COLUMBUS, Ohio – A proposed Ohio Medicaid policy that would have set oxygen rates at 36% below the lowest Ohio Round 2 rate is now off the table.

“The rates will still be cut, but not to the point where it threatens the benefit,” said Carl Mulberry, president of Columbus Medical Equipment. “We were able to reason with them, and now we’re in a much better situation.”

Rates for oxygen concentrators (E1380), for example, will go from around $165 to $130 per month, as opposed to the initial proposed payment of $54.89 per month. The rates go into effect Jan. 1.  

“We’ve had several cycles of bidding in Ohio, and the presence of those bid rates led to extremely unacceptable, very deep cuts,” said Kam Yuricich, executive director of the Ohio Association of Medical Equipment Services. “However, they quickly learned that there’s a big difference between how much it costs to provide home care and long-term care.”

Despite the victory, OAMES isn’t ready to relax: The same state law requiring the oxygen policy change also calls for Ohio Medicaid to rethink its custom mobility policies.

“Oxygen was just phase one,” said Yuricich. “Now, we will work with them to explore the ‘purchase strategies’ the law calls for. It’s hard to do something brand new with the most complex benefit in DME.”

It was while watching his father struggle with COPD that Jim Spellman, the newly-elected president of the Wisconsin Association of Medical Equipment Services (WAMES), learned what the HME industry means to patients. Since entering the industry in 1995, he has delivered oxygen, sold medical equipment and helped start a respiratory company in Milwaukee. Here’s what Spellman, the operations manager for Home Care Medical, had to say about his vision for the association and the importance of lobbying.

HME News: What brought you into the HME industry, and what’s made you stay?

Jim Spellman: My dad retired from his job—it’s funny how this works—and right after he retired, he got sick and went on supplemental oxygen. The guy who delivered his oxygen had this great relationship with my dad. I thought it was a great job and my dad needed those services. That’s how I got started, delivering oxygen for a company in Illinois. 

HME: You delivered oxygen, helped start an oxygen company, and now are operations manager. How has your perspective of the industry changed?

Spellman: The biggest eye opener at Home Care Medical was the scope of services. Coming from a respiratory provider to a full-service DME provider—with pharmacy, DME, power wheelchairs, service and repair department, and retail stores—I didn’t realize how big DME was. It opened my eyes to just how much need there is for people in their homes. 

HME: What are your goals for WAMES?

Spellman: I want WAMES to be a premier organization that providers think of when they have questions. Although I believe this is the case already, it’s something we want to expand and grow. We want to be a resource and partner with providers and healthcare organizations. 

HME: What are some of the association’s legislative goals? How do those affect national issues surrounding HME?

Spellman: WAMES wants to make sure appropriate companies are providing equipment and services to Wisconsin beneficiaries. Nationally, we’re partnering with and using other states with similar issues as resources and collaborating with them. 

HME: Why is lobbying so 

important?

Spellman: It takes sacrifice, dedication and time from people willing to think of the future of the HME industry, to work together to strengthen and preserve the DME community that provides to our seniors. The legislative fight is one worth fighting. These companies provide products people need. I want to do my part and I want WAMES to do its part to help keep these organizations viable, to keep delivering services people need.

YARMOUTH, Maine – Competitive bidding and bankruptcies (three of them, to be exact) dominated the headlines of HME News in 2013.

We compiled a list of the five most read stories for 2013, plus the five most read stories about respiratory, mobility and financial-related topics. Here’s what turned up.

Most read stories

CMS announces payment amounts for Round 2
BALTIMORE – CMS announced today that reimbursement rates for certain home medical equipment will be, on average, 45% lower than the current fee schedule as part of Round 2 of competitive bidding.

CMS announces contract suppliers for Round 2
BALTIMORE – CMS proceeded with its competitive bidding program today by releasing the names of 799 contract suppliers for Round 2.

CMS announces steeper cuts for Round 1 re-compete
BALTIMORE – The reimbursement rates for certain home medical equipment will be, on average, 37% lower as part of the Round 1 re-compete of competitive bidding, CMS announced today.

Competitive bidding: ‘Everybody’s in panic mode’
WASHINGTON – Although it’s too soon to gauge how many providers accepted initial contracts for Round 2 of competitive bidding, stakeholders say it’s likely that those who did, did so out of fear.

Bill calls for delay, review of bid program
WASHINGTON – Reps. Glenn Thompson, R-Pa., and Bruce Braley, D-Iowa, have introduced a bill to delay the implementation of Round 2 of competitive bidding, according to The VGM Group.

Top 5 respiratory

CMS throws safety net to oxygen patients
BALTIMORE – It appears CMS has finally realized that you can’t get blood from a stone—or oxygen equipment and services from an HME provider that has gone out of business.

Inogen stares down Round 2
‘You have to play ball,’ says Scott Wiklinson
SANTA BARBARA, Calif. – When CMS announced the payment amounts for Round 2 of competitive bidding, Inogen, which was “offered some contracts and accepted some contracts,” had some explaining to do, says Scott Wilkinson.

Confluence of factors led to LMI’s bankruptcy filing
‘It’s a big company and some people see that as an opportunity to fix what might be broken’
MOUNT VERNON, N.Y. – Landauer Metropolitan Inc. (LMI) is positioning itself for a quick sale in the wake of its decision to file for Chapter 11 bankruptcy protection, according to industry watchers.

Apria bullish on success under bid program
LAKE FOREST, Calif. – Execs at Apria Healthcare revealed during an earnings call March 11 that the company was offered “a significant number of contracts” for Round 2 of competitive bidding.

Rotech to file for bankruptcy
ORLANDO, Fla. – Rotech Healthcare announced late on Friday that it plans to restructure and reorganize under Chapter 11 of the U.S. Bankruptcy Code.

Top 5 Mobility

The Scooter Store: Will an indictment be next?
NEW BRAUNFELS, Texas – Federal and state officials, as well as The Scooter Store, are keeping a tight lid on the details of a raid at the company’s corporate headquarters.

The Scooter Store impact spreads
NEW BRAUNFELS, Texas – The woes at The Scooter Store could hurt more than The Scooter Store, say multiple industry sources.

The Scooter Store proposes ‘aggressive’ sale
NEW BRAUNFELS, Texas – The future of The Scooter Store is in the hands of prospective buyers now that it has filed for bankruptcy.

Speculation swirls around The Scooter Store
NEW BRAUNFELS, Texas – One thing is certain: The future is uncertain for one of the largest providers of scooters and power wheelchairs.

The Scooter Store: ‘A house of cards’
NEW BRAUNFELS, Texas – Being shut out from Rounds 1 and 2 of competitive bidding was the last straw for the nation’s largest mobility provider.

Top 5 Moneyline

ISG deal opens up old wounds
‘Things can get murky at times’
TWINSBURG, Ohio – Some HME providers are on edge about the new ownership at Invacare Supply Group (ISG).

Confluence of factors led to LMI’s bankruptcy filing
‘It’s a big company and some people see that as an opportunity to fix what might be broken’
MOUNT VERNON, N.Y. – Landauer Metropolitan Inc. (LMI) is positioning itself for a quick sale in the wake of its decision to file for Chapter 11 bankruptcy protection, according to industry watchers.

Apria bullish on success under bid program
LAKE FOREST, Calif. – Execs at Apria Healthcare revealed during an earnings call March 11 that the company was offered “a significant number of contracts” for Round 2 of competitive bidding.

Landauer files for Chapter 11 ahead of sale
WILMINGTON, Del. – Landauer Metropolitan, Inc., a Mount Vernon, N.Y.-based provider of home health equipment and supplies, filed for Chapter 11 bankruptcy protection on Aug. 16, citing an anticipated $26 million decline in revenue resulting from losses related to competitive bidding, according to news reports.

Rotech to file for bankruptcy
ORLANDO, Fla. – Rotech Healthcare announced late on Friday that it plans to restructure and reorganize under Chapter 11 of the U.S. Bankruptcy Code.

YARMOUTH, Maine – What resolutions do industry consultants have for HME providers for the new year?

