WASHINGTON – A new coalition led by a long-time industry healthcare attorney and former White House and Health and Human Services (HHS) advisers has made audit relief its singular priority.

The Medicare Appeals Due Process Coalition will work on behalf of HME providers to reform the appeals process for audited and denied claims.

“It’s important to get different types of providers together and raise their voice with CMS and Congress to see if we can get this fixed,” said Jennifer Summa, a senior policy adviser for Baker Donelson and a former senior adviser to CMS Deputy and Acting Administrator Leslie Norwalk. “You need to have numbers to be heard.”

Summa is joined by Stephen Azia, counsel at Baker Donelson; Lance Leggitt, chairman of the firm’s Health Care Government Affairs Practice Group and a former senior health policy advisor to George W. Bush; and Nancy Johnson, a former member of Congress and chairwoman of the Ways and Means Health Subcommittee.

The coalition has two goals. The first: Work with CMS to find a way to expedite the appeals process. By law, an ALJ must conduct a hearing within 90 days, but the Office of Medicare Hearings and Appeals (OMHA) announced recently that it would defer assignment to the ALJs up to 28 months.

“There has become a feeding frenzy in terms of audits and denials, and it has jammed the system,” said Leggitt. “CMS is letting the appeals system determine what’s a valid claim and what’s fraud, and because a small percentage is fraud, it’s not the most efficient way of doing it. The process needs to be more qualitative.”

The second goal: Work with Congress to get statutory language enacted that would prevent CMS from making any recoupments until a provider has gone through the ALJ level—at minimum. That’s key because the first two levels of appeals are more administrative and don’t involve a hearing, and because 56% of the time the ALJ reverses the decision of the previous level.

“No provider should have to wait two years for an appeal, while money is being taken away,” Azia said. “We’ve seen, because of extrapolation, where 30, 40, or 50 claims representing $20,000 become $2.5 million. It really becomes threatening to the existence of any provider.”

Since Leggitt, along with Summa, was part of a small group of advisors that oversaw the establishment of OMHA, he knows how broken the system has become.

“Congress has been very reactive when engaged on this,” he said. “We need to say, ‘Look, you made changes a decade ago and the problems are getting worse.’”

YARMOUTH, Maine – Long delays have made appealing denied claims a painful process for HME providers, forcing them to wait sometimes years for payment.

Nearly all of the 120 respondents to the December HME NewsPoll (91%) say they have one or more appeals awaiting a hearing with an administrative law judge (ALJ), the third level of appeal. Forty-one percent of respondents say they’ve already been waiting at least a year.

“Many of these claims are showing up as open invoices on our books and presenting a poor financial picture for our company because of outstanding revenue,” one respondent said.

Things could get worse: The Office of Medicare Hearings and Appeals recently announced that it will defer assignments for hearings with an ALJ up to 28 months.

While a 2012 report from the Office of Inspector General found that the ALJ ends up approving 56% of denied claims, the delays make getting there costly, respondents say.

“This patient continues to need and use the power wheelchair, which we are nice enough to let him use while we wait for the ALJ, making us the banker,” one respondent said.

Some respondents say they are no longer willing or financially able to go through the process, leaving beneficiaries on their own to appeal, or to pay out of pocket. 

“If a CPAP is denied at any point, then that patient is no longer able to get supplies on an assigned claim basis,” said Clark Robichaux of Wilmington, N.C.-based Oxy-Care. “They must pay up front. While we have never lost in the ALJ process, we are not willing to invest additional money for the period it takes to get a hearing.”

Other respondents say they stick it out because it’s the right thing to do.

“Until this ALJ is approved for the months that were denied, we have been providing enteral services to this patient every month at our expense because it is a life saving measure,” one respondent said. “If we do not supply this to him, the patient will not survive and we cannot rightly turn him away because Medicare doesn’t think he qualifies, when we know he surely does.”

WASHINGTON – A meeting with CMS and congressional staff on DME competitive bidding, originally cancelled due to the government shutdown, has been set for 11 a.m., Monday, Nov. 18, says The VGM Group. Because the briefings, for staff of the Energy and Commerce and Ways and Means committees, will not be public, VGM and AAHomecare are calling on providers to contact their members of Congress to urge them to attend.

Employees return to Invacare facility

ELYRIA, Ohio – A “small number” of employees are returning to Invacare’s Taylor Street facility, according to a story by the Chronicle-Telegram. Per a consent decree put in place by the U.S. Food and Drug Administration (FDA) in December 2012, the company limited design, manufacturing and distribution activities at the plant, resulting in the layoff of 236 employees. Returning employees are being placed throughout the facility, according to the story. “It’s a small number, but I know it is a goal to return to full capacity at the facility,” Lara Mahoney, spokeswoman, told the newspaper. “Is this good news? Yes, it is, but we still have a ways to go.” Invacare has submitted and passed two of the three audits required to lift the decree. It expects to submit the third audit in November.

KCI’s third quarter revenues slip

SAN ANTONIO, Texas – Kinetic Concepts Inc. (KCI) has reported a drop in third-quarter revenues: $320.9 million in 2013 vs. $329.7 million in 2012, a 2.7% decrease. The company said the decline stems from Round 2 of competitive bidding. KCI products that fall under the program’s umbrella saw a 42% price reduction. “KCI would have reported positive revenue growth in the third quarter, exclusive of this one item,” stated CFO Robert Hureau.

One in 10 will have diabetes by 2035, report says

BRUSSELS, Belgium – One-tenth of the world’s population—592 million people—will have diabetes by 2035, according to the sixth Diabetes Atlas, released by the International Diabetes Federation Nov. 14. The federation says 382 million people will have the disease by the end of 2013. Most people with diabetes are between 40 and 59 years old and live in low- and middle-income countries, according to the report. “Diabetes is a disease of development,” said Michael Hirst, IDF president, in a statement. “The misconception that diabetes is ‘a disease of the wealthy’ is still held, to the detriment of desperately needed funding to combat the pandemic.” About 9.2% of Americans will have developed some form of diabetes by the end of 2013, the report says. That figure should increase to 11.6% by 2035.

My Home Medical Care debuts online

ALPINE, Utah – A new website, MyHomeMedicalCare.com, has launched, offering a variety of supplies for home medical care, according to a Nov. 14 news release. Founder Daniel Wang’s work as an X-ray technician in private homes and nursing facilities helped him become familiar with the needs of patients receiving health care at home, according to the release. Products for sale on the site include mobility aides, such as walkers and canes; incontinence products; and blood-pressure monitors. MyHomeMedicalCare.com is a division of DJW Enterprises.

Provider collects scrubs for drive

ASHLAND, Ky. – King’s Daughters Home Medical Equipment and The Dressing Room are collecting new and gently used scrubs to donate to students, graduates and those entering the medical field. The drive is open until Dec. 31 and medical professionals who donate scrubs will be given a 10% discount off purchases at King’s Daughters HME. “Uniforms can be a major expense for anyone starting a job, in any field,” said Jamie Martinez, director of King’s Daughters. “But, if you’re a new grad, or someone who has just finished re-training after months of unemployment, the cost of uniforms can be a real obstacle.”

MDA names Numotion Company of the Year

HARTFORD, Conn. – The Muscular Distrophy Association (MDA) has named Numotion the 2013 Company of the Year, the company announced Nov. 11. MDA presented Numotion with the award during the 16th annual Connecticut area Black and Blue Ball in October, according to the release. The organization honored Numotion for supporting the ball, helping with mobility loan closets and volunteering at summer camps. “Numotion is excited to continue its support of the MDA,” stated Mark Miller, Numotion vice president of marketing and strategic partnerships, in the release. “Our team is geared up to be involved and support many MDA events across the country, including Muscle Walks and summer camps, in 2014.”

Company seeks crowdfunding support for sleep apnea device

BURLINGAME, Calif. – California company Lucky Knives is using Indiegogo to raise money to tool and win FDA approval for SpeakEasy, a product that it has developed to help patients talk while using CPAP devices. To use SpeakEasy, the wearer pinches two rubber buttons. “Now, it’s easy to say goodnight to your spouse, answer the phone and sneeze without having to take off the mask or reset the machine,” stated Hal Rucker, company president, in a release.

CMS clarifies “homebound”

BALTIMORE – Medicare beneficiaries must now meet two sets of criteria to be considered “homebound,” according to new rules that take effect Nov. 19. First, they must need supportive devices, special transportation or other help to leave the home. Second, they must be unable to leave the home, or leaving the home must take “a considerable and taxing effort.” CMS says its new definition will prevent confusion, lead to clearer enforcement and offer more definitive guidance to home health agencies.

