Feed aggregator

Number of remotely monitored patients spiked in 2016, according to Berg Insight

HME News - Tue, 02/14/2017 - 09:45
ResMed leads sleep vertical, market research firm says02/14/2017HME News Staff

GOTHENBURG, Sweden – The number of remotely monitored patients grew by 44% to 7.1 million in 2016, according a new report from Berg Insight.

What’s more, the number of remotely monitored patients will grow at a compound annual growth rate (CAGR) of 47.9% to reach 50.2 million by 2021, says the market research firm.

The two main applications in the market are monitoring patients with sleep therapy devices and monitoring patients with implantable cardiac rhythm management (CRM) devices. Berg Insight says these two verticals accounted for 80% of all connected home medical monitoring systems in 2016.

“The number of remotely monitored sleep therapy patients grew by 70% in 2016, mainly driven by ResMed, which has made connected healthcare a cornerstone of its strategy,” says Anders Frick, senior analyst at Berg Insight.

Other leading vendors in this segment are Philips Respironics and SRETT.

Telehealth is the third largest segment with half a million connections at the end of 2016, Berg Insight says. Leading telehealth vendors include Tunstall Healthcare, Honeywell, Cardiocom, Philips and Qualcomm Life.

All other device categories, including ECG, glucose level, medication adherence and others, stood for less than 1 million connections all together, the firm says.

Cellular connectivity has already replaced PSTN and LAN as the de-facto standard communication technology for most types of connected home medical monitoring devices, according to Berg Insight.

Stakeholders stand ready to change bid program, with Price’s help

HME News - Mon, 02/13/2017 - 11:15
The broad underlying statute governing the program gives complete discretion to the administration, they point out02/13/2017Theresa Flaherty

WASHINGTON – CMS’s decision to temporarily delay Round 2019 of competitive bidding could mean a revamp of the program, now that Rep. Tom Price, R-Ga., is taking the helm at the Department of Health and Human Services, say industry stakeholders.

CMS said on Feb. 7 it was delaying Round 2019 to give the new administration time to review the competitive bidding program. The announcement came one week after the agency announced it would consolidate all future rounds of competitive bidding into Round 2019.

“Given what we know of Price and his desire to make significant changes to the bidding program, I think this could be a good thing,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

The Senate on Friday approved the nomination of Price, a long-time HME champion and the architect of an alternative to the competitive bidding program called market-pricing program.

Industry stakeholders have hailed the nomination of Price, but they acknowledge there’s no quick fix for the competitive bidding program.

“I think a lot of people think Price is going to come in and just do away with competitive bidding and that’s not the case,” said John Gallagher, vice president of government relations for The VGM Group. “He can’t scrap competitive bidding, but he can rewrite it to include the market-pricing program.”

In fact, the broad underlying statute governing the competitive bidding program gives complete discretion to the administration. Details like what products to include, what areas to include, and how to set the median bid are “all up for grabs,” Bachenheimer says.

“There could be a major revamping of the program,” she said.

CMS itself had outlined several changes to the competitive bidding program as part of Round 2109. Many of those changes are positive, like requiring $50,000 surety bonds for each CBA in which a bid is submitted, and moving the bid ceiling to the 2015 fee schedule.

As head of HHS, Price will have a full plate, but stakeholders say they stand ready to press him on the competitive bidding program.

“We have been working on our opportunities with Dr. Price as secretary since the beginning of 2017 and we are working on a strategy as we speak,” said Kim Brummett, vice president of government relations for AAHomecare. “He will have his hands full with the Affordable Care Act repeal and replace, but we hope to be able to work with him to make changes to the current program.”

 

Invacare shifts into phase two of transformation

HME News - Fri, 02/10/2017 - 11:15
02/10/2017Liz Beaulieu

ELYRIA, Ohio – 2016 was the year Invacare tore itself down and 2017 will be the year it starts building itself back up, Matt Monaghan said during a conference call Feb. 9 to discuss the company’s fourth quarter and year-end financial results.

In 2016 and especially in the fourth quarter, Invacare saw the impact of significant costs from investing in the North America sales forces, quality remediation, and research and development—ahead of expected benefits, said Monaghan, chairman, president and CEO.

“We chose to do this to hasten change and get to building momentum sooner,” he said. “People will ask if the fourth quarter was worse than expected. In the fourth quarter, we made a lot of change.”

Monaghan noted that Invacare is poised to release more than 10 new products for the complex rehab and post-acute care markets in 2017. It kicked off these efforts in the fourth quarter of 2016, releasing the Platinum Mobile Oxygen Concentrator.

Invacare is also poised to make progress in lifting its consent decree with the U.S. Food and Drug Administration in 2017. The company submitted specified design history files to a third-party expert for review in January. Once the files are approved by the expert, they will be sent to the FDA, along with Invacare’s own report, for approval, paving the way for a re-inspection.

“I think there are a few things we’ll be talking about in the next couple of quarters that reflect continued milestones on quality progress,” Monaghan said.

The improvements can’t come soon enough. Monaghan acknowledged that Invacare ended the fourth quarter with “disappointing” results, especially for its North America/HME division. Net sales decreased 27.4% to $83.7 million for the fourth quarter of 2016 compared to $115.4 million in the same period in 2015. Net sales decreased 16.1% to $397.7 million for 2016 compared to $474.2 million in 2015.

“I think in the future, as we mentioned, there’s a little more sales reduction to do, but it’s not of the wholesale variety, especially in the seating and mobility lines like we’ve had recently,” he said.