Eliminate re-work like it’s your job

Karen Moore thinks providers should be working smarter and harder in 2014, but mostly smarter. In the wake of competitive bidding, providers are feeling tremendous reimbursement pressure, and they no longer have the time nor resources for “re-work,” she says.

“If you look at the top denials for Medicare, it’s submitting duplicate claims,” said Moore, vice president of AnCor Healthcare Consulting. “When you have to go back and figure out which claims you need to work on and which you don’t, it impacts your resources.”

If providers put quality control measures in place, they can reduce the work they do, achieve better outcomes, accelerate reimbursement and reduce bad debt, Moore says. The key to making that happen: training, she says.

“You need to provide good training to your staff and you need to make sure they’re actually implementing that knowledge in their daily work,” Moore said. “They can’t triple check claims; it’s just too costly.”

Don’t get caught sleeping

They may not be as buzz-worthy as competitive bidding or audits, but John Allman says the forthcoming enforcement of the face-to-face rule and the implementation of new HIPAA requirements in 2014 could be just as problematic for providers.

“These could be potential landmines,” said Alllman, president of John Allman Consulting. “It’s the silence among providers on these major issues that concerns me.”

Allman says compliance with the face-to-face rule is a relationship-building game to make sure referral sources are on the same page with providers about what’s required.

“Providers will hear that they’re the only ones doing this, but everybody has to do it,” he said.

As for the new HIPAA requirements: Providers need to keep an eye out for possible breaches, large and small, Allman says.

“One of the first things I look at is: does their website have a privacy policy in a prominent position?” he said.

Dig into digital

Everyone knows the recent rollout of www.healthcare.gov wasn’t without its bumps (maybe potholes is a better word?). But Anna McDevitt says it speaks volumes about the increasingly prominent role of the Web in 2014 and beyond.

“To think that this huge healthcare reform program is something that’s online is a good barometer of where we are in this digital world,” said McDevitt, president of Laboratory Marketing. “Saying your customers aren’t online isn’t a good enough argument anymore.”

When it comes to their digital footprint, McDevitt says providers need to do more than slap up a website, and create pages on Facebook and handles on Twitter.

“It’s one thing to understand the concept,” she said. “It’s another to put it into practice.”

A big picture ideal to keep in mind, McDevitt says: Think of your company as a person, not an institution.

“One of the things that the digital world has been doing is breaking down the barrier between products and companies,” she said.

LENEXA, Kan. – Mediware Information Systems will offer whitepapers, studies, surveys, testimonials, webinars and other resources to providers throughout 2014, the company announced Dec. 24. First up: a Jan. 29 webinar to help HME providers master the complex rules and regulations related to competitive bidding. “Mediware’s mission is to help homecare providers better understand the ever-changing homecare arena, while also providing business insights and best practices needed to growth their business and the industry,” the company stated in a release. Other topics for Mediware’s outreach programs: ICD-10, inventory control, accreditation standards, outcomes reporting, document management and more. Mediware, which acquired Definitive Homecare Solutions and Fastrack in 2013, is also in the process of developing a single management solution to serve home infusion, HME and specialty pharmacy providers.

Liberator Medical reports revenues of $69.1M

STUART, Fla. – Net sales for Liberator Medical Holdings were up 13.4% and operating income was up 173% in the fiscal year ended Sept. 30, 2013, the company announced Dec. 23. Net sales were about $69.1 million; operating income was about $11.8 million. Liberator Medical, which began trading on the New York Stock Exchange in November, plans to continue 1.) using direct response advertising to maximize profitability and cash flow; and 2.) exploring potential acquisition targets to acquire new customers, according to the release.

FAA puts sleep apnea policy on hold

FREDERICK, Md. – Faced with stiff opposition from some pilot groups, lawmakers and physicians, the Federal Aviation Administration (FAA) has put on hold plans to test all overweight pilots for sleep apnea, according to news reports. The FAA had planned to start testing pilots with body mass indices of 40 or greater in January. The FAA has now agreed to consult with industry groups to balance the concerns of all stakeholders, according to news reports. When the FAA announced its plans, legislation was introduced to require the agency to go through a rulemaking process. The agency has said the process is unnecessary because the plan enhances, not changes, existing policy. Untreated sleep apnea already disqualifies a pilot from flying.

Bruno, Advanced Rehab grant wish

OCONOMOWOC, Wis. – Bruno Independent Living Aids is donating a “Joey” platform lift to Sam Wedig, a 10-year-old with cerebral palsy. The lift will allow Sam’s grandparents, Coleen and Mark Wedig, who are raising him, to take him to school and church, and to watch the Iowa Cubs baseball team. Advanced Rehab Technologies in Urbandale, which supplied Sam with his power wheelchair, will install the lift in the Wedig’s Dodge Caravan. Bruno and Advanced Rehab learned about Sam through a local radio station’s “Make-A-Wish” contest. As part of the contest, Sam will also throw out the first pitch at a Cubs game this spring.

101 Mobility opens in Sarasota

SARASOTA, Fla. – Chuck Vollmer has opened a 101 Mobility location in Sarasota, Fla., where senior citizens make up one-third of the population. 101 Mobility sells, services and installs a complete line of mobility and accessibility products and equipment. Vollmer’s relationship with Harmar Mobility will benefit customers of 101 Mobility, according to a release. “They will notice added quality assurance, product diversity and reasonable price-points,” it states. 101 Mobility has an equity partnership with Cortec Group, which owns Harmar Mobility.

VGM raises money to replace stolen wheelchairs

WATERLOO, Iowa – The VGM Group is helping to raise money to replace sports wheelchairs belonging to the Iowa Chairiots, a wheelchair basketball team. Sometime over the weekend of Dec. 14-15, a trailer containing the wheelchairs was stolen from a Cedar Rapids YMCA parking lot. The replacement cost is estimated at up to $50,000. VGM will allow employees to wear jeans the week of Dec. 30 in exchange for $10. Both VGM and CEO Van Miller will match each dollar raised. U.S. Rehab will also make a contribution. U.S. Rehab President Greg Packer is working with VGM vendors to replace the wheelchairs, which are serviced by JVA Mobility in Waterloo.

BALTIMORE – It looks like the PECOS edits are still scheduled to go into effect next week.

Noridian Administrative Services, the DME MAC for Jurisdiction D, reminded providers in a Jan. 2 bulletin that Medicare plans to implement Phase 2 denial edits on Monday, Jan. 6.

Once the edits take effect, contractors will verify that the ordering/referring physician or healthcare provider on the claim is in the Physician Enrollment, Chain and Ownership System (PECOS), and is eligible to order/refer in Medicare. Ordering/referring physicians must be enrolled in PECOS or the billing provider will not be paid for items and services that physicians prescribed.

Contractors will continue to process claims for which the ordering/referring physician or healthcare provider is enrolled in PECOS but is not of the correct type or specialty to order/refer. If the physician is not enrolled in PECOS, or if the name on the claim does not match the name in the system, suppliers will receive an N544 alert, according to the bulletin.

The N544 alert will say: Although this was paid, you have billed with an ordering/referring provider that does not match our system record. Unless corrected, this will not be paid in the future.

Previously, CMS said the PECOS edits would start May 1, 2013, but the rollout was delayed due to technical glitches.

BALTIMORE – The PECOS edits are scheduled to go into effect today. Noridian Administrative Services, the DME MAC for Jurisdiction D, reminded providers in a Jan. 2 bulletin that Medicare planned to implement Phase 2 denial edits on Jan. 6. With the edits in effect, contractors will verify that the ordering/referring physician or healthcare provider on the claim is in the Physician Enrollment, Chain and Ownership System (PECOS), and is eligible to order/refer in Medicare. Ordering/referring physicians must be enrolled in PECOS or the billing provider will not be paid for items and services that physicians prescribed. Contractors will continue to process claims for which the ordering/referring physician or healthcare provider is enrolled in PECOS but is not of the correct type or specialty to order/refer. If the physician is not enrolled in PECOS, or if the name on the claim does not match the name in the system, suppliers will receive an N544 alert, according to the bulletin.The N544 alert will say: Although this was paid, you have billed with an ordering/referring provider that does not match our system record. Unless corrected, this will not be paid in the future.Previously, CMS said the PECOS edits would start May 1, 2013, but the rollout was delayed due to technical glitches.