Studies: V.A.C. VeraFlo speeds wound healing

SAN ANTONIO, Texas – Studies presented at two recent conferences show Kinetic Concepts’ V.A.C. VeraFlo Installation Therapy reduces the length of hospital stays, speeds wound closure and reduces debridement costs when compared to traditional V.A.C. therapy, the company announced Nov. 11. “This is one of those things that comes along every decade or so that literally radically changes the way you treat your patients,” stated study presenter Paul Kim, associate professor and research director at Georgetown University School of Medicine Center for Wound Healing, in the release.

Alliqua lands $1M to ramp up wound care biz

LANGHORNE, Pa. – Alliqua has obtained $1 million in financing from Crossover Healthcare Fund to fund key initiatives in the wound care space, the company announced Nov. 12. The biopharmaceutical company will put the money toward sales and marketing of hydrogel products sold under the SilverSeal brand, and its sorbion sachet S and sorbion Sana wound-care products. The financing is in the form of 250,000 shares of Series A Preferred Stock, which can be converted into 11,111,111 shares of common stock. Alliqua must redeem the stock on Oct. 21, 2015, according to the release.

HomeCare app speeds reporting

ORLANDO - HomeCare Connect has a new app that helps providers quickly and accurately complete paperwork for workers’ compensation payers. Synchronizing with the company’s servers, the app allows providers to start case reviews and applications while they’re still with patients, according to the company. “Payers can receive same-day reports if desired,” stated Vonesa Wenzel, CMO of HomeCare Connect, in a release. The system provides a portal for real-time updates, document downloads and electronic authorizations, as well. Clinical care coordinators help ensure reports are complete and accurate before they are sent to payers, according to the company. HomeCare Connect focuses on managing the quality and cost of home health, durable medical equipment and supplies for workers’ compensation payers.

SMP Home Medical donates to OT program

DUBOIS, Pa. – SMP Home Medical has donated a wheelchair and a trapeze lift to the Penn State DuBois Occupational Therapy Assistant Program, the company announced Nov. 10. “With updated equipment, our students will get to practice with the most up-to-date items that are out there, and it really improves their educational experience,” stated LuAnn Demo, instructor and OTA campus coordinator, in the release. SMP also hosts the OTA students at a yearly open house, showing them the latest home medical equipment.

Short takes

Wayne, N.J.-based Maddak’s Morph Wheels, folding wheelchair wheels, won Popular Science’s 2013 Best of What’s New award in the health field for innovation and advancement of functionality, the company announced recently…Onehealth & OneSource and its Diabetic 360 program will be the exclusive provider of diabetic supplies and education to clients of HMC Healthworks, a Florida-based provider of health management and wellness programs, the company announced Nov. 14 … Atlanta-based Patientco is the Metro Atlanta Chamber’s 2013 Healthcare IT Start-Up Company of The Year, according to a Nov. 13 news release…Lee Meagher, founder and CEO of Winnipeg, Manitoba-based Scootaround, Inc., was named one of Canada’s top 100 female entrepreneurs by Profit Magazine and Chatelaine. Scootaround rents wheelchairs and scooters to traveling customers, event attendees and business travelers.

BALTIMORE – One of the Office of Inspector General’s (OIG’s) four goals for the next four years is to fight fraud, waste and abuse, according to a strategic plan released Nov. 21.

The OIG says it plans to continue and expand existing initiatives in this area, like the Medicare Fraud Strike Force and the Health Care Fraud and Abuse Control Program.

The agency also says it plans to focus on compliance issues related to fraud, waste and abuse. It plans to promote compliance, resolve noncompliance issues and help the Department of Health and Human Services (HHS) assess whether providers are qualified to take part in government healthcare programs, according to the report.

Additionally, the OIG plans to take successful models, such as the Medicare Fraud Strike Force, and use them in other HHS programs, focusing on discouraging waste and promoting Medicare and Medicaid integrity. 

Other goals in the plan include promoting quality, safety and value; fostering financial stewardship and a high-performing healthcare system; and promoting expertise while leaning on leading-edge technology and tools.

COLUMBUS, Ohio – Providers in Ohio are fighting the state’s plan to set Medicaid rates for oxygen to 36% below the lowest Round 2 rate in the state.

“With the cuts we’re already seeing from Medicare, if Medicaid also makes those cuts, it’s going to hamper the service we offer our patients,” said Jamie Blair, vice president of New Boston, Ohio-based Genesis Respiratory Services. 

Ohio Medicaid in September announced the cuts as part of a plan to move both oxygen and custom seating/wheelchairs from nursing home per diem rates into fee-for-service, effective Jan. 1, 2014. The proposal came about after providers, consumer groups and manufacturers encouraged Medicaid to carve out custom seating, since the nursing homes couldn’t provide the same level of care in that product category as HME providers. Unfortunately, the agency took the request further, including oxygen and proposing the rate cut. 

Provider Carl Mulberry in October hosted Medicaid officials at Columbus Medical Equipment to share concerns.

“We talked about what it takes to do oxygen in people’s homes,” said Mulberry, president. “You could probably get away with those lower prices if you have 10 concentrators in one room (at a nursing home), but visiting each home one at a time? That reimbursement is not enough to do a homecare business.”

WASHINGTON – It’s gone from bad to worse for providers trying to get on the dockets of Administrative Law Judges (ALJs).

That’s because the Office of Medicare Hearings and Appeals (OMHA) recently posted a message saying it would defer assignments for the hearings for possibly as long as 28 months.

“There’s no end in sight and it’s probably going to get worse,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “I think all of us need to put pressure on CMS to say 28 months is not OK.”

The backlog at the ALJs—the third level of appeals—is nothing new. Increased levels of audits and appeals have created heavy workloads and there simply aren’t enough judges to handle the cases.

“If CMS wants to continue this ferocious cycle of audits, they need more ALJs,” said Brummett.

It would help if the audit contractors, on all levels, were held to consistent standards, say stakeholders. An Office of Inspector General report, released in November 2012, found that 56% of redeterminations were overturned by the ALJs. The report recommended that OMHA and CMS provide more coordinated training on Medicare policies, and that they identify and clarify Medicare policies that are unclear and interpreted differently. 

Despite the long wait—and potential cash crunch—industry attorneys still say appealing decisions is the best thing to do.

“It’s a business decision whether a claim is too small to go to the trouble,” said Asela Cuervo, a private practice attorney in Washington, D.C. “If you appeal, at least you’ve got a chance to be paid whereas, if you do not appeal, you definitely won’t get paid.”

WASHINGTON – CMS told lawmakers during a briefing on Nov. 18 that they’re investigating reports that some contract suppliers are not servicing their entire bid areas.

Although the briefings were closed to the public, industry stakeholders heard that CMS told lawmakers it’s using secret shoppers to see if contract suppliers are willing to service Medicare beneficiaries that are living in more rural areas.

“When that happens, they begin education,” said Seth Johnson, vice president of government affairs for Pride Mobility. “If the supplier remains out of compliance, they may ultimately terminate the contract.”

CMS held the briefings for Senate staff and staff of the Energy and Commerce and Ways and Means committees.

While stakeholders agree that CMS should be monitoring contract suppliers, they’re not sure the secret shopper program will be that constructive.

“It doesn’t appear that the secret shoppers are particularly educated about the requirements of the program,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Also during the briefing, CMS told lawmakers that they’ve received only about 120 complaints from beneficiaries. That’s in sharp contrast to the number of complaints collected by the People for Quality Care (PFQC). Nearly five months into Round 2, the PFQC’s hotline still averages 35 to 40 calls per day.

“I don’t know how CMS is counting complaints but ours are quite a bit different,” said Kelly Turner, PFQC director. “We have 2,600.”

One of the most common complaints?

“They can’t get a hold of someone at Medicare to help them find a new provider,” said Turner. “They get passed around or put on hold and finally they say, ‘forget it’ and hang up.”

While CMS continues to say the program is running smoothly, recent actions taken by the agency say otherwise, says Bachenheimer.

“They said they weren’t going to issue new contracts in Tennessee, but they did,” she said. “They changed the oxygen policy because these companies are going out of business and leaving patients stranded. Those are big signs there’s a problem. CMS will never admit there’s anything wrong and they control the flow of information.”

ATLANTA – Brightree has acquired McKinney, Texas-based MedAct, adding 330 HME providers to its customer base. “With the addition of MedAct, we are expanding our market reach to include some of the industry’s most nimble HME providers,” said Dave Cormack, president and CEO of Brightree, in a release. MedAct’s customers will join Brightree’s more than 3,000 customers. Under the terms of the agreement, MedAct CEO Gregg Timmons joins Brightree as executive vice president, MedAct Division. Brightree will continue to provide development and customer support for current MedAct solutions. In addition to MedAct’s customer base, Brightree will be able to leverage the company’s headquarters in Texas, giving it a presence in the central U.S.

