It's an honor to work with a program like Johnson County's that understands how adults learn best, which is crucial in instilling healthy habits that will help prevent diabetes," said Brenda Schmidt, Solera CEO in a press release.

Crest Healthcare to offer LifeGlider

DASSEL, Minn. – Crest Healthcare Supply and Core Mobility Solutions have partnered to make the LifeGlider mobility device more widely available. The LifeGlider allows independent, upright, hands-free mobility while reducing the risk of falls, and can be used in a therapeutic setting or as a personal assistive device, according to a press release. Crest Healthcare Supply is a provider of products and technical services that enhance the care environment. Core Mobility Solutions is a privately held medical device company. The LifeGlider is its first product.

DME-IQ allows physicians to bring DME programs in-house

MIRAMAR, Fla. – NuGenerex Distribution Solutions 2, a wholly owned subsidiary of Generex Biotechnology Corp., has launched DME-IQ, a service for physicians who distribute DME from their offices. DME-IQ focuses on several key areas, including negotiating on behalf of the physicians with key vendors to decrease the cost of goods, increasing insurance collections by providing oversight of coding during the billing process, providing the necessary personnel to manage the appeals processes, and ensuring compliance with state and federal regulations. NuGenerex has announced its first client for DME-IQ: The Orthopaedic Center in Tulsa, Okla., which has received a proprietary, tablet-based software package that verifies patient benefits and eligibility. It also manages DME inventory; collects patient copays and deductibles; and links patient information with DME and necessary patient forms all in one platform. “Previously, we had little control over our DME program, which was managed by an outside firm that rented space in our facility,” said Justin Clary, practice administrator of The Orthopaedic Center. “We are engaging DME-IQ to provide the management services that will enable TOC to bring the DME programs in-house, and allow us to expand our inventory and services offerings with new products that meet the needs of our patients and lower our cost of goods.”

People news: Compass Health, Vertess

Ted Metcalf has joined Compass Health Brands as Western Regional Director. He will manage the sales teams in 13 states. Most recently, Metcalf served as the director of rehab, O&P and HME retail for The MED Group/MHA. He has also worked for Numotion and Pride Mobility…Dave Turgeon has joined M&A advisory firm Vertess as a managing director. Turgeon, a seasoned professional in the behavioral healthcare and I/DD space, has played a central role in the acquisition of hundreds of companies and the investment of billions of dollars.

INDIANAPOLIS – Rehab Medical, a provider of complex rehab services has merged with Cork Medical, a manufacturer of devices ankd support surfaces used in the treatment of wounds. "The merger better aligns the companies’ efforts, which previously operated independently," said Patrick McGinley, CEO of both Cork Medical and Rehab Medical, in an article on Insideindianabusiness.com "Our new direction will allow our talented teams to collaborate and work toward our shared goal of improving lives." Terms of the deal were not disclosed. In November, Rehab Medical acquired Family Medical Supply in Oklahoma, expanding its footprint to 14 states.

Air Liquide makes pair of Swiss buys

PARIS – Air Liquide has acquired Sleep & Health SA and Megamed AG, it announced today. Sleep & Health SA was founded in 2003 and is a national provider of sleep apnea services. MegaMed AG, has been in business nearly 50 years and provides ventilation and other support for patient with respiratory failure. Through the acquisitions, Air Liquide will serve more than 3,000 new patients. “We are happy to welcome the teams from Sleep & Health SA and from Megamed AG to the Air Liquide Group,” said Francois Jackow, member of Air Liquide’s executive committee. “Their expertise and their knowledge of the Swiss market, combined with the expertise of Air Liquide, will allow us to better address the needs of patients and healthcare professionals alike.” Air Liquide supplies medical gases, home healthcare services, hygiene products, and medical equipment. In 2017, it served more than 15,000 hospitals and clinics and more than 1.5 million patients.

WASHINGTON – What’s to come of all of those draft clinical templates that CMS released in 2018?

There seemed to be a flurry of them last year, but the agency’s efforts in this area go back years, including a template for prostheses in 2013.

“We’re hoping this year to really push them on this,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “The thing with CMS is that everything takes so long, so we plan to continue to pressure them.”

When stakeholders make their push, they plan to argue that the only way templates will work is if 1.) physicians and hospitals are required to incorporate them into their EHRs, and 2.) they replace “all the other stuff we’re doing,” Brummett says, like CMNs and chart notes.

If this ideal were to become a reality, it would solve a lot of the pain points for providers, stakeholders say.

“Templates would help to direct the physicians to document properly and to help them determine that the patient really does need the equipment,” said Ronda Buhrmester, director of reimbursement for VGM. “That way the supplier doesn’t have to make the interpretation, ‘Well, they have four of the five criteria, should we send it or not?’”

Templates go “hand in hand” with e-prescribing, and stakeholders would like to see CMS mandate that, too, Brummett says.

“They’re not going to approve solutions per se, but they could release an FAQ with guidance, so providers feel better about using these solutions,” she said. “We have heard of many more suppliers doing demos with vendors on this. It’s cool to see that kind of activity.”

Stakeholders have calls scheduled with CMS on both matters.

“If we could get templates and e-prescribing, it would be so much easier,” Brummett said. “Audits would be easier, too, because everything would be standardized.”

ARLINGTON, Va. – AAHomecare’s Retail Work Group has diversified significantly since it first launched to help mobility providers add cash sales to their businesses.

Formed in 2017 within the association’s Complex Rehab & Mobility Council, the work group now includes respiratory and other providers—some with retail experience, others with none—that are all seeking to increase their cash flow, says Nancy Froslie, group chairwoman.

“We’ve got a good mix of folks in this group,” said Froslie, the rehab manager at Sanford Healthcare Accessories. “There’s so many cash and carry mobility products, but we are finding the sky’s the limit. We are seeing different providers bringing in different products and sharing their success stories.”

AAHomecare recently launched its 2019 schedule of webinars for the group, which meets monthly. The topics for this year’s lineup run the gamut from legal to marketing to product selection, led by industry experts and HME providers.

“We wanted to hit the key points and get different perspectives and make sure it’s a very well-rounded resource group,” said Froslie.

Many of this year’s topics address communicating with customers, says Ashley Plauche, AAHomecare’s manager of government affairs.

“Traditionally, we’ve always had the relationship with the referral source,” she said. “With retail, you are talking to the public, so how do you reach them where they are? How do you speak to them? I know how to be a traditional HME. What does life look like as a retail HME?”

Provider Kevin Brown, who will host one of the webinars, also believes providers need to know their communities. When he started out in 2009, his biggest seller was bath safety products. These days, he’d be out of business if he hadn’t kept up with changes in his local market.

“Nowadays, everybody—Walmart, Walgreens—does bath safety,” said Brown, a co-owner of Tennessee-based All Star Medical Supply. “You’ve got to know your location, know what’s out there, and know who your competition is. You’ve got to go after bigger cash sales like scooters and lifts to be viable.”