Harrison: ‘I never did anything wrong’

SAN ANTONIO – The former chairman and CEO of The Scooter Store has denied any wrongdoing in an interview with The San Antonio News-Express. “I think I have an extremely high level of confidence that the company never did anything wrong,” Doug Harrison told the newspaper. “I know I never did anything wrong.” Before closing in 2013, The Scooter Store was the subject of an FBI investigation. It had also come under scrutiny by numerous members of Congress. Harrison also told the newspaper: “That doesn’t mean you can’t be investigated and incur legal costs to defend yourself. But at the end of the day, no, I don’t think I’m in any legal trouble at all.” The Scooter Store filed for bankruptcy in April and closed in September.

Supplies companies merge

OKLAHOMA CITY – 180 Medical, a provider of sterile use catheters and urologic and disposable medical supplies, has acquired Symbius Medical. The acquisition extends 180 Medical’s ability to serve customers directly, CEO Todd Brown said in a release. Phoenix-based Symbius Medical is also a provider of medical supplies. 180 Medical is a subsidiary of ConvaTec, a global medical products and technologies company. Terms of the deal were not disclosed.

Nipro initiates voluntary recall

FORT LAUDERDALE, Fla. – Nipro Diagnostics has initiated a voluntary recall and replacement of a limited number of TRUEbalance and TRUEtrack blood glucose meters. The company has determined that certain meters distributed in the United States have an incorrect factory-set unit of measure that displays the result in mmol/L rather than mg/dL. If a user didn’t notice the incorrect unit of measure, it is possible that the result could be read as lower than expected. The recall affects 501 TRUEbalance and 105 TRUEtrack meters distributed from September 2008 to May 2013. Nipro advises users to call Stericycle at 1-866-236-4518 to determine whether or not their meter is affected.

Mediware hosts webinar series on ICD-10

CHANDLER, Ariz. – Mediware Information Systems will host a four-part webinar series to help providers prepare for the Oct. 1, 2014, transition from ICD-9 to ICD-10 codes, the company announced Dec. 30. Paula Digby, principal at AQ Consulting, will host the series on Jan. 22, March 26, June 25 and Sept. 10. Registration is limited to the first 500 attendees. The webinars are part of an outreach effort that will also include whitepapers, studies, surveys and testimonials on a variety of topics.

Furniture maker debuts nightstand to conceal CPAP devices

RAPID CITY, S.D. – This nightstand is for sleep apnea patients who want a good night’s sleep—and a neat bedroom. Purdue Woodworks will introduce a bedside cabinet that conceals CPAP and BIPAP devices, even while they’re in use, at the Las Vegas Market on Jan. 26. The machine and its components tuck neatly behind a pair of doors, while the hose that delivers air to the patient’s mask runs through a slot in the cabinet to the patient’s bed, according to a story in Furniture Today. Each nightstand holds two machines and will retail between $100 and $150.

Medicine Shoppe location closes after 20 years

SANTA BARBARA, Calif. – The Medicine Shoppe pharmacy in Santa Barbara, Calif., has closed its doors after almost two decades downtown, according to news reports. Financial woes are probably the cause of the closure, speculated David Thomasco, who owns a separate Medicine Shoppe location in the city, which is not closing. Patients were notified of the closure by signs posted on the doors, according to news reports. The store’s lease was set to end in February, but the owner negotiated out of the space at the end of December, according to Bob Bartlein of the property management firm Bartlein & Company. The store was owned by a franchisee and not the national company.

Study: Stick with CPAP therapy, improve golf game

MORRISTOWN, N.J. – Using a CPAP device helps sleep apnea patients rest, look better, and, according to a recent study, improve their golf games. Twelve golfers treated by Morristown Memorial Hospital doctors for sleep apnea shaved as many as three strokes off their handicap in 20 golf rounds, according to news stories. “More so than many sports, golf has a strong intellectual component, with on-course strategizing, focus and endurance being integral parts to achieving good play,” said study co-author Marc Benton of Atlantic Sleep and Pulmonary Associates, noting that obstructive sleep apnea (OSA) causes fatigue and cognitive impairment. Doctors said the golfers stuck with CPAP therapy 90% of the time.

Orthoco offers free shipping on bulk Kinesio Tape

WYNNEWOOD, Pa. – Orders of six or more large boxes or large rolls of Kinesio Tape from Orthoco now qualify for free shipping, the medical supply dealer announced Dec. 31. The elasticized cotton tape is used to treat athletic injuries. “The less a doctor or PT has to worry about their overhead, the more they can focus on the task at hand: helping people,” said Orthoco CEO Anthony Engel in a release. Orthoco now carries Kinesio Tex Gold FP, a new version of the tape made with higher-grade cotton, epidermis micro-stimulation and a new fabric weave, according to the release. The tape is latex free and hypoallergenic.

COPD mortality tied to poverty, study says

LONDON – Mortality rates among COPD patients in low-income countries are linked more to poverty than the prevalence of smoking, according to a new international study published in Thorax. Researchers examined COPD mortality data from 170 countries, finding a strong inverse correlation between mortality and gross national income (GNI). Where the annual GNI was below $15,000, they found COPD mortality rose, but it had no clear link to smoking. Mortality was strongly correlated with spirometric restriction, but not airflow obstruction, which is associated with smoking, according to the study. Authors noted environmental factors also play a role in the mortality rate in low-income countries.

WASHINGTON – Overall national health expenditures grew at an annual rate of 3.7% in 2012, marking the fourth consecutive year of low growth, the CMS Office of the Actuary reported Jan. 7.

Health spending as a share of gross domestic product fell slightly from 17.3% in 2011 to 17.2% in 2012.

“For the second straight year, we have seen overall healthcare costs grow slower than the economy as a whole,” said CMS Administrator Marilyn Tavenner in a release. “This is good news. We will continue to work with tools given to us by the Affordable Care Act that will both help us control costs for taxpayers and consumers, while increasing the quality of care.”

The Office of the Actuary’s report has been published on the CMS National Health Expenditures website and has been featured in an article in the January issue of Health Affairs.

Continued low growth in 2012 was driven by slower growth in prescription drug, nursing home, private health insurance and Medicaid expenditures. The ACA also contributed to slow growth, but it had a limited impact on overall spending as it was still being implemented in 2012, according to the report.

Despite a large up tick in enrollment, Medicare spending growth slowed slightly in 2012, increasing 4.8% for the year compared to 5% in 2011. Total Medicare spending per enrollee grew by only 0.7% in 2012, the report states.

Total Medicaid spending grew 3.3% in 2012. While an increase over 2011, it still represents historically low overall growth rates tied to improved economic conditions, as well as efforts by states to control costs, the report states.

CLEVELAND – A new device that stimulates a nerve at the back of the tongue to open a person’s airway effectively treats obstructive sleep apnea (OSA), making it a viable alternative to CPAP therapy, researchers say in a study published in the Jan. 9 issue of the New England Journal of Medicine.

The implantable device is called Inspire Upper Airway Stimulation. It delivers a mild electrical stimulation to the base of the tongue, preventing it from collapsing and blocking the airway. Patients turn the device on and off with a hand-held programmer.

“This device is a first of its kind therapy, and has the potential to help the many people suffering form moderate to severe sleep apnea who are unable to use or cannot tolerate CPAP,” said Kingman Strohl, senior study author, pulmonologist at University Hospital Case Medical Center and professor of Medicine at Case Western Reserve University School of Medicine. 

Researchers studied 126 patients with moderate to severe sleep apnea who could not use or adhere to CPAP therapy. To qualify for inclusion, study subjects could not be obese and had to show their OSA was tongue-related. Earlier studies showed the implant is less effective in obese patients and those with soft-palate collapse, according to news reports.

To conduct the study, researchers measured the patients’ apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) and found that after a year using the device patients’ median AHI score fell 68% and their median ODI score dropped 70%, according to the release.

A sub-study then found a sharp rise in the AHI index, fatigue and snoring of 23 patients who had the device removed for a week, researchers said.

The FDA is reviewing data on the Inspire Upper Airway Stimulation device, which has been provisionally approved for use in Europe, according to the release.