OIG releases strategic plan

BALTIMORE – One of the Office of Inspector General’s (OIG’s) four goals for the next four years is to fight fraud, waste and abuse, according to a strategic plan released Nov. 21. The OIG says it plans to continue and expand existing initiatives in this area, like the Medicare Fraud Strike Force and the Health Care Fraud and Abuse Control Program. The agency also says it plans to focus on compliance issues related to fraud, waste and abuse. It plans to promote compliance, resolve noncompliance issues and help the Department of Health and Human Services (HHS) assess whether providers are qualified to take part in government healthcare programs, according to the report. Additionally, the OIG plans to take successful models, such as the Medicare Fraud Strike Force, and use them in other HHS programs, focusing on discouraging waste and promoting Medicare and Medicaid integrity. Other goals in the plan include promoting quality, safety and value; fostering financial stewardship and a high-performing healthcare system; and promoting expertise while leaning on leading-edge technology and tools.

ResMed advances patent case

SAN DIEGO – ResMed has won preliminary injunctions in Germany against two medical device manufacturers for alleged patent infringements. The initial orders prohibit Apex Medical, a Taiwanese manufacturer, and BMC Medical, a Chinese manufacturer, from selling or marketing certain products in Germany without a court order, according to a press release. ResMed has also filed lawsuits in Germany that seek damages and permanent injunctions for certain products. "We will continue to defend our investment in intellectual property and pursue all legal remedies to prevent infringement in any country where that infringement exists," said David Pendarvis, global general counsel and chief administrative officer at ResMed. Earlier this year, ResMed pursued similar legal actions against Apex and BMC in the United States. The investigation into BMC is ongoing, while the investigation into Apex resulted in a consent decree requiring Apex to stop importing and selling infringing products.

Stakeholders increase outreach for complex rehab bill

WASHINGTON – The sponsors of a bill in the Senate to create a separate benefit for complex rehab are circulating a “Dear Colleague” letter to ramp up support. With little time left in the current legislative session, the bill, S. 948, has only six supporters in the Senate. “We need to increase our Senate outreach and build on the substantive positives we have,” wrote Don Clayback, executive director of NCART, in a bulletin. Sens. Charles Schumer, D-N.Y., and Thad Cochran, R-Miss., introduced S. 948 in May. Some of those positives: Schumer and Cochran are two of the most senior senators; both Democrats (four) and Republicans (two) support the bill; and members of the Finance Committee and the Health, Education, Labor and Pension Committee are represented among supporters. NCART asks providers to contact their senators and follow up with them about the letter. A similar bill in the House of Representatives, H.R. 942, has 85 supporters, with a goal of 100. A list of the supporters for both bills, as well as Schumer and Cochran’s letter, is available at www.access2crt.org.

PFQC to providers: Encourage bennies to report problems

WATERLOO, Iowa – The number of Medicare beneficiaries calling the People for Quality Care (PFQC) hotline to report problems related to competitive bidding continues to climb. The organization recently released an updated report containing 2,614 complaints. Because the number of complaints coming into the hotline, however, has slowed, the PFQC is calling on providers to encourage beneficiaries to report problems. The organization, which shares the reports with Congress, is releasing new fliers to help providers educate beneficiaries about the hotline.

Liberator stock heads to NYSE

STUART, Fla. – Common stock of Liberator Medical Holdings began trading on the New York Stock Exchange under LBMH on Nov. 20. “We are confident that our leading market positions and strong customer relationships, combined with the increased visibility of being listed on the NYSE, will help enhance value for all stakeholders,” stated Mark Libratore, Liberator CEO, in a release. Liberator, whose products include diabetic and ostomy supplies, posted strong earnings in the third quarter of 2013.

6-4-18 Series returns to Medtrade

LAS VEGAS – The 6-4-18 Series of educational sessions, which debuted at Medtrade in October, will be part of Medtrade Spring in March, show organizers have announced. Unlike at Medtrade, however, the series will be open to all attendees. “Medtrade is committed to survival and success of the HME industry,” said Kevin Gaffney, show director, in a release. “By making these important sessions open to all, we believe a large number of providers will benefit.” Topics in the series, which is designed to provide six building blocks for success in the next 18 months, include using software as a business management tool and becoming a certified DME specialist. The early bird rate for Medtrade Spring ends Dec. 31.

Alliqua secures $13M

LANGHORNE, Pa. - Alliqua has closed a pair of deals that brings the company two new products and $13 million in investments, the Philadelphia Business Journal reports. “Alliqua now has significant capital to bring our business plans to fruition,” said CEO David Johnson in the story. In a deal with Celgene, Alliqua obtained the rights to develop and market advanced wound care products Biovance and Extracellular Matrix, and Celgene purchased $6 million in Alliqua stock. Separately, Broadfin Capital and Perceptive Advisors rounded up $7 million in investment capital for Alliqua, according to the story.

New CPAP available online only

BOSTON – Human Design Medical released Z1, a new portable CPAP machine, on Nov. 21. The palm-sized machine weighs 10 ounces and uses a lithium ion battery that works for 8 hours without backup power, according to a release. “Our goal was to make CPAP treatment more user-friendly for people with active lifestyles and I think we really nailed it,” said Steve Moore, senior vice president of sales and marketing. “I am a CPAP user myself and have taken the Z1 on business trips across the U.S. and overseas.” The Z1 machine will be available exclusively through the following Internet resellers: thecpapshop.com, cpap.com, cpapsupplyusa.com and directhomemedical.com.

NIH finds poor communication a barrier to COPD treatment

BETHESDA, Md. - To more effectively treat COPD, patients and their doctors need to have open, detailed conversations, a web-based study by the National Institutes of Health has found. Current smokers are likely to talk with their doctors about COPD symptoms (82%), but former smokers, who are also at risk, are not (37%), according to the study, which was released Nov. 15. "A good conversation between patients and providers about COPD can make a real difference for disease sufferers,” said James Kiley, director of National Heart, Lung and Blood Institute Division of Lung Diseases. “It’s no secret that early diagnosis and treatment can improve daily living for those who have COPD—but you can’t get there without an open dialogue in the exam room.” The study says continuing to increase awareness of the disease and its symptoms will help improve patient-provider communications and treatment of the disease.

Short takes

Fifty children and their families attended the Nov. 22 Dallas Mavericks basketball game as part of “One Shot Away,” a diabetes recognition program hosted by Med-Care Diabetic & Medical Supplies, the Mavericks and the North Texas Chapter of the American Diabetes Association…Invacare has donated eight power wheelchairs to Youth Challenge’s new Paralympic Power Soccer program. Participants play four-on-four matches in power wheelchairs fitted with bumpers…Sunset Healthcare Solutions has launched its annual fundraising campaign to benefit the Toys for Tots Foundation. For each 6-foot long CPAP tube sold in the next two months, the company will donate a portion of the proceeds to Toys for Tots…The American Association for Respiratory Care honored Philips Respironics with the 2013 Zenith Award during the 59th International Respiratory Congress on Nov. 16. Philips received the award for the 15th time…Convaid recently volunteered at the fifth annual Strollathon in The Woodlands, Texas. The International Rett Syndrome Foundation organizes the event to raise research dollars and public awareness.

VALDOSTA, Ga. – Numotion has purchased the custom mobility division of Barnes Healthcare Services, according to a Nov. 26 release. Barnes, which offers post-acute complex care in Georgia, Florida and Alabama, will now focus on pharmacy, respiratory, nutrition and medical supplies. “The addition of Barnes’ seven locations in Georgia and Florida greatly expands our coverage and improves access to complex rehab technology to residents throughout the region,” said Bill Boyce, regional vice president of Numotion, in the release.

Smith & Nephew makes wound care buy

LONDON – Smith & Nephew has agreed to acquire the wound management-related assets and business of Brazil’s Politec Saude, furthering its plans to build an emerging markets business, according to a Nov. 26 release. Politec Saude is Brazil’s lone distributor of Smith & Nephew advanced wound management products. “Brazil is an exciting long-term opportunity and this is an important investment which creates a significant platform from which we can grow,” said Olivier Bohuon, Smith & Nephew CEO. The acquisition comprises one-quarter of Politic’s total business; the company will continue to operate its other businesses as usual, according to the release.

