WASHINGTON – CMS this week published final regulations for implementing a face-to-face rule for Medicaid.
Starting July 1, physicians must document that they’ve conducted face-to-face visits with Medicaid recipients no more than six months prior to those patients receiving certain home medical equipment and services.
CMS will delay compliance with the rule for up to two years, according to the regulations, which will be published in the Federal Register on Feb. 2.
CMS implemented a face-to-face rule for Medicare on July 1, 2013. The agency began enforcing a written order prior to delivery requirement on Jan. 1, 2014, but it has not begun enforcing the face-to-face visit requirement.
A bill was passed last year that expands the types of healthcare providers who can document the face-to-face visit with Medicare beneficiaries to include physician assistants, nurse practitioners and clinical nurse specialists.
Stakeholders believe the expansion paves the way for CMS to start enforcing the face-to-face visit requirement for Medicare.
WASHINGTON – Industry stakeholders are shifting gears in their fight against Medicare’s competitive bidding program.
Stakeholders are now advocating for a freeze of the current reimbursement rates in regional and rural areas, according to AAHomecare’s weekly bulletin, “Wednesday in Washington.”
“While these initial phase-in cuts will certainly cause financial hardships for HME suppliers in rural/non-bid areas, we believe that working to prevent planned subsequent cuts that could reduce prices for many items by as much as 45% is the best approach to keep these suppliers afloat and help maintain critical access to products and services,” the association stated in the bulletin.
On Jan. 1, Medicare began paying for HME in regional and rural areas based on a 50/50 blend of the previous fee schedule amounts and the bidding amounts. On July 1, it will pay for HME in those areas based only on the bidding amounts.
Previously, stakeholders were focusing their attention on bills in the Senate and House of Representatives that included a longer phase-in period for the reduced reimbursement and a 30% increase to reimbursement in rural areas and a 20% increase in regional areas.
The industry’s champions in the House and Senate have “reacted positively to the proposal as a realistic course of action to get legislation passed this year,” AAHomecare said.
“In addition, we hope to engage CMS to consider freezing the rates at the current phase-in levels beyond the six-month period before further cuts take place,” it said.
Stakeholders agreed on pursuing the freeze after considering “a range of options and approaches,” AAHomecare said.
“We believe that this approach represents the best chance to keep the deepest and most damaging cuts from wreaking further havoc on rural/non-bid HME suppliers,” it said.
WASHINGTON – Industry champion Sen. John Thune recently asked CMS officials if six months is long enough to monitor the impact of rolling out competitive bid pricing nationwide.
At a Senate Finance Committee hearing Jan. 21, Thune, R-S.D., asked CMS Acting Administrator Andy Slavitt how CMS is monitoring the roll out and whether or not the agency would consider extending the current phase-in period beyond July 1.
“We have the absolute authority, when we see access issues, to step in and prevent them,” replied Slavitt. “So, we can’t let the goals of this program, which I think are noble and are good for our budget, get in the way of common sense when we run into those issues, so we have hopefully been responsive along the way.”
Thune then asked, “Do you think six months is long enough?”
Slavitt: “We should not assume that six months is going to be enough until we work though it. Candidly, I want to see the data from our team that’s doing the monitoring and understand the impact, and if we believe that we are going too fast, then we will slow down.”
On Jan. 1, Medicare began paying for HME in regional and rural areas based on a 50/50 blend of the current fee schedule and adjusted rates from its competitive bidding program. On July 1, it will base pricing only on adjusted rates.
Thune in November introduced a bill that would require a two-year phase-in period for the national rollout. It currently has 20 co-sponsors.
LAKE FOREST, Calif. – Apria Healthcare has launched ApriaLink, an electronic order management system that it says will help it work smarter and more efficiently.
Apria says it’s the first national provider to launch such a system, which, among other things, allows physicians to sign electronically certificates of medical necessity, or CMNs, for oxygen orders for Medicare beneficiaries.
“Healthcare professionals can quickly and efficiently shift patients from the high-cost acute setting to the lowest-cost home setting through electronic means,” said Dan Starck, CEO, in a press release.
ApriaLink also provides instant, real-time access to the status of orders; simple, clear guidance about resolving issues around orders, including instructions for pending documentation requirements; and the ability to place new prescription orders online.
In these ways, the system not only empowers physicians but also patients, Starck says.
“With this ground-breaking portal, Apria is investing in our customers and leading the industry by putting powerful electronic homecare order management in the hands of our customers—giving them more control over the process,” he said.
ApriaLink is a web-based tool that is HIPAA-compliant, encrypted and secure from inappropriate access, according to the release.
YARMOUTH, Maine – January brought with it the cold, hard reality of reduced Medicare pricing nationwide and providers are bracing themselves for storms ahead.