Device maker Inspire Medical Systems funded the study.

WASHINGTON – HME industry stakeholders are hard at work trying to leverage a small victory in their fight against competitive bidding.

In December, stakeholders succeeded in getting an amendment in the “doc fix” bill that would require providers to prove they meet licensure requirements before they are allowed to submit bids. But that’s a far cry from what they had initially sought.

“We’ll be pushing to get some of the key components of the market-pricing program into the ‘doc fix’ bill—something that would move us in a better direction,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Lawmakers have until March 15 to hammer out a longer-term solution to avoiding reimbursement cuts to physician payments.

Requiring bids to be binding and setting payment amounts at the clearinghouse price are some of the elements of MPP that stakeholders are trying to get included in the “doc fix” bill.

“We’re talking to the key committees about MPP,” said Jay Witter, vice president of affairs for AAHomecare. “We think we have a good chance of convincing them that these should be included.”

As March approaches, however, there is a lurking danger: Will lawmakers eye cuts to HME—such as lowering Medicaid rates to the Medicare bid rates—to pay for the “doc fix” bill? Stakeholders haven’t heard anything.

“How they plan to pay for the bill seems to be one of the biggest kept secrets on Capitol Hill right now,” said Bachenheimer.

As for H.R. 1717, the bill that would do a full swap of competitive bidding for MPP? It’s still important to gather co-sponsors, says Witter. Rep. Doug LaMalfa, R-Calif., signed on last week—the first lawmaker from that state to do so—bringing the total to 165.

BALTIMORE – Medicare Administrative Contractors (MACs) failed to meet one-quarter of CMS’s performance standards, according to a new report from the Office of Inspector General (OIG). “Given the billion of dollars awarded to Medicare Administrative Contractors and the critical role they play in administering the Medicare program, effective oversight of performance is important to ensure that they are adequately processing claims,” the OIG states. The OIG based its findings on a performance assessment of 13 MACs conducted from September 2008 to August 2011. Of the 25% unmet standards, MACs had not resolved issues with 27% of those standards as of June 2012, the report states. Many of the standards CMS sets for MACs require 100% compliance, but the OIG found CMS did not require action plans in 12% of the unmet standards, leaving those problems four times more likely to go unresolved. CMS contractors can earn award fees for performing beyond basic requirements, but the OIG found problems, here, because some troublesome areas highlighted by quality-assurance reviews are not metrics in the award program. The OIG recommends CMS require action plans for all unmet standards; use reviews to select award fee metrics; meet timeframes for completing quality-assurance reports and award fee determinations; establish timeframes for issuing performance reports; and work with legislatures to increase the time between contract competitions to give CMS more flexibility awarding new contracts. CMS agreed on all six points, according to the report.

CMS: Growth in health spending remains low

WASHINGTON – Overall national health expenditures grew at an annual rate of 3.7% in 2012, marking the fourth consecutive year of low growth, the CMS Office of the Actuary reported Jan. 7. Health spending as a share of gross domestic product fell slightly from 17.3% in 2011 to 17.2% in 2012. “For the second straight year, we have seen overall healthcare costs grow slower than the economy as a whole,” said CMS Administrator Marilyn Tavenner in a release. “This is good news. We will continue to work with tools given to us by the Affordable Care Act that will both help us control costs for taxpayers and consumers, while increasing the quality of care.” The Office of the Actuary’s report has been published on the CMS National Health Expenditures website and has been featured in an article in the January issue of Health Affairs. Continued low growth in 2012 was driven by slower growth in prescription drug, nursing home, private health insurance and Medicaid expenditures. The ACA also contributed to slow growth, but it had a limited impact on overall spending as it was still being implemented in 2012, according to the report. Despite a large up tick in enrollment, Medicare spending growth slowed slightly in 2012, increasing 4.8% for the year compared to 5% in 2011. Total Medicare spending per enrollee grew by only 0.7% in 2012, the report states. Total Medicaid spending grew 3.3% in 2012. While an increase over 2011, it still represents historically low overall growth rates tied to improved economic conditions, as well as efforts by states to control costs, the report states.

Implantable device makes gains on CPAP therapy

CLEVELAND – A new device that stimulates a nerve at the back of the tongue to open a person’s airway effectively treats obstructive sleep apnea (OSA), making it a viable alternative to CPAP therapy, researchers say in a study published in the Jan. 9 issue of the New England Journal of Medicine. The implantable device is called Inspire Upper Airway Stimulation. It delivers a mild electrical stimulation to the base of the tongue, preventing it from collapsing and blocking the airway. Patients turn the device on and off with a hand-held programmer. “This device is a first of its kind therapy, and has the potential to help the many people suffering form moderate to severe sleep apnea who are unable to use or cannot tolerate CPAP,” said Kingman Strohl, senior study author, pulmonologist at University Hospital Case Medical Center and professor of Medicine at Case Western Reserve University School of Medicine. Researchers studied 126 patients with moderate to severe sleep apnea who could not use or adhere to CPAP therapy. To qualify for inclusion, study subjects could not be obese and had to show their OSA was tongue-related. Earlier studies showed the implant is less effective in obese patients and those with soft-palate collapse, according to news reports. To conduct the study, researchers measured the patients’ apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) and found that after a year using the device patients’ median AHI score fell 68% and their median ODI score dropped 70%, according to the release. A sub-study then found a sharp rise in the AHI index, fatigue and snoring of 23 patients who had the device removed for a week, researchers said. The FDA is reviewing data on the Inspire Upper Airway Stimulation device, which has been provisionally approved for use in Europe, according to the release. Device maker Inspire Medical Systems funded the study.

MED Group sees Golden opportunity

LUBBOCK, Texas – The MED Group has partnered with Golden Technologies to make the manufacturer’s full line of products available to its members. “Life chairs and mobility products are key growth areas for our members and we are excited that they will now have access to the Golden Technologies product line,” stated Jeff Woodham, senior vice president of The MED Group, in a release. The Old Forge, Pa.-based Golden makes lift chairs, scooters and Group 1 and Group 2 power wheelchairs. “The Med Group and its members are a natural fit for Golden,” stated Richard Golden, CEO, in the release. The MED group has nearly 500 provider members with more than 1,700 locations.

IDS opens California lab, expands insurance coverage

DECATUR, Ala. – Instant Diagnostic Systems (IDS) has opened a new lab in Valencia, Calif. With the new facility, the in-home diagnostics company is able to expand contract coverage with health insurance plans, according to a release. Other recent developments: IDS has become an in-network provider for Blue Cross and Blue Shield health plans, The Empire Plan, Scott & White Health Plan and Vanguard Health Plan, the release states. Both of IDS’s labs participate in Medicare and are accredited by the Joint Commission.

Centegra goes with Medline for supplies distribution

MUNDELEIN, Ill. – Medline Industries is now the preferred medical and surgical supplies distributor for Centegra Health System, which expects to save $1 million in supply-chain costs as a result of the arrangement, according to a Jan. 9 release. The three-year deal is expected to be worth $30 million, the companies said. “Medline’s manufacturer-direct approach and supply chain management expertise are critical to driving down cost,” said David Tomlinson, Centegra CFO, in the release. “Their strong logistics capabilities and robust product offering will allow us to effectively get products when and where our clinicians need them most, no matter the location.” Medline has 37 distribution centers throughout the country, and will help Centegra spend less through product standardization and better reporting capabilities, according to the release. 

PharMerica picks up BGS Pharmacy Partners

LOUISVILLE, Ky. – PharMerica, a national provider of institutional, specialty home infusion and oncology pharmacy services, has acquired BGS Pharmacy Partners, the company announced Jan. 10. The deal expands PharMerica’s footprint in Reno, Nev., and deepens its presence in Las Vegas and Salt Lake City, said CEO Greg Weishar. “BGS has a talented team and has built a strong business based on patient care, clinical expertise and customer service,” Weishar said, in a release. BGS is a provider of comprehensive pharmacy services to long-term facilities.