Lincare offers mobile cardio telemetry

CLEARWATER, Fla. – Raytel Cardiac Services, which Lincare has sole rights over, is now offering mobile cardio telemetry services through M-Air, according to a recent release. CardioComm Solutions, which develops technology to record, view, analyze and store ECGs, developed the wireless ECG monitoring solution using TZ Medical’s Aera CT device and Raytel’s CardioCare Diagnostic Arrhythmia Service, according to the release. CardioComm released the M-Air solution to Raytel for implementation on Nov. 9.

ResMed CFO sells 15K shares

SAN DIEGO - Brett Sandercock, ResMed CFO, sold 15,000 shares of company stock Nov. 20, according to news reports. The shares were sold at an average price of $51.06, for a total of $765,900. Sandercock now directly owns 94,902 shares in ResMed, worth about $4.8 million, according to reports. ResMed recently announced its first quarter earnings for 2014, reporting slower growth versus the previous year due to Round 2 of competitive bidding.

Contractor clarifies respiratory policy

WASHINGTON – Medicare does not reimburse for home oxygen used specifically to treat obstructive sleep apnea (OSA) because it is not the primary treatment for that disease, even if beneficiaries cannot tolerate PAP devices, CGS Associates said in a recent FAQ. The DME MAC said beneficiaries who use a PAP device to treat OSA and who are in need of oxygen for other chronic pulmonary conditions like COPD, however, qualify for reimbursement if they meet the requirements of the oxygen and PAP local coverage decisions (LCDs) and have been diagnosed using a titration polysomnogram. 

3B Medical releases PAP software

LAKE WALES, Fla. – 3B/BMC has released nPap Data Analyzer, a new software that works alongside the company’s line of CPAP and Auto-CPAP devices, according to a Nov. 22 release. The software allows clinicians to develop reports and graph trends in pressure, leak levels, apnea-hypopnea, flow level, tidal volume and respiration rate. The program is available to download at no cost. Also on Nov. 22, 3B Medical announced that its iCodeConnect, a web-based data management system, now features SD card functionality, the company announced Nov. 22. The iCodeConnect system allows DME providers and physicians to store patient data, generate sleep reports, exchange notes, and manage patients efficiently. The upgrade will allow the iCodeConnect patient management portal to integrate with the portable memory cards.

AABCP to launch post mastectomy awareness campaign 

HOUSTON – The American Association of Breast Care Professionals (AABCP) has announced plans for several events throughout 2014 to raise political and public awareness for the need for post mastectomy services. The campaign will include basic education and explanations of what post mastectomy services are and how these medically necessary items differ from normal lingerie or aesthetic beauty products. More information about the effort is available at www.aabcp.org.

Short Takes

101 Mobility Tampa partnered with Harmar to donate and install a wheelchair lift as part of an effort to build an accessible home for injured Army Staff Sergeant (SSG) Alex Dillmann. Dillmann will receive the house Dec. 5…New Berlin, Wisc.-based Home Care Medical has launched a redesigned website with additional educational materials, a promotions page and a new careers page.

DALLAS and ORANGE PARK, Fla. – A new partnership means DMEhub integrates with and supports Aprima Medical Software’s electronic health record (EHR) system, allowing physicians to order DME directly through Aprima.

“Aprima is very pleased to be able to offer this important new time-saving feature to our customers,” said Michael Nissenbaum, Aprima president and CEO, in a release. “The need to automate the DME ordering process is becoming increasingly important as we see the population age and the home healthcare market grow.”

As a result of the integration, DMEhub now pulls the patient demographic information directly from records and populates the necessary forms. It also allows physicians to attach documents.

DMEhub then electronically sends the forms to the correct supplier and incorporates the forms back into the records.

“We feel that through this partnership we are bringing a solution to Aprima’s customers that will save them time in their day-to-day workflow, therefore saving their practice money,” said Jeff Jacobs, DMEhub president, in the release.

WASHINGTON – As this year’s congressional session winds down, HME stakeholders are eyeing the “doc-fix” bill as the best vehicle for H.R. 1717. The Senate Finance and House Ways and Means committees are expected to mark up the doc fix bill on Thursday, according to Cara Bachenheimer, senior vice president of government relations for Invacare. If a finalized fix to physician reimbursement is delayed, it would give the industry more time to push H.R. 1717, which has 160 co-sponsors, said John Gallagher, vice president of government relations for The VGM Group. Stakeholders continue to receive positive feedback on H.R. 1717, which would replace competitive bidding with a market-pricing program. “We continue to receive positive signs from the Finance and Ways and Means committees in that they recognize there are problems with the program and want to fix them in the near future,” said Seth Johnson, vice president of government affairs for Pride Mobility.

CMS issues refunds

WASHINGTON – CMS will issue refunds for collections it made on incorrectly identified overpayments associated with incarcerated Medicare beneficiaries, according to National Government Services. The agency has acknowledged that, this past summer, when it initiated recovery of payments made to providers on behalf of beneficiaries it believed were incarcerated at the time of service, it used incomplete data. National Government Services says it will not be able to provide additional information on this topic until after Dec. 12. More information is available online.

ActiveCare ‘unlocks’ growth opportunity

OREM, Utah – ActiveCare, a diabetes and chronic disease management company, has retained DelMorgan & Co. to serve as its financial adviser. DelMorgan, an investment banking firm, will advise ActiveCare on strategic plans, including investments, possible acquisitions, divestitures and joint ventures, according to a release. “With a substantial sales pipeline and the need to fund working capital for growth, solving ActiveCare’s short-term financial challenges should unlock the opportunity for explosive future expansion and substantial profitability,” stated Neil Morganbesser, DelMorgan president and CEO, in the release. “Our goal is to help ensure that capital is available for growth and the company can execute its business plan.” ActiveCare manages more than 30,000 diabetes patients for nearly 100 employers. “With over 25 million diabetics and another 79 million pre-diabetics in the United States costing over $245 billion per year—33% of the nation’s total healthcare costs—there is tremendous market demand for an approach that has been shown to reduce those costs,” stated Rob Delgado, chairman of Delgado. “ActiveCare has that solution.” ActiveCare uses “state-of-the-art” meters that allow its CareSpecialists to intervene in real time and provides around-the-clock support.

DMEhub now integrates with physician system

DALLAS and ORANGE PARK, Fla. – A new partnership means DMEhub integrates with and supports Aprima Medical Software’s electronic health record (EHR) system, allowing physicians to order DME directly through Aprima. “Aprima is very pleased to be able to offer this important new time-saving feature to our customers,” said Michael Nissenbaum, Aprima president and CEO, in a release. “The need to automate the DME ordering process is becoming increasingly important as we see the population age and the home healthcare market grow.” As a result of the integration, DMEhub now pulls the patient demographic information directly from records and populates the necessary forms. It also allows physicians to attach documents. DMEhub then electronically sends the forms to the correct supplier and incorporates the forms back into the records. “We feel that through this partnership we are bringing a solution to Aprima’s customers that will save them time in their day-to-day workflow, therefore saving their practice money,” said Jeff Jacobs, DMEhub president, in the release.

Court ruling boosts Hasco’s biz

ADDISON, Texas – Hasco Medical has received orders for $2.5 million worth of handicap accessible taxicabs, the company announced today. The orders represent about 80 taxicabs that will be deployed in the New York City market. “This is such a great purchase for our company,” said CEO Hal Compton in a release. “Hasco will continue to work with more taxi companies in various states to continue to provide accessible vehicles for every person that requires one.” A court ruling has required that New York City put more handicap accessible taxicabs on the road. In mid-November, the city auctioned 200 medallions, or licenses, for handicap accessible taxicabs, and in the next three years, it will auction off another 1,800. Currently, New York City has 233 handicap accessible taxis, representing less than 2% of its total fleet of 13,000 cabs. Hasco sells handicap accessible vans in 18 locations from Maine to Florida. It consists of Ride-Away, Auto Mobility Sales, Mobility Freedom and Wheelchair Vans of America. In Florida, Hasco also sells medical equipment and supplies through Certified Medical.

Sleep support community celebrates first year

SAN DIEGO - Wake Up to Sleep, an online support community for sleep apnea patients, has celebrated its first anniversary, ResMed announced Dec. 5. Patients can use the site for screening tools and symptom tests, or if they’re already using CPAP therapy, to monitor their therapy data and set goals. “Patients who are engaged in their own therapy are more likely to be compliant in the long run,” said Jim Hollingshead, president of ResMed Americas, in a release. “This decreases patient health risks, while also creating a smoother path to reimbursements for HMEs.”