Overall, Invacare reported net sales of $264.7 million for the fourth quarter of 2016 compared to $283.3 million for the same period in 2015. It reported net losses of $17.6 million vs. $2.93 million. The company reported net sales of $1.05 billion for 2016 compared to $1.14 billion for 2015. It reported net losses of $42.86 million vs. $26.45 million.

But there should be signs of positive change in 2017, with Invacare moving into the second phase of its three-phase transformation: “rebuilding the company in alignment with our new direction,” Monaghan said. It kicked off these efforts in January by laying off 100 associates and closing a facility in Kirkland, Quebec, two moves that will save $6.6 million on an annualized basis.

“We plan to continue implementing broader, sustainable quality improvements throughout the business,” he said.

CMS limits K0108 for manual wheelchairs

HME News - Fri, 02/10/2017 - 11:13
02/10/2017Liz Beaulieu

WASHINGTON – CMS has taken away a Medicare beneficiary’s “right to choose,” now that providers aren’t allowed to use K0108 for titanium or heavy duty upgrades for manual wheelchairs, industry stakeholders say.

In a joint article on Dec. 15, the DME MACs state that the codes for manual wheelchairs—K0001 through K0009—have always included the cost of these upgrades.

“Suppliers billing for manual wheelchair bases must not include HCPCS code K0108 in addition to the base wheelchair code when a wheelchair is constructed of titanium or for a ‘heavy duty package’ reflecting titanium construction materials,” they state. “Claim HCPCS code K0108 reflecting titanium construction or ‘heavy duty package’ comprised of titanium components are considered as incorrect coding-unbundling.”

The DME MACs state this has been the case since the codes were developed in 1993.

It has been common practice among providers to use K0108—“wheelchair component or accessory, not otherwise specified”—for titanium and heavy duty upgrades on complex manual wheelchairs. Because the DME MACs have labeled this practice “unbundling,” that’s no longer an option, stakeholders say.

“The article claims that by using the K0108, a provider would be ‘unbundling’ charges, which is not allowed,” said Claudia Amortegui, president of The Orion Consulting Group. “They also then cannot bill the extra charge as an upgrade. This philosophy would go against the principals of the upgrade provision. Simply put, the end-users’ right to choose has been taken away, if they want to pay the difference to obtain specific features and options.”

Now the only choice providers have is to bill non-assigned for manual wheelchairs with titanium and heavy duty upgrades, leaving beneficiaries to pay upfront for the total cost of the chair and to try to wrangle reimbursement for the chair, but not the upgrades, from Medicare.

“It’s unfortunate,” said John Goetz, director of government affairs for Permobil. “A lot of people can pay the difference, but they can’t pay the whole amount upfront.”

NCART has formed a work group and developed an issue paper in response to the change. It is reaching out to CMS to express its concerns and is pursuing “other channels in the congressional and advocacy arena,” it stated in a bulletin to members.

In the issue paper, NCART pushes CMS to rescind the change, and issue a policy clarification stating suppliers can use K0108 to bill for titanium for wheelchairs for K0005, and can use K0108 to bill for heavy duty upgrades for K0004, K0005 and E1161.

Medtrade Spring preview: Keep reserves

HME News - Fri, 02/10/2017 - 11:12
‘While we don’t know what crisis is around the corner, we understand that a crisis will occur,’ says speaker Steve Burman02/10/2017John Andrews

LAS VEGAS – Although considerable challenges exist within the HME industry, astute companies can still find prosperity in the market, provider Steve Burman says.

Burman, CEO of Aston, Pa.-based Burman’s Medical Supplies, will sit on a panel at Medtrade Spring to discuss “Success Stories in HME: How Providers Have Grown in the Face of a Declining Industry.” Through “persistence, integrity, productive paranoia, hyper-focusing and outstanding service,” he has managed to keep his company viable amid a chaotic and inhospitable HME environment.

Ahead of the event, Burman shared some of his thoughts with HME News.

HME News: What’s an example of how your company has grown in the face of industry challenges?

Steve Burman: Through our outstanding customer service—most notably in regard to our clinical knowledge of wounds. We are a resource to our referral sources in making the most appropriate choices in supplies. If your customer service team is better than your competition, then you will grow. Naturally, this is not the case in a competitive bidding atmosphere and our business has not been impacted as much as the rest of the industry.

HME: What has been the key to your succeeding despite the challenges?

Burman: Persistence, integrity, productive paranoia—understanding the need to keep reserves. While we don’t know what crisis is around the corner, we understand that a crisis will occur. We are hyper-focusing on what we do well and not jeopardizing our service by taking part in competitive bidding program business 

HME: What is the role of your leadership in that success? The role of your employees?

Burman: My role is to empower my employees to perform their jobs as close to 100% correct as possible in a style and schedule that works for them. My role has included creating new programs that are clinical in nature and that benefit all interested parties by delivering better outcomes at a lower cost. Employees need to constantly keep up with industry changes and remember we are here for the patients first.

HME: What new challenges do you see down the road?

Burman: One of the biggest challenges is educating insurers so they understand that we are not suppliers—we are health providers made up of pharmacists and nurses who understand how difficult it is to create good outcomes.

HME: Why is the HME industry worth sticking with?

Burman: Providers furnish more than equipment or supplies. It’s almost shocking to me that anyone actually believes a mega provider can deliver more value than a focused independent provider. Our challenge and goal is to prove that our services actually do provide better outcomes at a reduced cost to our healthcare system.

HME: What’s the one thing you want attendees to take away from your session?

Burman: If you’re passionate about your ability to be part of the healthcare solution, that will provide the energy to succeed.