“We have reduced our footprint and we have reduced what we are offering in certain areas,” said Mike Calcaterra, northern zone vice president for Boise, Idaho-based Norco, which has locations in in Montana, northern Idaho, and central and eastern Washington state. “Liquid oxygen is something we are holding back on. Under the new rates, it is almost impossible to provide.”
CMS plans to phase-in its new pricing for regional and rural areas over six months. Starting Jan. 1, pricing was based on a 50/50 blend of the current and adjusted rates. On July 1, it will be based only on the adjusted rates.
Provider Glenn Steinke, made the hard decision to drop nebulizers, which in his area saw a reimbursement drop from $17.87 to $14.49—a loss he can’t absorb.
“We are a DME that focuses on respiratory and we can no longer do nebulizers,” said the owner of Bishop, Calif.-based Airway Medical. “Before, we were breaking even, but I’ve got to watch every penny.”
So far, Steinke has resisted cutting his service area—he’s the only provider covering about 10,000 square miles—but he will cut back on nursing visits to seniors from 45 days to 60 or 90 days, he says.
“The patients are the losers in this whole thing,” he said.
Cutting his service area is also a last resort for Clark McInroy, who instead is assessing the number of oxygen cylinders his company delivers.
“In the past we were pretty lenient and some patients would take advantage of that,” said McInroy, owner of COPD Respiratory Services in Cheyenne, Wyo. “We are trying to be smarter, but we realize it’s going to get even tougher.”
McInroy plans to reassess his budget in three months, and again in six months, when the second phase of cuts is implemented in July.
“If it gets bad, we’ll have to do something,” he said.
Unfortunately, things will have to get bad, especially for beneficiaries, if the industry is to make headway in its fight against competitive bidding pricing, says Karyn Estrella, executive director of the Home Medical Equipment and Services Association of New England.
“My concern is that CMS is just going to believe that they were right all along and that providers have been overpaid,” she said.
WASHINGTON – The CERT error rate for DMEPOS dropped to 39.1% in 2015 from an all-time high of 73.8% in 2010, but further improvements may be harder to come by.
Industry stakeholders credit HME providers for doing a better job preventing errors due to technical issues, and the DME MACs for applying policies more consistently for the dramatic decrease in the error rate in five years.
“A lot of the technical issues have been resolved,” said Wayne van Halem, president of the van Halem Group. “When providers realized how important those tiny issues were and the contractors became more consistent, they were mostly resolved.”
From 2014 to 2015, alone, the CERT error rate dropped 14%, according to the recently published supplementary appendices for the “Medicare Fee-for-Service 2015 Improper Payments Report.” (At press time, stakeholders were still waiting for the agency to publish the actual report, which will contain its interpretations of the results.)
Stakeholders acknowledge that the 39.1% error rate for DMEPOS is still very high. Because the majority of those errors are due to insufficient documentation (67.3%), further reductions will be more difficult, they say.
“That’s always going to be a challenge for HME providers, because they’re relying on physicians,” van Halem said. “In some ways, it’s out of the provider’s control.”
Stakeholders say providers are making progress, however, by requesting documentation from physicians up front, prior to submitting claims and providing equipment.
“They’re looking at the documentation before they set up patients and they’re not accepting patients until the documentation is good,” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “They have to be that way. If the documentation is not good, they have to say no.”
Stakeholders say various policy changes at play could also help providers make a dent in the number of errors due to insufficient documentation, including required prior authorizations for certain DME and reinstated clinical inference by medical reviewers.
“The elimination of clinical inference has had a huge impact on increasing the error rate in the past,” van Halem said. “If it were to be reinstated, we’d easily see the error rate drop even more.”
Additionally, providers should consider the DME MACs partners and take advantage of the increasing number of resources they provide, such as the pre-claim reviews offered in jurisdictions C and D, stakeholders say.
“We are seeing the contractors really rolling up their sleeves and taking a more one-on-one approach,” said Andrea Stark, a reimbursement consultant with MiraVista.
SAN DIEGO – ResMed plans to do for portable oxygen concentrators what it has done for CPAP machines. That is, make them connected devices that lower costs for HME providers and improve outcomes for patients.
During a Jan. 21 conference call to discuss second quarter financial results, ResMed officials provided some color to the company’s recent acquisition of Inova Labs, an Austin, Texas-based manufacturer of the Activox DUO2 integrated stationary and POC system, and the LifeChoice Activox POC.
“We like the products (and) we will continue to sell existing products,” said Mick Farrell, CEO of ResMed. “But we like even more the combination of the Inova portable oxygen concentrator engineering with ResMed’s healthcare informatics and what that synergy could bring.”
ResMedexpects to have a next generation POC—one with connected capabilities—out by 2020 “for sure,” Farrell said. In some ways, it will be second to market: O2 Concepts has rolled out a software platform that allows providers to access usage and other data from a Verizon modem in the company’s OxLife POC.