Jafari Medical Supply calls for diabetic-friendly recipes

BOSTON – Jafari Medical Supply is calling for diabetic-friendly holiday recipes that it will assemble into an electronic recipe book, the company announced Dec. 4. “Around the holidays, especially, we know it gets really rough for diabetics,” said Robert Jafari, company owner, in a release. “We wanted to give them some options so they’re able to participate fully in the joys of the season.” Jafari Medical Supply recently sponsored a Facebook contest seeking diabetic-friendly desserts. Visit Jafari’s Facebook page to learn more about the contest, which runs through Dec. 18.

Clay Home Medical donates wheelchairs to vets

PETERSBURG, Va. – Clay Home Medical provided 10 wheelchairs to veterans participating in an Honor Flight in October, the company announced Dec. 5. Veterans of the Second World War and the Korean War traveled to Washington, D.C., to visit the nation’s war memorials as part of the event. “We are proud to support Honor Flight and our veterans in this special event,” said Sam Clay, president, in a release. “It is our hope that we can continue to honor veterans in this manner in the future.”

Audit tools available for download

WASHINTGON – AAHomecare’s audit checklists and tracking tool are now available to download from the association’s website. The association’s Regulatory Council produced five processing checklists to help providers avoid audits—all have been reviewed by attorneys and provider representatives. The tracking tool is a spreadsheet that providers can use to monitor the volume and effect of audits. The checklists and tracking tool are free for AAHomcare members.

Study examines reason for COPD in women

LEXINGTON, Ky. – The growing prevalence of COPD in women is due to changes in smoking trends, work hazards and, possibly, hormones, according to a new study published in Translational Research. “Over my 30 years of treating patients, I’ve seen the number of women with COPD increase dramatically to where they now outnumber the number of men with COPD in my practice,” said study author Dr. David Mannino of the University of Kentucky. “Women with COPD are particularly at risk for certain complications, such as osteoporosis.” More women are smoking, and may be exposed to more chemicals and pollution at work than they traditionally were, according to the study. Female sex hormones are now shown to influence airways, as well, with scientists learning tobacco smoke and air pollution have a greater effect on the lung function of girls than boys.

American HomePatient names new president, CEO

BRENTWOOD, Tenn. – Mark Lamp will take over as president and CEO of American HomePatient (AHP) on Jan. 1, the company announced Dec. 3. Lamp was most recently president and COO of Guardian Homecare Holdings, which he led to a successful sale in 2012. He has extensive prior experience in private equity-backed and public companies in healthcare information systems and services. Lamp replaces Joseph Furlong, who will retire after 15 years at the helm of AHP. Furlong will remain on the board of directors as an advisor to AHP and Highland Capital Management, which manages the funds that owns the company.

Heartland IV Care sweeps enteral contracts

TOLEDO, Ohio – Heartland IV Care has been awarded contracts to provide enteral care in all nine competitive bid areas included in the Round 1 re-compete, the company announced Dec. 3. The company was awarded 41 contracts in Round 2. Heartland IV operates in partnership with Heartland Home Health Care and Hospice, both part of the HCR ManorCare family. HCR ManorCare is a provider of home infusion, home health care and hospice services, as well as short-term post-acute and long-term care services. It has 60,000 caregivers nationwide.

CMS: Mail order costs more than pharmacies

ALEXANDRIA – It costs Medicare up to 83% more to fill prescriptions through mail-order pharmacies than through community pharmacies, a new analysis has found. Examining millions of claims from March 2012, CMS found that 21 prescription drug plans (PDPs) routinely paid more to fill prescriptions by mail. “Mail order is not for everyone and its appeal as a cost-saver is severely undermined by this analysis,” said Douglas Hoey, CEO of the National Community Pharmacists Association (NCPA), in a release. A possible reason for the increased costs: The pharmacy benefit managers (PBMs) that administer the PDPs own most mail-order pharmacies, the release states. “PBMs can grow their profits by steering a plan’s patients to a PBM’s mail-order pharmacy, regardless of the patient’s preference or whether doing so results in higher costs to the drug plan or the Medicare program,” the release states.

CareCentrix program reduces readmissions

HARTFORD, Conn. – CareCentrix’s HomeSTAR program has cut hospital readmissions by 20% for Aetna members in Florida, the company announced Dec. 3. The program offers support to patients moving to self-managed home care after hospitalization. “Our HomeSTAR program is a great example of the significant impact that targeted interventions delivered in the home can have on patients’ recovery and overall health,” said John Driscoll, CareCentrix CEO, in a release. Readmissions cost more than $31 billion per year, according to the U.S. Agency for Healthcare Research and Quality.

CMS announces bidding webinars

WASHINGTON – Webinars on the Round 1 re-compete of competitive bidding have been scheduled for Dec. 9, Dec. 11 and Dec. 12, CMS has announced. Each lecture-style webinar is limited to 1,000 participants, and CMS asks each participant to register for only one session. Although questions will be taken, they will not be answered live, CMS says.

Water Street divests infusion company

CHICAGO – Water Street Healthcare Partners has sold Stoughton, Mass.-based Medical Specialties Distributors to New Mountain Capital, according to a Dec. 2 release. Medical Specialties Distributors, which supplies infusion therapy products, supplies, biomedical services and IT solutions, purchased Medical Technology Resources in June. “Water Street has been instrumental in our company’s success,” said Jim Beck, president and CEO of Medical Specialties Distributors, in a release. “Its team helped us generate new ideas and expand our relationships with the industry’s leading manufacturers and multi-site health care providers.”

ResMed seals deal in Czech Republic

PRAGUE – ResMed has acquired Unimedis, a Prague-based company that distributes equipment for sleep disorders, according to news reports. Unimedis covers the Czech Republic and Slovakia. Ondrej Kalas will remain as manager. “This acquisition continues ResMed’s emerging market strategy of growing our distribution to bring market-leading sleep-disordered breathing and respiratory care solutions to places where they’re needed most,” said ResMed-Europe President Anne Reiser. Terms of the deal were not disclosed.

Former Apria exec moves to new post

DENVER – Daniel Greenleaf is now president and CEO of specialty-infusion company Home Solutions, the Denver Post reports. “His strong executive skills and commercial and operations background bring crucial elements to achieve significant growth, operational efficiencies and continued success for Home Solutions,” said Steve Neumann, managing partner of KRG Capital Partners. Greenleaf joined Apria as president of Coram Specialty Infusion in 2008, which CVS Caremark purchased last week for $2.1 billion.

WASHINGTON – AAHomecare is urging HME providers to reach out to Senate Finance Committee members in the wake of a late-breaking development concerning competitive bidding.

The committee is scheduled to markup a sustainable growth rate (SGR) reform bill, or “doc fix” bill, tomorrow at 10 a.m. and Sens. Ben Cardin, D-Md., Bob Casey, D-Pa., Rob Portman R-Ohio, Pat Roberts, R-Kan. and Debbie Stabenow, D-Mich., all members of the committee, have either offered to include or are supporting including amendments to the bill to fix the competitive bidding program.

“Today is the day to make your thoughts on the disastrous Medicare bidding program known to your senators,” AAHomecare stated in a bulletin to members. “This is the first time in many years that the Senate has taken action to help us, so now we all need to help ourselves by drumming up as much additional support as possible.”

AAHomecare is advising providers to call senators who sit on the committee and ask them to support the amendments. If their senator is not on the committee, they should ask them to contact the committee’s leadership and declare their support.

For a list of committee members, go here.

WASHINGTON – The HME industry scored a small victory last week when an amendment to fix a problem with Medicare’s competitive bidding program was included in a markup of the “doc fix” bill passed by the Senate Finance Committee on Dec. 12.

“The goalposts are a little closer,” said Tom Ryan, AAHomecare president and CEO. “By no means are we putting up a mission accomplished flag, but the fact that there’s a mention of a fix for competitive bidding in the markup is an achievement.”

The amendment, offered and supported by a bi-partisan group of four senators led by Sen. Rob Portland, R-Ohio, would require providers to prove they meet licensure requirements in states where they don’t have a presence before they’re allowed to submit bids.

Stakeholders say, however, that the language in the amendment isn’t carved in stone.

“It’s very fluid right now,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “It’s difficult to pinpoint what will happen but it gives us a placeholder to build on.”

In fact, going into last week’s vote, the amendment was more expansive. It also sought to prohibit providers from expanding into more than five new areas and adding any more than two new product categories in any single year.

“The Congressional Budget Office indicated that there were administrative costs associated with CMS having to rewrite the regulation to meet that part of the amendment and due to that they had to gut it to only include the licensure requirement,” said Seth Johnson, vice president of government affairs for Pride Mobility.

Ultimately, the Senate bill will need to be reconciled with the House bill—which didn’t include any amendments related to competitive bidding—when lawmakers return to work in January. A three-month patch to the “doc fix,” also voted on last week, means they’ll be working on the bill well into March, stakeholders say.