Steve Burman

CEO, Burman’s Medical Supplies

Monday, Feb. 27, 3 p.m. to 4 p.m.

Session: “Success Stories in HME: How Providers Have Grown in the Face of a Declining Industry”

In brief: CMS releases guidance on bid-rate relief, OIG updates Medicare market shares for diabetes test strips

HME News - Fri, 02/10/2017 - 11:10
02/10/2017HME News Staff

WASHINGTON – Suppliers won’t need to resubmit claims to get retroactive payment adjustments mandated by the 21st Century Cures Act, according to guidance released Feb. 9 by CMS.

The Cures Act, signed into law in December, rolled back cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers in those areas to recoup six months worth of payments.

In guidance released to the DME MACs, CMS said it will recalculate the fee schedule to extend the 50/50 blended fee schedule in effect from the Jan. 1 to June 1, 2016, timeframe to the July 1 to Dec. 31, 2016, timeframe, according to a bulletin from AAHomecare.

The revised fee schedule will be available to the DME MACs on or after May 1, 2017. The DME MACs can start processing affected claims as soon as the revised schedule–expected to be available May 1—is loaded into their systems.

Suppliers don’t need to submit new claims or other materials. Instead, the DME MACs will create a one-time process to validate and adjust claims, and will automatically perform a mass reprocessing of claims. Suppliers who believe that their claims weren’t reprocessed will then need to submit a request.

OIG updates Medicare market shares for diabetes test strips

WASHINGTON – Suppliers in Medicare’s national mail-order program provided 18 types of diabetes test strips to beneficiaries from July through September 2016, according to a new report from the Office of Inspector General.

The top strip type accounted for 43% of the mail-order market, and the top 10 strip types accounted for 98% of the market, the OIG found.

The OIG conducted its report by sampling 1,210 claims from a population of 456,784 claims for mail-order test strips.

Suppliers must comply with a rule outlined in the Medicare Improvements for Patients and Providers Act (MIPPA) that they provide at least 50% (by volume) of the types of test strips provided to beneficiaries. The OIG states suppliers could comply with this rule by committing to provide at least two strip types.

This is the second of three reports from the OIG to determine the market shares of diabetes test strips for the periods April through June 2016; July through September 2016; and October through December 2016. This most recent report assesses the market shares for test strips for the three-month period after the implementation of the current mail-order program, which started on July 1.

The OIG’s previous report for the period April through June 2016 found two strip types accounted for about half of the mail-order market, and the top 10 strip types accounted for 93% of the market.

AAH paper makes case for preserving Medicaid rates

WASHINGTON – AAHomecare has released a briefing paper designed to help HME providers engage state Medicaid programs now that a new law has been passed that limits the federal contribution for HME to these programs to the Medicare rates starting Jan. 1, 2018. The paper, “States Should Not Accept Flawed Medicare Rates,” notes the unsustainable rates facing providers operating under competitive bidding-derived Medicare rates and provides perspectives on the problems with applying these rates to state Medicaid programs. The paper focuses on four arguments: 1) the distinct patient populations and differing missions of Medicare vs. state Medicaid programs; 2) the defective and unsustainable Medicare bidding program; 3) major differences in reimbursement structure between the two programs; and 4) significant geographic variances in patient populations that Medicare rates do not adequately account for. AAHomecare argues “there is no federal requirement for a state Medicaid program to tie its payment limits to Medicare rates,” and that states are, in fact, directed to set their own rates as needed to maintain beneficiary access and a sufficient number of participating providers.

MTA taps Respira, HomeSleep for sleep screening, treatment

PARAMUS, N.J. – The board of the Metropolitan Transportation Authority of New York has awarded Respira-HomeSleep a contract to provide medical services to screen, treat, manage and monitor select MTA employees for obstructive sleep apnea. “We look forward to collaborating with HomeSleep and local DME companies in creating this groundbreaking model of care for the transportation industry,” said Yolanda, Mara Martinez, founder and CEO of Respira. Respira is a respiratory therapy, sleep medicine, DME and healthcare management company. Its custom-tailored programs serve more than 80,000 patients. HomeSleep is a diagnostic company in sleep medicine, providing home sleep devices to patients in their homes to diagnose OSA. “We have put a tremendous amount of time and effort into building a comprehensive sleep program with the Respira team and are confident that together we can assist the MTA and their employees,” said Jonathan Perrone, founder and CFO of HomeSleep.

VGM carves out new role for Clark as chief leadership officer

WATERLOO, Iowa – VGM Group has promoted Dennis Clark, president of its Orthotic Prosthetic Group of America division, to serve as chief leadership officer. In this new role, Clark will lead the advancement of values, mission and brand for the employee-owned company. He will also serve as “post-acute health care visionary and ambassador” across all of VGM’s health care membership communities, according to a press release. Clark is a nationally known prosthetist who has served as president of OPGA for the past 20 years. “I’m proud to have Dennis serving in this important new leadership role,” said Mike Mallaro, CEO of VGM. “Dennis has a unique and powerful insight into VGM’s history, culture and values. He is particularly brilliant at connecting people and ideas, as we as building teams.” Todd Eagan, vice president of the OPGA, will step up to president. He has been with OPGA for six years.

AOPA celebrates centennial

WASHINGTON – The American Orthotic & Prosthetic Association has launched www.aopa100.org, a commemorative website in honor of its 100th anniversary. The website features AOPA’s history, an interactive timeline, photo gallery, personal stories from members, and the association’s plans for the future. “The website celebrates our members’ deep roots and rich history in working together to ensure the viability of O&P for the patients we serve,” said Traci Dralle, chairwoman of AOPA’s Centennial Committee. AOPA will mark its anniversary in other ways this year, including events at the AOPA World Congress Sept. 6-9 in Las Vegas, and Throwback Thursday posts on social media platforms each week.