OIG to CMS: Update guidance on EHRs to prevent fraud

BALTIMORE – CMS needs to provide guidance to contractors on how to detect fraud associated with electronic health records (EHRs), according to a report from the Office of the Inspector General (OIG). Additionally, CMS needs to direct contractors to use audit logs, which distinguish EHRs from paper records, a valuable tool when reviewing medical records. The OIG issued its guidance after conducting an online questionnaire and finding out CMS did not change program integrity strategies after the adoption of EHRs and provided limited guidance on fraud vulnerabilities to contractors, according to a recent release.

ResMed, Invacare dive into R&D in 2014

SAN DIEGO and ELYRIA, Ohio – ResMed has been awarded a patent for a device to treat apnea and hypopnea by detecting and responding to events by adjusting the positive airway pressure a patient receives, according to news reports. Invacare has a patent in the approval process for a wheeled-vehicle suspension, according to news reports. The suspension system involves a pivot arm, front and rear casters, a stabilizing system and a sensor, according to the patent application.

Active Healthcare launches new website

CARY, N.C. – Active Healthcare has launched a new website, featuring an online store, as well as educational resources and forms, the company has announced. “Our vision always has been to make things simple for both provider and patient,” said Steve Feierstein, Active Healthcare cofounder, in a release. “We believe the new site accomplishes this, while also creating an easy interface for exchange of information and services.” Active Healthcare offers sleep, respiratory and diabetes care products.

Finnegan Medical Supply carries Nova Medical

LITTLE ROCK, Ark. – Finnegan Medical Supply is now carrying Nova Medical Products, including colorful and patterned walkers, canes, mobility accessories and bath safety equipment, the company announced Jan. 7. Finnegan Medical was attracted to Nova Medical by its Glamor line of mobility accessories, according to the release. “Most of the ambulatory products we normally see are gray or black and boring,” said Su-Lauren Wilson, CFO at Finnegan Medical, in a release. “Nova brings you colors and patterns that reflect who you truly are and make your cane or rolling walker an accessory, not a device.”

The CareGiver Partnership launches 2014 sweepstakes

NEENAH, Wis. – The CareGiver Partnership, a national retailer of incontinence products and other home healthcare supplies, has launched its 2014 “Helping You Get On With Life” sweepstakes. “We created this sweepstakes to raise awareness of the many product and service solutions available among the caregiver community,” said Lynn Wilson, co-founder, in a release. “Each item chosen represents a family caregiver solution—a product or service that helps seniors live more independently and gracefully in their homes.” To win the prize in January—an activity therapy systems kit from R.O.S. and the book “Activities 101 for the Family Caregiver”—participants must email info@caregiverpartnership.com, explaining how the prize will be useful to them and their loved ones. Entries will be accepted through Jan. 31.

CMS offers further analysis of PMD demo

BALTIMORE - CMS reported in December that its power mobility device (PMD) demonstration project brought down overall expenditures in seven states from $12 million in September 2012 to $4 million in September 2013. Expenditures in non-demo areas fell from $20 million to $9 million during the same timespan. In demo states, the agency estimates it saved $10.3 million through denials of claims without prior authorizations, $350,000 through non-affirmed requests, and $876,909 through claims whose denials were upheld under reconsideration. CMS says the agency's spending fell, in part, because providers have been better educated and have adjusted their billing practices. “While we recognize that multiple factors contributed to the decrease in PMD expenditures, there was also a significant decrease in the number of beneficiaries receiving PMDs in the demonstration states after the start of the demonstration,” the agency stated. “We believe this decrease is because prior authorization is ensuring that only beneficiaries who meet Medicare requirements receive a PMD.”

Mobility companies make donations

101 Mobility has teamed up with Homes for Our Troops to help provide an ADA-complaint, wheelchair accessible home for Army Staff Sgt. Alex Dillman, who was paralyzed by an IED blast in Afghanistan, according to a Jan. 6 announcement. “What we’re doing for him just seems so minor compared to what he’s done for us,” said Dennis Clouser, owner of 101 Mobility Tampa…Vantage Mobility International has donated an Access360 Northstar system for a 2013 Toyota Sienna to Charlie Harvey, a disabled veteran who won the Operation Independence Star Spangled Salute contest. VMI, Toyota and NASCAR driver Darrell Waltrip presented Harvey with the system on Jan. 8 “We launched the VMI Operation Independence initiative to better support our disabled veterans in obtaining their mobility vehicle benefits,” said Monique McGivney, VMI corporate communications director, in the release. The program now includes a dedicated advocate center and the Star Spangled Salute Contest, she said…A wheelchair user who helps people with disabilities play adaptive sports and a service dog trainer won donations through Sunrise Medical’s Propel Donation Program, the company announced Jan. 7. New Jersey resident Brandon Holiday was denied reimbursement for seating products, leaving him too uncomfortable to use his wheelchair for long; the program provided him seating products for his Quickie 2 wheelchair. Dogsong Animal Training and Behavior received a Quickie Q7 and a QM-710 to help the company train service dogs to work with people using wheelchairs.

DeVilbiss moves oxygen concentrator production to the US

SOMERSET, Pa. – In the latest step in its effort to move production from China to the U.S., DeVilbiss is now manufacturing its redesigned 5 Liter Oxygen Concentrator at its Somerset, Pa. headquarters, the company announced Jan. 6. The new two-piece cabinet design is quieter, easier to assemble and disassemble, and has more efficient cooling, according to a release. “We are proud to offer an improved concentrator that is built to last and easy to maintain,” said Jim Clement, director of global product management–respiratory solutions, in the release. The redesigned unit uses at least 15% less power than comparable designs, the release states.

Numotion strengthens New Orleans presence

MADISONVILLE, La. – Numotion has acquired New Orleans-area complex mobility provider Specialty Wheelchairs, the company announced Jan. 6. Jeff Cosentino, co-owner of Specialty Wheelchairs, will remain with the company. “The sale will allow me to pull back from the administrative duties of running a business and maximize my time serving customers who need complex mobility equipment to improve their daily lives,” Cosentino said in a release. The acquisition expands Numotion’s service area and strengthens its relationships with New Orleans-area referral sources, said James Hartman, Numotion regional vice president, in the release. 

Now hiring DME sales reps: West Corp.

SAN ANTONIO – West Corp. is adding 70 positions here to provide medical sales support to a new client and an existing client, both unnamed, according to the San Antonio Business Journal. The company seeks applicants with durable medical equipment or pharmaceutical sales experience, according to the story. Based in Omaha, Neb., West Corp. provides contact center sales and support to a variety of clients, including companies in the healthcare industry. Services include automated patient interactions, communication, care coordination and adherence monitoring, according to the company’s website.

Hope Medical acquires Wheelchairs Plus

SAN ANTONIO – HME provider Hope Medical Supply has acquired Wheelchairs Plus, adding complex rehab to its growing product portfolio. Wheelchairs Plus, which is located in a prime location in South Texas Medical Center, specializes in complex rehab for patients with disabilities, including children. Three employees, including former owner Tom Cottle, who will remain as professional team director, have assistive technology professional (ATP) certification. The acquisition is Hope Medical Supply’s latest attempt to develop niche markets. It recently expanded its specialty lines to include prosthetic limb and orthotic bracing. Hope Prosthetics and Orthotics is located in a downtown medical neighborhood.

Carolina’s HME now offers Medela breast pumps

CHARLOTTE, N.C. – Carolina’s Home Medical Equipment is now an authorized dealer of Medela breast pumps and negative pressure wound therapy devices, the company announced Jan. 3. Under the Affordable Care Act, most insurers are now required to pay for breast pumps. “This changes the market entirely, shifting a business previously dominated by retail to an insurance-covered item that generally must be billed via a DME provider,” said Andrew Trammell, CFO of Carolina’s HME, in a release. Carolina’s HME will be the first authorized Medela DME provider in the Charlotte market. It accepted contracts to provide respiratory, mobility and negative pressure wound therapy products as part of the Round 1 re-compete of competitive bidding.