“Being in there this early is good,” Johnson said. “As it works its way through, we can try to add more substantive relief.”

For providers struggling to survive in areas already included in competitive bidding, these developments may not mean much, acknowledges Ryan, but it’s the big picture that the industry needs to focus on.

“Sen. Portman, in his opening statements in a packed room, talked about the fact that we have to recognize that there’s been an issue with the DME benefit with competitive bidding and the licensure issue,” he said. “That’s significant.”

YARMOUTH, Maine – Despite reimbursement cuts and heavy audits by insurers, the revenue mix of HME providers isn’t as diversified as you’d expect, according to the results of a recent HME NewsPoll. 

The largest percentage of respondents to the poll (40%) say they continue to rely on insurance—including Medicare, Medicaid, private-pay, etc.—for 76% to 100% of their revenues.

“We’ve had a slight increase in retail, but mostly, we’ve just stayed the same for 15 years,” said one respondent.

Seventy-seven percent of respondents to the poll report they earn 25% or less of their revenue from retail. Ninety-two percent report they earn 25% or less of their revenue from e-commerce.

For some respondents, diversification efforts go beyond retail and e-commerce. Several reported an increase in revenues from markets like home accessibility and payers like hospice facilities.

“It was 75/25, with Medicare and other insurers dominating,” one respondent wrote. “Now, it’s 75/25, with hospice dominating.”

There’s no doubt, however, that some respondents are passionate about the potential of retail and e-commerce.

“The No. 1 biggest change for me is making an effective online store, hands down,” said one respondent. “A big part of that is the development of my website to allow consumers to research all my products and services efficiently and effectively. Most of my consumers do their research on my website before they ever make an attempt to call or come into the store.”

For some respondents, retail and e-commerce have totally transformed their businesses.

“Retail was 1% of revenues 10 years ago and now it over 20%,” said Med Fadel of BetaMed in Bryan, Texas.

One thing’s for sure, as one respondent said: “Our company will always be a work in progress.”

“Since our traditional funding sources have decided to not adequately fund our industry, it’s our task to find our own way in the market again,” said Brent Bradshaw of Austin’s Durable Medical Equipment, Inc., which has been in business for 44 years.

WASHINGTON – A 5th Circuit Court ruling over runny eggs could be just the ammunition HME providers need in cases involving ambiguous CMS guidelines.

“People think this case is humorous because of the underlying facts, but it has implications for all types of Medicare providers,” said Edward Vishnevetsky, an associate with Munsch Hardt in Dallas. “This is the first time we’ve seen a court not defer to CMS’s interpretations.”

Prompting the ruling was an appeal filed by Elgin Nursing Rehabilitation Center disputing a $5,000 fine it received for soft cooked eggs. At issue: Whether or not eggs could be soft-cooked if heated to a certain temperature depended on the interpretation of a semicolon as meaning “and” or “or.”

When the court sided with the nursing home’s interpretation, that opened the door to other providers with “reasonable” interpretations of CMS’s guidelines to challenge denials, attorneys say.

“Providers are not going to be laughed at—they’re not going to be ignored,” said Neil Caesar, president of the Health Law Center in Greenville, S.C. “The reasonableness of the interpretation (in this case) is based on the layman’s standard, not an attorney’s standard.”

Providers could use the Elgin case to convince administrative law judges (ALJs) to rule in their favor, attorneys say. That could ultimately lead to clearer CMS guidelines and should reduce the number of denials based on ambiguous provisions in local coverage determinations (LCDs) and other policy manuals, attorneys say. 

“We’ll need numerous cases proving this in different scenarios,” said Vishnevetsky. “This is a starting point to see how much, or how little, courts will defer to the agency going forward.”

HIGH POINT, N.C. – Advanced Home Care has merged with WellStar HME & Infusion to expand its footprint in Georgia, the provider has announced. Marietta, Ga.-based WellStar HME & Infusion provides home infusion, specialty pharmacy and home medical equipment and services in the greater Atlanta area. “We entered the Atlanta market at the beginning of 2013 with the purchase of a company in Norcross,” said Joel Mills, CEO of Advanced Home Care, in a release. “Our new relationship with WellStar strengthens our commitment to this region.” Advanced Home Care announced on Jan. 1, 2013, that it had acquired Extrakare. The merger also allows Advanced Home Care to broaden its services to WellStar Health System, an integrated healthcare delivery system that includes numerous medical centers, hospitals, urgent care centers and other providers. WellStar Home Health is not part of the merger and will continue to provide in-home nursing for infusion patients, according to the release. Advanced Home Care will continue to operate its Norcross location. In all, it has 34 locations throughout Georgia, North Carolina, South Caroline, Tennessee and Virginia.

ASP: Budesonide reverses course

BALTIMORE – When it comes to nebulizer medication pricing, one quarter you’re up; another quarter you’re down. Average sales price (ASP) figures for the first quarter of 2014 revealed a decrease for budesonide (J7626) of nearly 35 cents to $5.60 per dose. That’s in contrast to the previous quarter, when the drug increased 85 cents. The only other drugs to see increases for the upcoming quarter: brand names Brovana (J7605) and Perforomist (J7606), which increased 22 cents and 6 cents, respectively. That puts pricing for Brovana at $5.77 and Perforomist at $6.36. There was relatively little change for other neb meds. Albuterol (J7613) and ipratropium (J7644) were both down less than one cent to just under 12 cents per dose each.

Invacare board member sells shares

ELYRIA, Ohio – C. Martin Harris, a member of the board of directors of Invacare, sold 1,775 shares of company stock Dec. 9, according to new reports. Harris sold the shares for, on average, $22.15 each, for a total of $39,316. Harris, who is the chief information officer and chairman of the Information Technology Division at the Cleveland Clinic Foundation, now owns 16,806 shares of Invacare stock, worth about $372,253.

Liiv turns to Onehealth & One Source for diabetic supplies

LOS ANGELES and HOLLAND, Mich. – Onehealth & One Source’s Diabetic 360 program is now the exclusive provider of diabetic supplies and education to Liiv’s clients, the companies announced Dec. 13. Diabetic 360 offers blood-glucose meters, diabetic supplies and full-spectrum healthcare information. “Managing the health status of individuals through an integrated care management program is the most effective way to improve compliance and reduce health-care costs,” said Mike Archambault, Onehealth CEO, in the release. Liiv provides online health management and wellness programs. 

Orthotic Holdings buys SafeStep

RONKONKOMA, N.Y. – Orthotic Holdings Inc. (OHI) announced Dec. 12 that it has acquired SafeStep, a provider of therapeutic footwear, custom ankle-foot orthotics and other podiatry DME. “The acquisition of SafeStep is consistent with OHI’s vision of creating a complete continuum of care for our healthcare partners,” said Jason Kraus, OHI president and COO in the release. SafeStep provides more than 500 shoe styles from eight manufacturers to more than 3,000 medical practices. The company helps podiatrists remain compliant with Medicare by streamlining billing and procurement. OHI’s brands include Langer Biomechanics, Arizona AFO and The Orthotic Group. It distributes medial technologies throughout North America, Europe and Australia.

VMI creates Veteran Advocate Center

PHOENIX – Vantage Mobility International (VMI) and its dealers have created a Veteran Advocate Center at the company’s Phoenix headquarters. At the center, which is part of VMI’s Operation Independence, a team of former military personnel assists and supports disabled veterans who may qualify for mobility vehicles through Veterans Affairs, according to the release. “The process of finding and applying for veterans’ benefits can overwhelm even the most patient and tech savvy veteran,” said Jeff Weston, VMI vice president of sales and business development, in the release. “Our Veteran Advocate Center team is solely focused on helping our veterans obtain the mobility vehicle benefits.”

Convaid expands Canadian distribution

TORRANCE, Calif. – Convaid has expanded distribution of its products in Canada through a new partnership with Drug Trading, the company announced Dec. 11. Drug Trading is the oldest and largest independent pharmacy program and services provider in Canada, according to the release. “With the addition of the Drug Trading partnership, Convaid is experiencing double-digit growth in Canadian sales,” said Chris Braun, Convaid president, in the release. 

CVS Caremark, Cardinal create nation’s largest generic source

DUBLIN, Ohio and WOONSOCKET, R.I. – CVS Caremark and Cardinal Health have agreed on a 50-50 partnership to create the nation’s largest source of generic drugs, according to a Dec. 10 announcement. Both companies will contribute their sourcing and supply chain expertise to the joint venture and will source generic drugs through it. Over the 10-year term of the agreement, Cardinal Health will pay CVS Caremark $25 million each quarter, but neither company will contribute physical assets. “This venture is an extremely compelling combination where volume and efficiency matter,” said George Barrett, chairman and CEO of Cardinal Health, in the release. Both companies have a toe in the HME industry: Cardinal Health acquired AssuraMed earlier this year, and CVS Caremark bought Apria’s home infusion business, Coram, in November.