Lodi Health closes HME store

LODI, Calif. – Lodi Health is closing Memorial Home Med-Equip due to changes in Medicare reimbursement, according to the Lodi News-Sentinel. The full-service store has provided area residents with medical equipment like hospital beds, walkers, canes and oxygen equipment for 33 years. Company officials cite a 50% reduction in reimbursement as the driving factor in the decision. Lodi Health is not alone. There were once three medical equipment supply stores in the city at one time, but they have all disappeared, the newspaper reports. Memorial Home Med-Equip is expected to close some time in February.

Chart Industries taps Quality Medical for repairs

BALL GROUND, Ga. – Chart Industries has appointed Largo, Fla.-based Quality Medical as the authorized service center for its customers in the Southeast. Quality Medical will perform both warranty and non-warranty service for Chart products from its new service facility in Cartersville, Ga. Chart manufactures the AirSep, CAIRE and SeQual brands of stationary and portable oxygen concentrators. “Quality Medical is an experienced service provider for a wide range of biomedical equipment and will play an important role in maintaining the high level of service our customers have come to expect from Chart Industries,” said Miguel Cervantes of Chart Industries.

Quality Medical opens new service facility

LARGO, Fla. – Quality Medical has opened a new service facility in Cartersville, Ga., to better serve customers in Georgia, Alabama, Tennessee, North Carolina and South Carolina. “One of the most important elements of great service is turnaround time and this new facility helps us deliver great service in less time,” said PK Bala, CEO of Quality Medical. The new facility services and repairs respiratory, infusion, and patient monitoring equipment from a variety of healthcare companies throughout the Southeast. Its customers include Chart Industries, Philips Respironics, CareFusion, Flight Medical, B. Braun, Baxter and Abbott. Quality Medical aims to have five locations nationwide by 2020. “This location in Georgia is an important milestone toward this goal as we implement standard procedures of excellence across several locations,” said Jim Worrell, senior vice president of corporate development.

Sperduti picks up the tab at Medtrade Spring

LAS VEGAS – Sales guru Mike Sperduti will lead a free, four-part sales training workshop at Medtrade Spring, Feb. 27-March 1, at the Mandalay Bay Convention Center. All show attendees are eligible to attend, and may pick and choose among the four sessions, held Monday and Tuesday, or attend all four. “I recognize how thankful I am to the HME industry,” said Sperduti, president/founder of the Mike Sperduti Companies/Emerge Sales. “This year I want to pick up the tab for anybody who wants to attend any of the sessions, or all four.” For session descriptions, Click Here. To register, Click Here.

Short takes

BioScrip has joined Keep My Infusion Care at Home, a coalition formed in response to a change in the payment model for Medicare Part B home infusion drugs. The Denver-based BioScrip is a leading provider of infusion and home care management solutions…Staff members of the Board of Certification and Accreditation (BOC)are finalists for two Stevie Awards: Front-Line Customer Service Team of the Year and Business Development Professional of the Year. Finalists were chosen from more than 2,300 nominations. Winners will be announced Feb. 24 at a banquet at Caesars Palace in Las Vegas…Mediware Information Systems is now contracted with more than 30 customers for its CareTend software. Mediware released its latest version of the point-of-sale system in June…The National Association of Specialty Pharmacy has released the NASP Member App. Available for Android and iOS, it allows users to network, strategize and communicate…Rancho Cucamonga, Calif.-based PSP Homecare has launched a targeted marketing strategy featuring new radio, online and direct mail advertising. “We are all very excited to now be positioned to start a greatly expanded advertising campaign for our products and services, all supported by our own new dedicated call center,” said Michelle Ricco, CEO of Proto Script Pharmaceutical Corp, the parent company of PSP Homecare…Exeter, Pa.-based Quantum Rehab will have a theme of “To Be As Independent As Possible” at the International Seating Symposium, March 2-4 in Nashville. It will showcase its Q6 Edge 2.0 power base, iLevel seat elevation and Q-Logic 3 Advanced Drive Control technologies at the event.

Tom Price is in as HHS secretary

HME News - Fri, 02/10/2017 - 10:00
‘Dr. Price has a strong appreciation of the role that home medical equipment providers play in allowing people to remain in their homes,’ says AAHomecare’s Ryan02/10/2017HME News Staff

WASHINGTON – The Senate early on Friday approved the nomination of Rep. Tom Price, R-Ga., as secretary of the Department of Health and Human Services.

The Senate voted 52 to 47 to confirm Price, a long-time champion of the HME industry.

“Dr. Price has a strong appreciation of the role that home medical equipment providers play in allowing people to remain in their homes when recuperating from an illness or dealing with long-term health changes,” said Tom Ryan, president and CEO of AAHomecare, in a statement. “He has been a long-time advocate for legislation that would improve Medicare reimbursement practices for home medical equipment, and has led Congressional efforts to make sure that individuals who rely on home medical equipment in rural communities and other less-densely populated areas can get the products and services they need.”

Price, the architect of an alternative to Medicare’s competitive bidding program called the market-pricing program, is a popular choice among HME stakeholders. His long-standing desire to repeal and replace the Affordable Care Act, popular with President Donald Trump and Republicans, also resonates with stakeholders.