People news

The Board of Certification/Accreditation recently announced BOC-certified orthotist James Hewlett is now chairman of its board of directors, succeeding John Kenney. Hewlett, most recently vice chairman, has been a member of the board since 2008…ResMed’s board of directors has announced Peter Farrell, executive chairman, has been appointed non-executive chairman, effective Jan. 1. The board has approved the following compensation arrangements: an annual $65,000 retainer, annual equity grant with a grant date fair value of $250,000 and an annual salary of $300,000. Farrell is eligible for a bonus for his service prior to Jan. 1, 2014, but not for his service after…The Community Health Accreditation Program (CHAP) has elected Elizabeth Buff chairwoman of its board of directors. Buff, senior vice president of quality management and clinical excellence at the Visiting Nurse Service of New York, was previously the board’s vice chairwoman. Joining her are new board members Steven Landers and Barbara McCann. Additionally, Nicole Silverman was reappointed to a four-year term on the board.

Short takes

The 2014 version of the National Home Infusion Association’s National Coding Standard for Home Infusion Claims under HIPAA is available to the public at no charge. Updated yearly, the document presents a comprehensive coding system, and provides procedures and examples for using codes, according to a release...Numotion is now a premier-level national partner of The ALS Association. The complex wheelchair provider will support the Walk to Defeat ALS and the National ALS Advocacy Day and Public Policy Conference; will be an exhibitor and presenter at the ALS Expo in Washington, D.C., on May 9; and will sponsor the National Clinical Conference Nov. 6-8.

BATLIMORE – Medicare Administrative Contractors (MACs) failed to meet one-quarter of CMS’s performance standards, according to a new report from the Office of Inspector General (OIG).

“Given the billion of dollars awarded to Medicare Administrative Contractors and the critical role they play in administering the Medicare program, effective oversight of performance is important to ensure that they are adequately processing claims,” the OIG states.

The OIG based its findings on a performance assessment of 13 MACs conducted from September 2008 to August 2011.

Of the 25% unmet standards, MACs had not resolved issues with 27% of those standards as of June 2012, the report states.

Many of the standards CMS sets for MACs require 100% compliance, but the OIG found CMS did not require action plans in 12% of the unmet standards, leaving those problems four times more likely to go unresolved. 

CMS contractors can earn award fees for performing beyond basic requirements, but the OIG found problems, here, because some troublesome areas highlighted by quality-assurance reviews are not metrics in the award program.

The OIG recommends CMS require action plans for all unmet standards; use reviews to select award fee metrics; meet timeframes for completing quality-assurance reports and award fee determinations; establish timeframes for issuing performance reports; and work with legislatures to increase the time between contract competitions to give CMS more flexibility awarding new contracts.

CMS agreed on all six points, according to the report.

ATLANTA – Brightree has acquired Strategic AR Solutions, a provider of private-pay billing and collections solutions.

Kevin Winkley, founder and CEO of Strategic AR, will continue to lead the company, which will operate as a separate entity, according to a release.

For Brightree customers, the deal means additional integration, such as the automatic posting of payments back into the billing system, the release notes.

“In the past, many home care providers have chosen not to pursue the patient portion of an order due to the manual-intensive business processes required to collect the amount owed,” said Dave Cormack, Brightree president and CEO. “With greater adoption of high deductible plans and an increase in private pay patients, we believe patient collections must become a critical component to every HME provider’s success in 2014. Based on these changing dynamics and increased demand from our customer base for a more tightly integrated payment solution, it made perfect sense for us to forge this deeper relationship with Strategic AR.”

Winkley agreed.

“We felt it was the right time to align ourselves more closely with Brightree as the dominant software vendor in the HME industry,” he said. “We look forward to continuing to deliver first-class solutions and customer service to all of our customers regardless of their billing system.”

It has been a busy few months for Brightree. It announced it bought competitor MedAct Software in November and formed a strategic agreement with athenahealth earlier this months.

Brightree’s acquisition of Strategic AR is its first this year and sixth since 2008.

BALTIMORE – Medicare can pay for repairs to capped rental DME provided by The Scooter Store and transferred to beneficiaries on Oct. 24, 2013, according to a bulletin from CMS.

Medicare can pay for the repairs performed on or after that date, so long as contractors deem the repairs reasonable, necessary and in accordance with Medicare regulations, CMS states.

Industry stakeholders have been calling on CMS to address repair issues in the wake of The Scooter Store closing its doors in September.

To date, providers have had their hands tied: They couldn’t bill Medicare for repairs if equipment provided by The Scooter Store was still in the capped rental cycle.

WASHINGTON – A recent memo from the chief administrative law judge (ALJ) makes it clear that the Office of Medicare Hearings and Appeals (OMHA) is in over its head.

In the Dec. 31 memo, which was sent to providers who currently have appeals pending, Chief ALJ Nancy Griswold states that the office’s workload has increased 184% since 2010 and that the average number of appeals received each week has increased from 1,250 to 15,000. The office currently has a backlog of 460,000 appeals.

As a result, the OMHA has suspended the assignment of hearings for appeals going back to July 15, 2013, and warned that it could take as long as 24 months before it resumes activity. By law, providers who file an appeal must receive a decision within 90 days.

“You can’t have a two-year backlog, but if you do, you need to stop auditing claims that are going to end up in the appeals process,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “This isn’t a DME issue; it’s a healthcare issue.”

Stakeholders have seized on the memo to make their case. The VGM Group last week sent letters to Griswold and to Sen. Chuck Grassley, R-Iowa, urging CMS to, among other things, suspend audits immediately and stop recoupments on current claims denials that are waiting for an ALJ hearing.

Industry attorneys are also exploring judicial options to see whether due process is being denied.

“We’re looking to see if there’s some sort of constitutional tort or wrong with this to see if it would rise to that level,” said Rick Addison, a partner with Munsch Hardt. “There’s a punitive aspect in having timelines run against you and costs being incurred while you are waiting for a hearing. Some of these folks will never have a hearing because they’ll be driven out of business.”

Stakeholders place the blame squarely on an audit system run amok, with increased types of audit contractors—ZPIC, RAC, CERT—denying claims for technical reasons. That has led to a surge in providers filing appeals with the ALJ, where 56% of the time they win, according to a 2012 report from the Office of Inspector General.

“They get overturned routinely because they never should have been denied in the first place,” said Steve Azia, counsel at Baker Donelson. “I handle a lot of claims that should never get to the ALJ.”

It’s gotten so bad that even a favorable ALJ decision won’t necessarily safeguard providers against further audits from other contractors, stakeholders say.

“We’ve got claims that are getting looked at four or five times by different contractors,” said John Daniel, president of Superior Medical Supply in Clarksville, Tenn. “We tell them we’ve already been to the ALJ and the response is, ‘Well, you’ll be going to the ALJ again.’ We won the last time, so yeah, we’ll be going again.”

OMHA will host a daylong forum Feb. 12 to discuss its workload and provide information on initiatives to make the appeals process more efficient. Currently, the forum is an in-person-only event, but the office is considering adding a phone-in or live stream component.

YARMOUTH, Maine – If you use accounts receivable (A/R) to paint a picture of the financial health of HME providers, what you see doesn’t look very good, according to the results of the latest HME Newspoll.

A majority of the 46 respondents to the poll—55%—said the portion of their A/R that is at least 60 days old was larger at the end of 2013 than it was at the end of 2012.

“Audits and delay tactics by all payers are driving up our A/R beyond a reasonable level,” said one respondent.

In other bad news: 53% of respondents said at least 20% of their A/R was more than 60 days old. 

David Chestnut is another provider seeing his A/R grow and, again, the culprit is audits.

“The largest factor is the pre-pay and post-pay audits,” he said.

While the majority of respondents said audits have had the biggest negative impact on their A/R, they also cited payment delays by state Medicaid programs.

“Illinois Public Aid (is) behind nine months to a year; private insurers (are) “developing” every claim—requesting documentation for almost all claims, (they) may as well go back to paper billing and attaching it on the front end; and increased Medicare pre-pay review,” one respondent said. “DME is a tough industry these days.”

To help alleviate these difficulties, some respondents said they have changed their billing systems or hired billing specialists.

The rest of the poll holds a bit of better news: A very slight majority of respondents says their DSO has decreased in 2013 compared to 2012; and a very slight majority says they collected a larger percentage of balances owed by patients in 2013 vs. 2012.

ATLANTA – Brightree has acquired Strategic AR Solutions, a provider of private-pay billing and collections solutions.