ResMed is zeroing in on the smaller but growing market for POCs, estimated to be about $200 million vs. $1.2 billion for the total market, because it’s the future.
“The POC market has very strong growth, mid- to high (single digit) to even low double digit growth year over year,” Farrell said. “We are really excited to participate in the POC market and bring our innovation to play.”
ResMed also outlined plans to expand Inova’s footprint globally, from the five to 10 countries Inova currently sells in, to the 100 countries it sells in.
“That alone represents a 10x to 20x multiple on the number of countries you can move into,” Farrell said.
ResMed’s connected solutions for sleep therapy, the AirSense 10 and AirCurve 10 platforms and Air Solutions software, were big contributors to the 17% increase in revenues for the Americas for the second quarter of fiscal year 2016. Individually, growth in flow generators was 23%; growth in masks and accessories was 11%.
Company officials acknowledge that the growth rate for flow gens would be difficult to sustain long term.
“I think we’ve now proven to our customers that we can drive efficiencies in their business with the platform,” said Jim Hollingshead, president, Americas. “So that’s a compelling offer and remains a compelling offer, even in light of competitor launches. We intend to grow our program and position ourselves above the market growth rate. But given the share we’ve taken, I don’t think the growth rate is sustainable indefinitely.”
Overall, ResMed reported revenues of $454.5 million for the three months ended Dec. 31, 2015, compared to $423 million for the same period in 2014, a 7% increase. It reported net income of $90.5 million vs. $91.2 million, a 1% decrease.
ORMOND BEACH, Fla. – While beach-ready wheelchairs have been around for decades, Greg McNair, owner of Beach Mobility Rentals, says he’s putting a new spin on them.
“People are used to seeing beach chairs made of PVC pipe,” he said. “They’re clunky, hard to push and you’re always going to need an attendant, as opposed to my electric chairs which are independently operated.”
Launched in November, Beach Mobility Rentals offers powered all-terrain wheelchairs, designed to navigate Daytona Beach’s hard-packed sand with ease, and non-power wheelchairs, which are safe to get wet. Prices for the rentals range between $50-89 per day for powered chairs and $39-49 per day for non-powered chairs.
Due to Florida’s growing elderly population (persons 65 years and older made up 23% of the population of Volusia County in 2014, according to the United States Census Bureau), McNair says the majority of his renters are seniors.
“The power chairs are far more popular,” said McNair. “People want their independence. They don’t want to have to rely on someone else.”
Additionally, Florida’s year-round warm weather makes it one of the top tourist destinations in the United States, which is why McNair linked up with hotels to get the word out about his services.
“What happens is, someone calls the hotel and says, ‘I want to book an ADA room,’ and they say, ‘Great,’ and that’s usually where they stop,” said McNair. “When I met with the hotels, I explained to them that they have an opportunity to enhance someone’s stay in Daytona Beach in a way that no one’s ever done before.”
Going forward, McNair is open to the idea of opening syndicate offices, but not franchises, which cost an “exorbitant amount of money” for the franchisee and “come with a lot tax consequences,” he says.
“Instead, I’ll get a percentage of their annual sales and they get to piggyback off all my marketing,” he said. “The advantage to that is, it becomes a brand and that’s what I’m trying to establish—a consistent and reliable brand that people can find anywhere in the country.”
WASHINGTON – While overall Medicare spending has increased more than 175% from 2000 to 2014, spending on HME accounted for just 1.25% of overall Medicare spending in 2014, dropping from 2% in 2004, according to AAHomecare’s analysis of a December update of the National Health Expenditure Accounts. Furthermore, spending on DME can lower overall Medicare costs in the long-term, the association argues. Every $1 spent on mobility equipment, for example, saves $16.78 in fall-related recovery; every $1 spent on supplemental oxygen therapy for COPD saves $9.62 in complications; and every $1 spent on CPAP therapy saves $6.73 in obstructive sleep apnea complications.
PlayMaker CRM lands $3 million credit facility
DURHAM, N.C. – Square 1 Bank, a division of Pacific Western Bank, has provided a $3 million credit facility to PlayMaker CRM, a cloud-based customer relationship management solution for post-acute care, it announced. “PlayMaker CRM has experienced a tremendous amount of growth under the leadership of its seasoned management team,” said Zack Mansfield, senior vice president of Square 1 Bank’s technology banking practice, in a release. “We are delighted to serve as their partner and support a Nashville-based, high impact company.” Proceeds from the facility will be used to support the company’s growth.