Price has had a bumpy road to HHS. Democrats on the Senate Finance Committee tried to block his confirmation by the committee by boycotting a vote on Jan. 31 and again on Feb. 1, but Republicans changed the rules that required Democrats to be present for a quorum. The 14 Republican members of the committee then voted to confirm him.

In overseeing HHS, Price will manage an annual budget of more than $1 trillion. The agency encompasses CMS, the Centers for Disease Control and Prevention, and the National Institutes of Health, the Food and Drug Administration, among others.

CMS releases guidance on bid-rate relief

HME News - Thu, 02/09/2017 - 14:38
02/09/2017HME News Staff

WASHINGTON – Suppliers won’t need to resubmit claims to get retroactive payment adjustments mandated by the 21st Century Cures Act, according to guidance released today by CMS.

The Cures Act, signed into law in December, rolled back cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers in those areas to recoup six months worth of payments.

In guidance released to the DME MACs, CMS said it will recalculate the fee schedule to extend the 50/50 blended fee schedule in effect from Jan. 1 to June 1, 2016, timeframe to the July 1 to Dec. 31, 2016, timeframe, according to a bulletin from AAHomecare.

The revised fee schedule will be available to the DME MACs on or after May 1, 2017. The DME MACs can start processing affected claims as soon as the revised schedule–expected to be available May 1—is loaded into their systems.

Suppliers don’t need to submit new claims or other materials. Instead, the DME MACs will create a one-time process to validate and adjust claims, and will automatically perform a mass reprocessing of claims. Suppliers who believe that their claims weren’t reprocessed will then need to submit a request.

CMS taps the brakes on Round 2019

HME News - Tue, 02/07/2017 - 20:34
02/07/2017HME News Staff

WASHINGTON – CMS has decided to temporarily delay Round 2019 of competitive bidding to give the new administration the chance to review the program.

The agency made the announcement on Feb. 7, about a week after announcing it would consolidate all rounds of competitive bidding into Round 2019.

CMS has removed all information on Round 2019 that was released Jan. 31, including information on the agency’s website and the Competitive Bidding Implementation Contractor website.

The agency advises providers to continue to monitor these websites—www.cms.gov and www.dmecompetitivebid.com—for updates.

Per CMS’s initial announcement, Round 2019 will include 141 competitive bidding areas and have a total of 11 product categories. Contracts will be effective Jan. 1, 2019, through Dec. 31, 2021. The current Round 1 2017, Round 2 re-compete and national mail-order program for diabetes supplies end on Dec. 31, 2018.

CMS announced several changes to competitive bidding as part of Round 2019, including a new product category for insulin pumps and supplies.

The agency also announced it would add 10 new competitive bidding areas for CPAP devices only. In five of those CBAs, payment will be made on a bundled, non-capped monthly rental basis. In the other five, payment will be made on a capped monthly rental basis like all other existing CBAs.

Additionally, CMS announced it would use a lead item bidding methodology for certain items in Round 2019.

Stakeholders applauded a number of changes that CMS plans to make as part of 2019, including moving the bid ceiling to the 2015 fee schedule amounts, and requiring bidders to obtain a $50,000 surety bond for each CBA in which a bid is submitted.

OIG updates Medicare market shares for diabetes test strips

HME News - Tue, 02/07/2017 - 08:38
02/07/2017HME News Staff

WASHINGTON – Suppliers in Medicare’s national mail-order program provided 18 types of diabetes test strips to beneficiaries from July through September 2016, according to a new report from the Office of Inspector General.

The top strip type accounted for 43% of the mail-order market, and the top 10 strip types accounted for 98% of the market, the OIG found.

The OIG conducted its report by sampling 1,210 claims from a population of 456,784 claims for mail-order test strips.

Suppliers must comply with a rule outlined in the Medicare Improvements for Patients and Providers Act (MIPPA) that they provide at least 50% (by volume) of the types of test strips provided to beneficiaries. The OIG states suppliers could comply with this rule by committing to provide at least two strip types.

This is the second of three reports from the OIG to determine the market shares of diabetes test strips for the periods April through June 2016; July through September 2016; and October through December 2016. This most recent report assesses the market shares for test strips for the three-month period after the implementation of the current mail-order program, which started on July 1.

The OIG’s previous report for the period April through June 2016 found two strip types accounted for about half of the mail-order market, and the top 10 strip types accounted for 93% of the market.

CMS adds teeth to bid program

HME News - Fri, 02/03/2017 - 14:46
02/03/2017Theresa Flaherty

WASHINGTON – After several rounds of the competitive bidding program now under its belt, CMS has implemented improvements to Round 2019 that could curb the ongoing race to the bottom, say industry stakeholders.

The biggest improvement, say stakeholders: the bid ceiling has been moved to the 2015 fee schedule amounts. Previously, the bid ceiling had reset to each new round of bid rates.

“Raising the bid ceiling is a huge indication that CMS thinks they’ve hit rock bottom—and gone below rock bottom,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “In order to be financially sustainable, it was necessary to raise the bid ceiling.”

CMS on Jan. 31 announced it would consolidate all rounds of the program into a single competition, with contracts effective Jan. 1, 2019, through Dec. 31, 2021.

Another improvement: Round 2019 marks the first time bidders will be required to obtain a $50,000 surety bond for each CBA in which a bid is submitted. That increases the stakes for bidders, say stakeholders.

“Providers will no longer have the luxury of just declining when the bid prices come out,” said Andrea Stark, a reimbursement consultant with MiraVista. “You will forfeit the bond if you said you could do it for ‘X’ and they offer you a contract for at least ‘X’ and you don’t take it.”