Kevin Winkley, founder and CEO of Strategic AR, will continue to lead the company, which will operate as a separate entity, according to a release.

For Brightree customers, the deal means additional integration, such as the automatic posting of payments back into the billing system, the release notes.

“In the past, many home care providers have chosen not to pursue the patient portion of an order due to the manual-intensive business processes required to collect the amount owed,” said Dave Cormack, Brightree president and CEO. “With greater adoption of high deductible plans and an increase in private pay patients, we believe patient collections must become a critical component to every HME provider’s success in 2014. Based on these changing dynamics and increased demand from our customer base for a more tightly integrated payment solution, it made perfect sense for us to forge this deeper relationship with Strategic AR.”

Winkley agreed.

“We felt it was the right time to align ourselves more closely with Brightree as the dominant software vendor in the HME industry,” he said. “We look forward to continuing to deliver first-class solutions and customer service to all of our customers regardless of their billing system.”

It has been a busy few months for Brightree. It announced it bought competitor MedAct Software in November and formed a strategic agreement with athenahealth earlier this month.

Brightree’s acquisition of Strategic AR is its first this year and sixth since 2008.

DHS gets Progressive

HARRISBURG, Pa. – Dynamic Healthcare Services (DHS), a portfolio company of GMH Ventures, a Newtown, Pa.-based private equity group, has continued its string of acquisitions into 2014.

DHS has acquired Clarion, Pa.-based Progressive Home Medical Equipment, a full-service HME provider serving the Pittsburgh and western Pennsylvania market. Progressive accepted contracts for respiratory products as part of the Round 1 re-compete that went into effect Jan. 1.

“Progressive’s presence in the Pittsburgh and western (Pennsylvania) market immediately increases growth opportunities in the DME space and brand awareness for DHS in these competitive locations,” said Michael Holloway, president of GMH Ventures, in a release.

In 2013, DHS acquired APO2 in Hazelton, Pa. In 2012, it acquired HomeTown Oxygen and Evanko Respiratory, also in Pennsylvania.

Eric and Bridget Dobrowski, who founded Progressive in 2005, will lead the combined businesses in Clarion and surrounding markets, according to the release.

“I’m really looking forward to the growth potential we’ll see as part of DHS,” said Eric Dobrowski in the release. “We have been looking for a partner who could support our plans to expand offerings and services in our core Clarion and surrounding neighborhoods. In fact, our first day together, we were able to provide one of our local customers a product previously not available to us.”

DHS, which was formed in 2000 as the parent company of Central Medical Equipment and East Suburban Medical Supply, has grown into a strong regional provider of HME, employing more than 120.

Terms of the deal were not disclosed.

Norco grows in Northwest

BOISE, Idaho – Norco’s footprint in Washington state is growing, thanks to its acquisition of Walla Walla Home Medical. 

Norco now has 16 branches in the state, with more than 65 branches when you also include Idaho, Montana, Oregon, Nevada, Utah and Wyoming.

“This is a great time for healthcare in the Walla Walla Valley,” said Ned Pontious, Norco president, in a release. “A Northwest family-owned company serving the great hospitals and residents of this community helps to strengthen a local, continued partnership in the area.”

In 2013, Norco acquired two other providers in the Northwest: Care Medical, with six locations in the Seattle and Portland, Ore., areas; and Walgreens Respiratory Services, with four locations in the Seattle and Vancouver region.

The mounting challenges of running an independent medical supply company led The Walla Walla Clinic and Providence St. Mary Medical Center, owners of Walla Walla Home Medical, to sell, according to the release

“We believe that this will allow Walla Walla Home Medical to continue to provide the excellent service to Walla Walla that the community has come to expect,” said Kevin Michelson, Walla Walla Clinic CEO, in the release. “It’s a good thing for the community.”

NASHVILLE, Tenn. – A problem with ordering/referring physician data in the DME MAC claim system is affecting processing, as well as the data available in the myCGS web portal and the Jurisdiction C IVR, according to a bulletin from CGS. CMS and DME MAC system maintenance contractors are researching the issue. CGS says it will provide more information when it becomes available. CMS on Jan. 6 started denying claims with the names of physicians who are not enrolled in PECOS.

Medicare overpays for VES, report finds

BALTIMORE – Medicare payments for vacuum erection systems (VES) are more than twice the amount paid by other payers, such as the Veterans Affairs, and the amount paid by consumers online, the Office of Inspector General (OIG) has found. The OIG recommends CMS determine whether the payments are “grossly excessive” and, if they are, seek legislative authority to add VES to the competitive bidding program, which most recently resulted in a 45% reduction in payments for certain HME. By adjusting the Medicare fee schedule, the government could have saved $14.4 million for each of the six years reviewed and beneficiaries about $3.6 million, according to the report.

Bill seeks to lift ban on supply deliveries

ALEXANDRIA, Va. – Two senators have introduced a bill that would allow independent community pharmacies to deliver diabetes testing supplies to Medicare beneficiaries the same day an order is placed. The bill, introduced by Sens. Jerry Moran, R-Kan., and John Thune, R-S.D., would reverse restrictions placed on community pharmacists on July 1, 2013. “Pharmacists have reported cases of seniors going out in hazardous circumstances and risking a debilitating fall or other accident to obtain diabetes testing supplies because the local pharmacy can no longer deliver them,” said Douglas Hoey, CEO of the National Community Pharmacists Association, in a Jan. 16 release. “Now more than ever, Congress should scrap this indefensible delivery ban.”

Comparative billing report on CPAP due this month

BALTIMORE – eGlobeTech will provide comparative billing reports (CBR) on CPAP devices and accessories to providers in mid-January as part of a contract with CMS. The reports will feature tables, graphs and an explanation of findings comparing billing and payment patterns in states across the nation, according to a bulletin from CMS. The reports will offer only summary billing information to protect privacy.

Bill takes aim at FAA’s sleep apnea policy

WASHINGTON – A bill introduced Jan. 16 in the Senate would require the Federal Aviation Administration (FAA) to follow a rulemaking process before changing its sleep apnea policy, according to news reports. Faced with stiff opposition from some pilot groups, lawmakers and physicians, the FAA recently put on hold its plans to require pilots with body mass indices of more than 40 to be screened for sleep apnea. “Testing private pilots for sleep apnea might be a worthwhile idea but the agency should have talked to its stakeholders first,” said Sen. Mark Begich, D-Alaska. “If they had been willing to listen to the aviation community they might have found smarter and less intrusive ways to ensure pilots are safe to fly. The irony is that sleep apnea has never been identified as a factor in a general aviation incident.”Late last year, Congress stepped in to require that the Federal Motor Carrier Safety Administration go through a similar process before issuing sleep apnea guidelines for truckers.

Cushions up for prepayment audit

NASHVILLE, Tenn. – CGS, the DME MAC for Jurisdiction C, will implement a prepayment edit for E2603 (skin protection wheelchair seat cushion, any depth, but less than 22 inches wide) and E2622 (adjustable skin protection wheelchair seat cushion, any depth, less than 22 inches wide). The contractor is conducting the edit because of high claims payment error rates for this product category, according to a Jan. 14 bulletin. For claims subjected to the edit, providers will need to provide delivery documentation; detailed product description (for motorized base) or written order (for manual base); medical records demonstrating need; and advanced beneficiary notice. Providers must file the additional documentation within 45 days of notification or the claim will be denied, according to the bulletin.

VGM raises $12,000 for stolen wheelchairs

WATERLOO, Iowa – The VGM Group dressed down to help the Iowa Chariots get back on the court. During the week of Dec. 30, employees could pay $10 to dress casually to raise money to replace the team’s stolen wheelchairs. Both VGM and company founder Van G. Miller matched each dollar raised and U.S. Rehab also made a donation. The total amount raised: $12,000, according to a Jan. 13 release. “In our industry, we understand that a wheelchair means independence and it allows a person to live the best quality of life possible,” said Greg Packer, U.S. Rehab president. “We know that wheelchair athletes are the real deal and we hope this contribution helps keep the Chairiots competing.” The Chairiots have raised about half of the $40,000 to $50,000 needed to replace the stolen wheelchairs, according to the release.