Complex rehab stakeholders fight capped-rental change

WASHINGTON – Providers, consumer groups, clinicians and other stakeholders are fighting a rule that will transition certain complex rehab codes to capped-rental items in April, according to a bulletin from NCART. First on their agenda: Communicate concerns to Department of Health and Human Services Secretary Kathleen Sebelius and CMS Administrator Marilyn Tavenner and ask for an immediate delay in implementation until at least July 1, 2014. They also seek an in-person meeting as soon as possible to discuss needed modifications to the rule, according to the bulletin. Stakeholders will also meet with lawmakers to encourage them to reach out to CMS on the issue.

CPAP use may help lower blood pressure, study says

VALENCIA, Spain – Sleep apnea sufferers with hard-to-control blood pressure may find an ancillary benefit to CPAP therapy: Spanish researchers say it may lower resistant blood pressure. In a study published Dec. 11 in the Journal of the American Medical Association, researchers examined sleep apnea patients taking three or more blood-pressure medications. Those who used CPAP for 12 weeks saw a drop in their diastolic blood pressure, according to the study, partly funded by Philips Respironics. “The prevalence of sleep apnea in patients with resistant high blood pressure is very high,” said head researcher Miguel-Angel Martinez-Garcia of Valencia’s Polytechnic University Hospital. “This treatment increases the probability of recovering the normal nocturnal blood pressure pattern.”

Rice Home Medical invests $1M in new look, new store

WILLMAR, Mich. – Retail is the focus of Rice Home Medical’s newly renovated space in Willmar, Mich., according to a story in the West Central Tribune. In addition to doubling its retail space, the company has added a sleep wellness center for CPAP and BIPAP machines. “We’re at a changing time in our industry,” Mike Schramm, chief executive, told the newspaper. “There continues to be much more of a need for patients in the home setting. We’re really trying to diversify our services to enable care at home.” The store, which also includes a women’s health area, now retails therapeutic and diabetic shoes, clothes and home equipment in what staff call a boutique setting. Over the past couple of months, the company has invested $1 million to renovate the Willmar store and an Alexandria store, and break ground on a new store in Redwood Falls, according to the newspaper.

Insulet, Amgen form agreement

BEDFORD, Mass. – Under a five-year agreement announced Dec. 10, Insulet will supply biotech company Amgen with a device to deliver medications. Insulet makes the OmniPod insulin management system. “We are thrilled to advance our collaboration with Amgen to supply this version of our technology,” said Duane DeSisto, Insulet president and CEO, in a release. “Insulet’s current device, the OmniPod, is a unique drug platform that provides the ability to vary the rate at which medication is infused.”

Medtrade Spring has new schedule

LAS VEGAS – Medtrade Spring will run from Monday through Wednesday this year, March 10-12, organizers have announced. “Unlike in past years when the show ran from Tuesday to Thursday, it will run from Monday to Wednesday in 2014,” said Kevin Gaffney, group show director, in a release. “Attendee feedback has demonstrated to us that this is a more convenient timeframe.” Early bird registration for the Las Vegas event is open through Dec. 31. 

Family: Son died because medical equipment was removed

ATLANTA – A Georgia woman has filed a $10 million lawsuit against Odyssey Hospice and Mobility Warehouse, alleging her disabled son died after the companies removed his medical equipment from the home. Eight days after delivering an oxygen concentrator and other medical equipment to Emmanuel Lee, who suffered from chronic heart and lung problems and was receiving home health care, Mobility Warehouse removed the equipment and Lee collapsed, according to court papers. A physician’s affidavit included in those papers placed blamed on “the removal of the equipment …resulting in destabilization, decompensation and eventual death.”

BMC pledges to fight ResMed’s allegations

BEIJING – Weeks after ResMed announced it won preliminary injunctions in its German patent-infringement case against BMC, the Chinese sleep therapy device maker is pledging to fight. “We will take all the measures required to defend our IP and products, thus protecting our consumer and business interests against the preliminary injunctions,” stated BMC President James Xu in a release. The preliminary injunction that ResMed won did not and could not take BMC’s story into account, according to Ulrich Worm, an attorney retained by BMC. “The court’s decision to grant the preliminary injunction does not mean the court has concluded that BMC’s products infringed the patents,” Worm said. “Until now, no hearing is conducted.” ResMed is pursuing similar legal action in the U.S. BMC has also retained patent specialist Gary Hnath of Mayer Brown to fully contest those proceedings.

Shirvinsky gives notice

HARRISBURG, Pa. – John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers (PAMS), will resign Dec. 20 after 10 years, according to Medtrade Monday. Chuck Blackburn, chairman of Blackburn’s, credited Shirvinsky for shoring up the association’s financial standing and making it “one of the more influential and successful state organizations in the industry.” Shirvinsky previously worked in the coal, steel and solid waste industries, and was chief of staff to the attorney general of Pennsylvania.

Correction

In last week’s HME Newswire story, “Liberator Medical Supply moves to Big Board,” the company’s ticker symbol should have been LBMH.

WASHINGTON – Industry watchers expect CMS to select a contractor early next year to administer a new fingerprinting provision aimed at curbing fraud and abuse

An RFP seeking a contactor to handle the process has a submission deadline of Dec. 23 and an award date of late February, according to AAHomecare

The provision mandates that “high-risk” providers submit fingerprints for a background check through the FBI’s database. Those who will be subjected to the rule include newly enrolling DMEPOS providers and home health agencies; those with payment suspensions in the past 10 years; and those owning at least 5% of a company, directly or indirectly

The provision is part of a final rule published in 2011 setting screening levels for DME providers. The rule established three levels of risk—high, moderate and limited—to guide screening procedures. Re-enrolling providers are considered moderate risk, while physicians and skilled nursing facilities are of limited risk

AAHomecare said it “supports all efforts to curb fraud and abuse, and will work closely with CMS on the implementation phase.”

BALTIMORE – CMS plans to start the new year by enforcing part of its face-to-face rule on Jan 1.

On Dec. 19, National Heritage Insurance Company, the Jurisdiction A DME MAC, stated in a bulletin that it would enforce the written order prior to delivery (WOPD) requirement for dates of service on or after Jan. 1.

“Providers that weren’t getting WOPDs need to start getting them,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “They are saying, ‘Do it.’”

CMS implemented the rule July 1, but the agency has delayed enforcement of the face-to-face exam requirement until some time in 2014.

How CMS will enforce the WOPD requirement but not the face-to-face requirement is a big question mark, Brummett says.

“There’s not a lot of clear direction from CMS,” she said. “We still don’t have a ‘Dear Physician’ letter, and we know there’s an FAQ that we worked on that went back to CMS months ago and we still haven’t seen it.”

CMS has stated that it delayed the enforcement of the face-to-face requirement to give providers enough time to establish protocols. Unfortunately, not everyone has done that yet, says consultant Mary Ellen Conway.

“There are always people that drag their feet in every industry,” said Conway, president of Capital Healthcare Group. “They really have to start getting set up and getting a process in place.”

Stakeholders have recommended from the get-go that providers comply with the rule as soon as possible and not wait for an enforcement date from CMS. The reason: fear that not doing so will open them up to future audits.

“We are about the only DME in our area that’s enforcing it so we have a lot of referrals who don’t understand it,” said Scott Perkins, general manager of Bradley Medical Equipment in Cleveland, Tenn. “It’s a challenge, but if the paperwork is incomplete, we can’t bill for it and we can’t just volunteer our services.”

WASHINGTON – It looks like the timeframe for responding to initial documentation requests as part of the Comprehensive Error Rate Testing (CERT) program will stand at 75 days.

CMS had planned to shorten the timeframe to 60 days, but Kim Brummett, senior director of regulatory affairs for AAHomecare, confirmed last week that the agency has tabled its plans indefinitely.

“I received word from the CERT coordinator that the change in the timeframe has been placed on hold until further notice,” she said. “We don’t know why.”

The CERT program measures improper payments in the Medicare fee-for-service program. Historically, DME has had a notoriously high rate of improper payments: It was 66% in 2012, representing $6.4 billion of $9.7 billion in claims.

It’s anyone’s guess as to why CMS would seek to shorten the timeframe, but one theory is that it may make providers take the requests more seriously, says Rose Schafhauser, executive director of the Midwest Association of Medical Equipment Services (MAMES).