CMS has also added insulin pumps and supplies as a product category in the bid program, but stakeholders question how that will work.

“My experience has been that most pumps are supplied directly from the manufacturers,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “Will the manufacturers really bid?”

The other product categories are: enteral nutrients, equipment and supplies; general HME and related supplies and accessories; nebulizers, negative pressure wound therapy; respiratory equipment; standard mobility equipment and TENS devices.

Brummett says she is disappointed that oxygen and sleep are still lumped into a singular respiratory category.

“Forcing them together denigrates the bid,” she said.

CMS has added 10 new CBAs—in Alabama, Iowa, Michigan, California and North Carolina—for the CPAP category only. In five of those CBAs, payment for the CPAP device, related accessories, and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like all other existing CBAs.

“I think CMS is going to be watching to make sure providers in those areas don’t limit the choice to certain brands or models,” says Stark.

ResMed settles with 3B Medical

HME News - Fri, 02/03/2017 - 14:44
Company believes it has ‘larger case’ with F&P02/03/2017Liz Beaulieu

SAN DIEGO – ResMed recognized an expense of $8.5 million in its second quarter fiscal year financial results, part of a global settlement of all litigation between the company and BMC and its U.S. distributor 3B Medical.

ResMed and 3B Medical announced a five-year settlement on Jan. 21 that involves ResMed making a one-time payment to 3B Medical to close ongoing litigation between the two companies in Florida.

“Obviously, one of the reasons you settle cases is to avoid the further ongoing expense and that was one of the reasons that motivated us to reach this settlement with BMC,” said David Pendarvis, global general counsel for ResMed, during a conference call on Jan. 23 to discuss the company’s finance results. “We’re very pleased with it.”

The settlement also entails 3B Medical being able to sell their existing products in exchange for making royalty payments to ResMed.

Pendarvis said the royalties, while not likely to be material to ResMed’s financial results going forward, are “helping to validate the strength of our intellectual property.”

Despite the settlement, ResMed expects to have “ongoing legal expenses,” Pendarvis said, due to litigation with a larger competitor, Fisher & Paykel Healthcare.

“We continue to have, frankly, a larger case against F&P,” he said.

F&P filed patent infringement proceedings against ResMed in the U.S. District Court for the Central District of California in August. It seeks judgment that ResMed’s AirSense10 and AirCurve10 range of flow generator products, its ClimateLineAir heated air tubing and its Swift LT and FX masks infringe patents that it holds.

ResMed counter-filed with actions against F&P in U.S., German and New Zealand courts, as well as the U.S. International Trade Commission, that same month. It seeks an injunction banning the import of F&P’s Simplus full-face mask, and Eson and Eson 2 nasal masks, asserting that the masks infringe on ResMed’s patents relating to modular mask systems, headgear design and cushion design.

ResMed’s settlement with 3B Medical also resolves all pending litigation before the U.S. International Trade Commission, lawsuits pending in district court in Florida and California, foreign litigation in China and Germany, and validity challenges pending in various patent offices around the world.

ResMed and 3B Medical have been volleying legal charges back and forth for years. At the crux of the battle: ResMed’s patent on its CPAP humidifier, and whether or not it was valid and whether or not 3B Medical was violating it with its own humidifier.

 

Work group aims to ‘reframe’ payment for technology

HME News - Fri, 02/03/2017 - 14:41
‘Why is it important and what does it prevent?’02/03/2017Liz Beaulieu

WASHINGTON – The members of AAHomecare’s new Hi Tech Work Group will meet face-to-face at Medtrade Spring to set next steps in their goal of getting private payers to increase reimbursement for new oxygen and sleep therapy technology, or create new payment models for them.

Leading up to the event, members of the work group were gathering information about how payments for other product categories have been reshaped. One recent example: CMS classified “therapeutic” continuous glucose monitors as DME and assigned them a one-time fee schedule amount of $236 to $277, plus bundled monthly payments for supplies.

“It’s interesting that they recognized the therapeutic aspect of these devices,” said Maura Toole, director of field marketing for Philips Healthcare, who is leading the work group. “Being able to monitor sleep apnea and what’s going on with mask fit, AHI and periodic breathing—these are all therapeutic benefits that providers offer with new technology. We’ve all focused on utilization, and not as much about the therapeutic benefits. That’s a way to reframe the issue to payers.”

The work group encompasses a cross-functional representation of manufacturers and providers. Helping Toole to lead the group is Laura Williard, AAHomecare’s senior director of payer relations.

While the work group doesn’t have a road map yet to achieve their goal, their strategy is to set a precedent with one payer, then give providers tools that they can use to motivate other payers to follow suit, Toole says.

“With private payers, there’s no cookie-cutter, turn-key solution,” she said. “So we want some kind of mechanism that providers can use to take it further.”

Key to setting that precedent will be proving the value of new technology, Williard said.

“Why is it important and what does it prevent?” she said. “What outcomes can we ensure to get payment?”

Williard, whose main job responsibility at AAHomecare is to improve the HME industry’s relationships with payers, says she believes “there is an opening there.”

“In my initial conversations with payers, there is some openness to discussing this,” she said. “But you definitely have to prove the value of it.”

In brief: Republicans push through Price’s confirmation, reps introduce separate benefit legislation

HME News - Fri, 02/03/2017 - 14:37
02/03/2017HME News Staff

WASHINGTON – The 14 Republican members of the Senate Finance Committee have voted to confirm Rep. Tom Price, R-Ga., as secretary for the Department of Health and Human Services, according to news reports.

Price’s confirmation now goes to the Senate floor for a full vote.