Orthofeet, AADE promote foot health

NORTHVALE, N.J. – Specialty footwear maker Orthofeet is working with the American Association of Diabetes Educators (AADE) to develop an educational campaign promoting foot health for adults with diabetes, the company announced recently. Preventative care and therapeutic shoes can help diabetics maintain foot health and avoid neuropathy, according to the statement. “There are many teaching tools to help patients understand how to monitor glucose levels or eat a healthy diet, but there are very few resources that communicate the importance of daily foot care for this population,” said Bill Wald, vice president of corporate relations and development for AADE, in the release. The curriculum, developed by Dennis Janisse, the scientific affairs director at Orthofeet, and AADE, will be available for diabetes educators to share with their patients.

Study links spinal-cord injuries, sleep apnea

DETROIT – Ninety-two percent of patients with spinal-cord injuries sleep poorly and 77% suffer from symptomatic sleep disordered breathing, according to a study published Jan. 15 in the Journal of Clinical Sleep Medicine. “Sleep disordered breathing may contribute to increased cardiovascular mortality in spinal cord injury patients,” said M. Safwan Badr, president of the American Academy of Sleep Medicine, and a researcher involved in the study. “All spinal cord injury patients should undergo a comprehensive sleep evaluation using full, overnight polysomnography for the accurate diagnosis of sleep apnea.” Researchers studied 26 spinal cord injury patients, 15 with cervical injuries and 11 with thoracic injuries, and found central sleep apnea was more common in those with cervical injuries.

Convaid redesigns website

TORRANCE, Calif. – Convaid has launched a redesigned website. The site features easy navigation with separate sections for dealers, medical professionals, patients and families. It also features updated industry resources, brochures and online order forms. “Convaid’s new enhanced website will serve as a valuable tool and source of information,” said President Chris Braun in a release.

Ottobock earns state tax credit for expansion plans

SALT LAKE CITY – Utah is giving Ottobock a $392,000 post-performance tax credit to help the manufacturer add more than 80 jobs at its expanding Salt Lake City facility, the Salt Lake Tribune reports. The credit represents about 20% of the $2 million in new taxes the company is expected to pay over the seven-year term of its deal with the Utah Governor’s Office of Economic Development, according to the story. Fifty-five of the new jobs generated will pay at least 125% of Salt Lake County’s minimum wage, generating $16.2 million in new wages over seven years. Ottobock plans to invest $1 million to expand its Salt Lake City facility and relocate two divisions from Minneapolis there. In other company news, two American snowboarders will compete in the Sochi Paralympics using Ottobock prosthetics.

Wheel:Life book provides fundraising tips

SANDY SPRINGS, Ga. – Wheel:Life, an online community for wheelchair users, has published Lisa Wells’ e-book, “10 Fundraiser Ideas to Help People with Disabilities.” In it, Wells shares ideas about how to raise money for people who need financial help with medical equipment, rehab, daily medical needs or adaptive sports equipment. “Wheel:Life receives hundreds of inquiries each year from people who are seeking advice on ways to raise money for medical equipment, adaptive sports gear or specialized health care,” said Wells, who has worked in healthcare marketing for more than 20 years. “While Wheel:Life doesn’t have the funds to financially support these requests, we are able to provide intelligent support by offering resources like this book.”The book is available for purchase at Amazon’s Kindle bookstore.

Contractor warns of delays with paper claims

INDIANAPOLIS – National Government Services (NGS), the DME MAC for Jurisdiction B, is experiencing delays updating the optical character recognition system it implemented to process CMS-1500 paper claims. Effective April 1, all paper claims must be submitted in that format; any files using the older format will be returned as unprocessable. Because of the delays, NGS is manually verifying paper claims data and has increased the inventory of paper claims awaiting validation, according to a recent bulletin. “Until these paper claims are entered, we cannot fully respond to claim status related questions,” the bulletin states. “The claims may have been received and are awaiting claim detail entry into the Multi Carrier System. An extensive effort is underway to expedite processing for these outstanding paper claims.” The problem only affects paper claims; most electronically submitted claims and claims submitted using free features on the NGSConnex portal are being processed on time, according to the bulletin.

CareFusion to pay $40.1M for kickback scheme

SAN DIEGO – CareFusion will pay the government $40.1 million to settle, without liability, government allegations that it paid kickbacks and promoted products for uses not approved by the U.S. Food and Drug Administration (FDA), according to a Jan. 9 release. The government charged that CareFusion paid $11.6 million to Dr. Charles Denham, then co-chairman of the Safe Practices Committee at the National Quality Forum, to recommend and promote ChloraPrep products, encouraging providers to purchase them, according to the statement. “When companies pay kickbacks to doctors, especially doctors involved in setting standards for the health care industry, they undermine the integrity of the health care system,” said Stuart Delery, assistant attorney general of the Department of Justice’s Civil Division, in a statement. The settlement resolves a case filed by Dr. Cynthia Kirk under the whistleblower provision of the False Claims Act. Her share of the settlement: $3.26 million. CareFusion previously disclosed the settlement in April of 2013.

Short takes

Tricia Huong Thi Nguyn has been appointed to BioScrip’s board of directors and will serve on the Nominating and Governance Committee and the Corporate Strategy Committee. Nguyen, president of the Texas Health Population Health, Education, Research and Innovation Center, has more than 20 years of leadership experience in managed care and health insurance…Courtney Sanchelli has won the Most Inspirational Client Award from Maddack and Morph Wheels. Quadriplegic and on a ventilator since she was in a car accident at age four, the 17-year old will receive a set of Morph foldable wheelchair wheels…Global revenue for the telehealth market is expected to reach $4.5 billion in 2018, up from $440.6 million in 2013, according to a new report from IHS Technology. The use of medical devices and communication technology to monitor patients’ symptoms and manage chronic diseases reduces readmission and mortality rates, while increasing adherence, according to the report…Molnlycke, a Swedish medical supply company, is investing between $5.5 million and $7 million in a new Wiscasset, Maine, facility where it will manufacture the foam used in its wound care products, according to news reports. The company expects to add 10 to 30 jobs in the next five years.

BOISE, Idaho – Norco’s footprint in Washington state is growing, thanks to its acquisition of Walla Walla Home Medical. 

Norco now has 16 branches in the state, with more than 65 when you also include Idaho, Montana, Oregon, Nevada, Utah and Wyoming.

“This is a great time for healthcare in the Walla Walla Valley,” said Ned Pontious, Norco president, in a release. “A Northwest family-owned company serving the great hospitals and residents of this community helps to strengthen a local, continued partnership in the area.”

In 2013, Norco acquired two other providers in the Northwest: Care Medical, with six locations in the Seattle and Portland, Ore., areas; and Walgreens Respiratory Services, with four locations in the Seattle and Vancouver region.

The mounting challenges of running an independent medical supply company led The Walla Walla Clinic and Providence St. Mary Medical Center, owners of Walla Walla Home Medical, to sell, according to the release

“We believe that this will allow Walla Walla Home Medical to continue to provide the excellent service to Walla Walla that the community has come to expect,” said Kevin Michelson, Walla Walla Clinic CEO, in the release. “It’s a good thing for the community.”

WATERLOO, Iowa – In a new video, People for Quality Care (PFQC), the advocacy arm of The VGM Group, zooms in on CMS’s crippling audit program.

“CMS payment denials occur due to paperwork errors and ignore the medical necessity of equipment for individuals with spinal cord injuries and other disabilities,” the PFQC states in a release. “Denials cause unnecessary burden on patients, caregivers and family members.”

The eight-minute video features patients of Mobility Medical, a Dallas-based provider that is currently appealing denials for up to 80 patients.

One of those patients: Phillip. His physician forgot to include a sentence in her notes indicating that she had referred him to a seating specialist in her clinic.

“Twenty-eight years in a wheelchair and I’ve never had an issue until now,” Phillip says in the video.

Mobility Medical operates at a loss when Medicare delays payments, because it has often already provided the needed equipment and services.

“(While Mobility Medical) has filled in the gaps that Medicare policies have left…many Medicare patients across the country are not so lucky,” the PFQC states.