Respiratory provider agrees to $600,000 settlement
MIDDLEBURY, Conn. – J&L Medical has agreed to settle allegations that it violated state and federal regulations by using unlicensed technicians to set up CPAP and Bi-level machines. J&L president John Loyer said using patient care technicians, LPNs and others supervised by licensed RTs is common practice in the industry, but he agreed to pay $600,000. "We think it's important for our patients and the members of the medical community to understand that the government never claimed J&L Medical Services failed to deliver quality care or equipment," said Loyer, who is also co-owner of the company. "This was a matter of our disagreeing with their interpretation of Connecticut law about who can work with sleep apnea patients to do the initial setup of their CPAP machines." John Hart, a licensed RT formerly employed at J&L, filed a whistleblower complaint.
Health system sells HME business
GRAND HAVEN, Mich. – North Ottawa Community Health System has sold its HME business to CareLinc Home Medical & Equipment Supply in Grand Rapids, Mich., according to a local newspaper. CareLinc now has 20 locations in Michigan. The health system’s Grand Haven location fills a gap in CareLinc’s footprint in the lakeshore market, the newspaper reports. The health system says it decided to exit the HME business due to declining Medicare reimbursements. It says CareLinc has the economies of scale to withstand the 30% cuts. “From a financial viability, we knew this was something that we were not going to be able to sustain, but on the other hand, there was a need in the community,” Dan Holwerda, COO of the health system, told the newspaper.
O&P companies become ESOP
SOUTH BEND, Ind. – Midwest Orthotic & Technology Center and Surestep are now owned by their 170 employees, according to a local newspaper. The center is a full-service O&P company; Surestep manufactures, markets and sells a bracing system and complete line of products for children with developmental challenges. The owners of the company, Bernie Veldman and his wife Pam, will remain president and vice president, respectively. The Veldmans transitioned Dienen, Inc., the parent company of Midwest Orthotic & Technology Center and Surestep, to an employee stock ownership plan or ESOP on Jan. 4, the newspaper reported.
CCS debuts streamlined website
DALLAS – CCS Medical has launched a redesigned website at www.ccsmed.com. The new website has a more current look and improved functionality, making it easier for customers and healthcare providers to do business with the company online, says Rodney Carson, president and CEO. “One of our highest priorities going forward is to streamline things for our customers,” he said. More specifically, the new website, which is optimized for mobile use, simplifies the process of reordering supplies, paying bills and other tasks. It also provides health living tips. CCS Medical is a provider of medical supplies to patients with chronic conditions.
ACHC golfs for charity
Cary, N.C. – The Accreditation Commission for Health Care (ACHC) will host its inaugural charity golf tournament at the Brier Creek Country Club in Raleigh, N.C.,on May 16, the non-profit accreditation organization announced. Proceeds from the tournament will go to two local charity organizations: the Inter-Faith Food Shuttle, which supports hunger relief, and Big Brothers Big Sisters of the Triangle. “We hope the donations raised through the tournament will make a difference in the lives of those around us,” said José Domingos, ACHC CEO, in a release. “We are grateful for the volunteers, corporate sponsors, and players who have come together to support our local community.”
Harmar donation puts 12-year-old in the pool
SARASOTA, Fla. – Harmar has donated a pool lift to a 12-year-old with Duchenne Muscular Dystrophy. The P350 pool Lift has restored Grayson Tullio’s ability to get in and out of the pool, according to a release. “For Grayson, swimming puts a smile on his face and gives him great joy, and we are so pleased we could help him,” said David Baxter, vice president of marketing for Harmar. 101 Mobility of Sarasota donated their time to perform an evaluation and install the lift.
Short Takes: VGM Insurance, InfuSystem Holdings, 3B Medical, Thermoskin
VGM Insurance Services has partnered with AAHomecare to offer preferred pricing to AAHomecare members. Going forward, AAHomecare members will receive a 10% discount on Medicare/Medicaid Surety Bond premiums, and general and professional liability insurance…InfuSystem Holdingshas announced the implementation of InfuSystem EXPRESS, which includes the company's patent-pending EMR connectivity solution, at The Ellis Fischel Cancer Center at The University of Missouri Hospital & Clinics…3B Medical has committed to allocating a significant portion of its profits to fund adult autologous stem cell research for use in treatment of pulmonary fibrosis, diabetes and neurological diseases. "We spend a lot of resources treating the symptoms of diseases, and not enough trying to target the actual causes,” said President Thomas Thayer, Sr., in a release…Thermoskin has appointed Orthozone as the new exclusive distributor of its full line effective Jan. 1.
People news: O2 Concepts, SleepQuest
02 Concepts has named Cory Smith CFO. Smith has held leadership positions in finance and information technology for more than a decade, most recently at Endologix, which has gone from a $7 million device maker to a $150 million company…SleepQuest has named Bill Vandervennet as president and CEO. Vandervennet has held healthcare leadership positions for more than 25 years, most recently as COO for URAC, an accrediting organization.