Democrats made headlines on Jan. 31, when they boycotted the vote on Price scheduled to take place at 10 that morning, saying they wanted more time to ask questions about his background. An article in the Wall Street Journal reported that Price received a special discounted rate for stocks of an Australian pharmaceutical company named Innate Immunotherapies.

Price, the architect of an alternative to Medicare’s competitive bidding program called the market-pricing program, is a popular choice among HME stakeholders. His long-standing desire to repeal and replace the Affordable Care Act, popular with President Donald Trump and Republicans, also resonates with stakeholders.

Eighty-five percent of respondents to a recent HME Newspoll said having Price as secretary would be positive for the HME industry. Fifty-six percent said his first priority should be repealing the bid program and replacing it with MPP, followed closely with 28% saying it should be repealing and replacing the ACA.

In overseeing HHS, Price would manage an annual budget of more than $1 trillion. The agency encompasses CMS, the Centers for Disease Control and Prevention, and the National Institutes of Health, the Food and Drug Administration, among others.

Price has endured long and grueling hearings before not only the Senate Finance Committee on Jan. 24 but also the Senate Health, Education, Labor and Pensions Committee, known as HELP, on Jan. 18.

Reps. Crowley, Sensenbrenner introduce separate benefit bill for complex rehab

WASHINGTON – Reps. Joe Crowley, D-N.Y., and Jim Sensenbrenner, R-Wis., have introduced a bill that would create a separate benefit for complex rehab technology. “This legislation would guarantee that patients have access to the high-quality products and services they need to lead a more independent life,” said Crowley, chairman of the Democratic Caucus. “For those with disabilities and other medical conditions, these complex rehabilitation technology products are necessities.” Currently, Medicare classifies complex rehab products like specialized power wheelchairs and adaptive seating systems as DME, limiting access and choice for users. The bill, H.R. 750, would also help prevent fraud and abuse by requiring that a licensed physical or occupational therapist evaluate any patient seeking complex rehab products through Medicare. H.R. 1516, a previous bill to create a separate benefit for complex rehab, drew support from 172 co-sponsors. A similar bill in the Senate, S. 1013, drew support from 19 co-sponsors.

AAHomecare to Tricare: Reprocess claims

WASHINGTON – AAHomecare is calling on the contractors administering Tricare military health plans nationwide to reprocess claims for HME for the last six months of 2016. Congress directed Medicare to do just that in a provision included in the 21st Century Cures Act passed in December. “Congress recognized the need to provide relief for home medical equipment companies operating under drastic Medicare reimbursement cuts,” said Tom Ryan, president and CEO of AAHomecare. “It’s clear from current statutes and regulations that this relief is also applicable to the Tricare program.” AAHomecare argues that since Tricare reimbursement rates are pegged to Medicare reimbursement rates by law and by current network agreements, these plans are obligated to follow suit. The association has sent a letter to the three contractors administering the Tricare plans and the Department of Defense outlining its argument.

Ottobock draws PE interest

DUDERSTADT, Germany – Ottobock has attracted interest from private equity firms, including KKR and CVC, according to Reuters. The firms are looking for a 20% stake in the company core business of making artificial limbs. Ottobock is also drawing interest from buyout firms BC Partners and Advent. The company is targeting PE firms, affluent families and technology funds as potential buyers in a deal it hopes to complete by the end of June, ahead of a planned initial public offering, Reuters reported. Ottobock, which is being advised by J.P. Morgan, is currently valued at $3.2 billion. It’s currently a private company owned by the founder’s grandson, Hans Georg Naeder.

It’s official: Inspired by Drive launches

PORT WASHINGTON, N.Y. – Drive DeVilbiss Healthcare today announced the official launch of Inspired by Drive, a brand dedicated to manufacturing positioning and mobility products for the pediatric market. “Making a difference for families of children with special needs matters to us,” said Matt Lawrence, vice president and general manager of Inspired by Drive. “The grace, love and determination of special needs families gave birth to our company name and motivates the current and future vision of the Inspired by Drive Product line.” Inspired by Drive was formed when Drive combined Columbia Medical, Specialized Orthotic Services and Wenzelite Rehab.

Safeguard Services tapped for UPIC contract

CAMP HILL, Pa. – SafeGuard Services has been awarded the Unified Program Integrity Contractor (UPIC) for the Northeastern Jurisdiction. UPICs are new CMS contractors that will be replacing the functions of: Zone Program Integrity Contractor (ZPIC), Program Safeguard Contractor (PSC), and Medicaid Integrity Contractor (MIC). The Northeastern Jurisdiction consists of the following states: Connecticut, Delaware, Maine, Massachusetts, Maryland, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont and Washington DC.  

RxWiki,TeleManager Technologies form new company

AUSTIN, Texas – RxWiki, a digital health company, has merged with TeleManager Technologies, a communication solutions company, to form Digital Pharmacist. Digital Health’s platform enables pharmacies and patients to communicate via phone, web or text to fill prescriptions, set reminder alerts, learn about their health conditions or ask the pharmacist questions. RxWiki in December signed a five-year renewal with the National Community Pharmacists Association to offer association members access to its services.

Arch Comfort finds new home in pharmacy

WILKES-BARRE, Pa.  – Arch Comfort, which specializes in therapeutic and corrective footwear, has moved inside Harrold’s Pharmacy, according to the local newspaper, The Times-Leader. The owners of Arch Comfort, both certified pedorthists, said the new location will give the company more visibility and allow it to accept more kids of insurances, the newspaper reported. Arch Comfort provides personalized fittings for braces and orthotics, a shoe lab for in-house modifications, a selection of name brand orthopedic footwear and other therapeutic products. Harrold’s Pharmacy encompasses a 22,000-square-foot facility, a former bakery that the company spent $3 million to $4 million renovating in 2013.