“One of the issues with the higher error rates is providers not responding to the requests,” she said.

Even if CMS goes ahead with the change eventually, having 15 fewer days to respond to requests shouldn’t be a big deal for providers that collect their documentation up front and, therefore, have it at the ready, says Sylvia Toscano, owner of Professional Medical Administrators.

“It’s only devastating if you don’t have the documentation at all,” she said.

One thing’s for sure: Whether providers must respond in 60 days or 75 days, they should respond, even when the request is for a small-dollar claim, Schafhauser says.

“The error rate just never seems to going down,” she said. “When you look at all the percentages—it reflects negatively on the industry and DME companies.”

WASHINGTON – Industry watchers expect CMS to select a contractor early next year to administer a new fingerprinting provision aimed at curbing fraud and abuse. An RFP seeking a contactor to handle the process has a submission deadline of Dec. 23 and an award date of late February, according to AAHomecare. The provision mandates that “high-risk” providers submit fingerprints for a background check through the FBI’s database. Those who will be subjected to the rule include newly enrolling DMEPOS providers and home health agencies; those with payment suspensions in the past 10 years; and those owning at least 5% of a company, directly or indirectly. The provision is part of a final rule published in 2011 setting screening levels for DME providers. The rule established three levels of risk—high, moderate and limited—to guide screening procedures. Re-enrolling providers are considered moderate risk, while physicians and skilled nursing facilities are of limited risk. AAHomecare said it “supports all efforts to curb fraud and abuse, and will work closely with CMS on the implementation phase.”

DME MACs remind physicians of PECOS rules

BALTIMORE – Beginning Jan. 6, CMS will withhold payments to providers who provide DMEPOS prescribed by physicians not enrolled in the Provider Enrollment, Chain and Ownership System (PECOS), the four DME MACs reiterated in a letter to physicians this month. Physicians must enroll and register in PECOS, and have a specialty that makes them eligible to order DMEPOS for Medicare beneficiaries. “Help your DMEPOS supplier to continue providing quality service to your Medicare patients by promptly enrolling in PECOS, or by updating your existing Medicare enrollment information if you have not done so recently,” the said in the letter.

VGM launches survey of referral sources

WATERLOO, Iowa – The VGM Group is conducting a survey of referral sources to document discharge problems related to competitive bidding. The group is supplying a set of questions to providers to give to local referral sources. Once providers have sent completed surveys to The VGM Group, it will collect the data, and distribute it to members and state associations to help them discuss discharge problems with lawmakers.

CMS updates DMEPOS fee schedule

BALTIMORE – Providers will see a tiny bump in the 2014 Medicare DMEPOS fee schedule. The 1% increase reflects the 1.8% Consumer Price Index-Urban update minus the 0.08% annual productivity adjustment for 2014, according to AAHomecare. The increase applies only to allowables in non-competitive bidding areas, the association says.

PHM on course for record revenue, profit growth

SAN FRANCISCO – Patient Home Monitoring, a company servicing patients with chronic diseases, expects to meet record revenue and EBITA figures for the quarter ending Dec. 31, according to a Dec. 18 news release. In October and November 2013, the company’s revenue exceeded $1.65 million, setting up the company for triple-digit quarterly revenue growth, according to the release. “We continue to focus our energies on cross selling and acquiring companies that can increase our patient database,” said CEO Bob Kusher. In the release, PHM announced its first acquisition, HHC, is now serving 30,000 patients in its pharmacy channel diabetes program.

CMS changes rule to combat mail-order waste

ALEXANDRIA, Va. – Effective Jan. 1, Medicare Part D prescription drug plans must obtain consent from beneficiaries or their caregivers before filling or refilling prescriptions, according to a Dec. 17 bulletin from the National Community Pharmacists Association (NCPA). Pharmacists have told CMS that patients are turning in large quantities of unused and expired medication, usually obtained through automated refill services. “We commend Medicare officials for acknowledging mail-order waste and for responding to the concerns of patients and community pharmacists by implementing this new policy,” said NCPA CEO Douglas Hoey in a statement. Medicare recently found it costs as much as 83% more to fill prescriptions through mail-order pharmacies than through community pharmacies.

With CareTouch, Argosy’s reorder rate soars

DENVER – By teaming up with CareTouch Communications, Argosy Group has realized a 78% reorder rate, CareTouch announced Dec. 18. Argosy was losing 40% of resupply orders because the company wasn’t in constant contact with patients, according to a release. “Utilizing CareTouch’s live-call team was critical to the early success of the program,” said Douglas Stallbaumer, Argosy partner, in the release. “The patient demographics, combined with the need to articulate the changes in the program, led to our decision to start all of the patients with a live call.” 

Science Channel features Sigvaris compression products

PEACHTREE CITY, Ga. – Tune into the Science Channel later this month to learn how Sigvaris compression socks and hosiery are made. The show “How It’s Made” visited the company’s Peachtree City manufacturing facility, getting a behind-the-scenes tour that will air Dec. 19, Dec. 20, Dec. 21 and Dec. 26. “We are excited to show America the steps taken to create our products, which not only look fashionable but also offer health benefits,” said Michael Leonard, North America product development manager, in a release.

FAA advances plan, rejects calls for rulemaking

WASHINGTON –The Federal Aviation Administration is skipping the rulemaking process and moving ahead with plans to test all overweight pilots for sleep apnea, news reports say. Because the plan enhances, not changes, existing policy, the agency says the rulemaking process is unnecessary. The screening policy will go into effect after the agency has completed its formal guidelines, probably in January, reports say. Pilots with body mass indices of 40 or greater must be screened for sleep apnea and if they suffer from the condition must be treated. If they do not submit to a screening within 60 days, pilots will be disqualified, the agency says.

Study ties COPD, cognitive impairment

ROCHESTER, Minn. – Patients with COPD are almost twice as likely to develop mild cognitive impairment (MCI), including memory loss, according to a study published in Mayo Clinic Proceedings. The risk of developing MCI grew the longer a person had COPD, according to the study. “COPD is reversible in early stages, especially in smokers,” said Balwinder Singh, the study’s first author, in a statement. “These findings are important because they highlight the importance of COPD as a potential risk factor for MCI and will hopefully lead to early intervention to prevent incidence or progression.” The Mayo Clinic study examined 2,000 people from 70 to 89 years old.

Short takes

Convaid has appointed Medix21 as the exclusive importer of its products in Australia. “We are expecting to see our product distribution in Australia grow considerably in the coming years,” President Chris Braun stated in a release. Medix21 has been the sole importer for Convaid products in New Zealand for more than 20 years…OxySure Systems has appointed Pacific Medical Systems to be the exclusive distributor of its products in Hong Kong and Macau. “What is unique about Hong Kong is that there is currently no mandatory medical device registration or approval process, which means we can get down to business right away,” CEO Julian Ross stated in a release. OxySure’s agreement with Pacific Medical is for three years, renewable thereafter…Numotion has acquired the rehab division of Myrtle Beach, S.C.-based Southeastern Health Plus, the company announced Dec. 18. Numotion Regional Vice President Neill Rowland said the purchase “allows Numotion to expand its complex mobility business throughout the state and provide greater access to rehab equipment to residents needing these products and services.” The deal frees Southeastern Health Plus to focus on expanding its orthotics and prosthetics business, CEO Ralph Lombardo said in the release…Veterans and longtime friends Cecil Raney and Jerry Keiffer have opened Nashville’s first 101 Mobility location with the hope of easing the stresses of at-home care, according to a Dec. 10 news release…Amenity Health’s Medcline Reflux Relief System, a sleep-positioning device to treat nighttime gastro-esophageal reflux disease (GERD), is now available through Apria Direct online, the company announced Dec. 18. Medcline allows people to sleep at an incline and on their sides, both positions that relieve GERD and acid reflux, according to the release.

People news

Christian Kiely is the new vice president of marketing and sales for Instant Diagnostic Systems (IDS), an independent diagnostic testing facility specializing in home-based testing, the company announced Dec. 16. Kiely, who has more than 10 years of experience in the homecare and sleep industries, most recently spent five years at Apria Healthcare, according to the release…Daniel Starck, CEO of Apria Healthcare’s respiratory and HME unit, has been appointed to the company’s board of directors, according to a Dec. 16 announcement. Starck joined Apria in April 2012 after serving as CEO of workers’ compensation company CorVel Corp. for five years. He previously held a variety of positions at Apria, according to the release…Paul Tobin has resigned as president and CEO of the United Spinal Association after 17 years. Among Tobin’s accomplishments: shepherding the association’s merger with National Spinal Cord Injury Association to create the largest SCI/D membership organizations in the United States, according to a release.