Essential Medical Supply taps ARI for website services

MILWAUKEE and ORLANDO, Fla. – ARI Network Services is now the preferred website provider of the more than 2,000 independent dealers of Essential Medical Supply, a manufacturer of in-home medical and health-related products. ARI will offer Essential Medical Supply dealers special package pricing and discounts on their websites. ARI’s websites give dealers easy access to Essential Medical Supply’s full library of pre-loaded product data, and industry specific functionality, including a prescription refill module and secure online bill pay. “The effects of competitive bidding have encouraged HME providers to explore new online profit centers, and this program offers providers the opportunity to optimize their online presence to ‘Sell More Stuff’ online and in-store,” said Patrick Miller, ARI’s HME business development director.

CCS Medical’s diabetes program earns DEAP accreditation

FARMERS BRANCH, Texas – CCS Medical’s diabetes education program CCS Connects has been named a Diabetes Education Accreditation Program by the American Association of Diabetes Educators. CCS Connects uses health risk assessments and smart devices to collect real-time data, and also uses wireless glucose technology and clinical monitoring. CDEs interact with members every three months to provide ongoing education and coaching focused on nutrition, product training, behavioral changes and goal setting. "If we can increase high-risk member awareness to their condition, diagnosis and self-management principles, we can reduce diabetes-related ER visits and hospitalizations, resulting in reduced healthcare costs," said Kristine Erdman, vice president of clinical services for CCS Medical. CCS Medical is a mail provider of diabetes supplies, insulin pumps and continuous glucose monitors, and wound care, urology, ostomy and other supplies.

CRT conference registration opens

ARLINGTON, Va. – Registration is now open for this year’s National CRT Leadership and Advocacy Conference, slated for April 26–27 at the Hyatt Regency Crystal City. This year’s event has been condensed into two days; the conference fee is $199. A key focus of the event is pushing legislationto permanently delay CMS’s plan to apply competitive bidding-derived pricing to accessories for manual and power wheelchairs, and to create a separate benefit for complex rehab. NCART and NRRTS expect to have bills introduced by the event. For more information or to register: www.ncart.us or www.nrrts.org.

CFA hosts networking reception

LAS VEGAS – Medtrade Spring attendees will have the opportunity to attend a networking reception at the Environments for Aging Expo on Feb. 28, 5-7 p.m. EFA is co-co-locating with Medtrade Spring, which takes place Feb. 27-March 1 at the Mandalay Bay Convention Center. The networking event is $25. Register here.

People: Cure Medical taps Wells for exec position

NEWPORT BEACH, Calif. – Lisa Wells has been named vice president of marketing at Cure Medical. Well has more than 20 years of experience in healthcare marketing, digital technology, product development and community relations, most recently as president of Get Social Consulting. She is also the founder of several social communities for wheelchair users, including Wheel:Life, which she sold to Comfort Medical in April 2016. Cure Medical is a manufacturer of intermittent catheters and closed catheter systems. It donates 10% of net profits to research.

Reps. Crowley, Sensenbrenner introduce separate benefit bill for complex rehab

HME News - Fri, 02/03/2017 - 09:46
02/03/2017HME News Staff

WASHINGTON – Reps. Joe Crowley, D-N.Y., and Jim Sensenbrenner, R-Wis., have introduced a bill that would create a separate benefit for complex rehab technology.

“This legislation would guarantee that patients have access to the high-quality products and services they need to lead a more independent life,” said Crowley, chairman of the Democratic Caucus. “For those with disabilities and other medical conditions, these complex rehabilitation technology products are necessities.”

Currently, Medicare classifies complex rehab products like specialized power wheelchairs and adaptive seating systems as DME, limiting access and choice for users.

The bill, H.R. 750, would also help prevent fraud and abuse by requiring that a licensed physical or occupational therapist evaluate any patient seeking complex rehab products through Medicare.

H.R. 1516, a previous bill to create a separate benefit for complex rehab, drew support from 172 co-sponsors. A similar bill in the Senate, S. 1013, drew support from 19 co-sponsors.

Competitive bidding: CMS to combine all future bids into one

HME News - Wed, 02/01/2017 - 11:53
02/01/2017HME News Staff

WASHINGTON – CMS today announced it will consolidate all rounds of the competitive bidding program into a single competition, Round 2019.

Round 2019 will include 141 competitive bidding areas (CBAs) and have a total of 11 product categories. Contracts will be effective Jan. 1, 2019 through Dec. 31, 2021.

The current Round 1 2017, Round 2 re-compete, and national mail-order program for diabetes end on Dec. 31, 2018.

CMS also announced several changes to the program for Round 2019. Insulin pumps and supplies will be added as a product category. CMS is also adding 10 new CBAs to the program for the CPAP devices and related accessories product category only.  

The other product categories are: enteral nutrients, equipment and supplies; general HME and related supplies and accessories; nebulizers, negative pressure wound therapy; respiratory equipment; standard mobility equipment and TENS devices.

In five of these 10 new CBAs, payment for the CPAP device, related accessories, and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like all other existing CBAs.

CMS is also including a lead item bidding methodology for certain items in Round 2019 in which suppliers will bid for a lead item within a grouping of similar equipment that takes into account the costs of furnishing all of the equipment in the grouping. The single payment amount for the other items within the grouping will be based on their relative differences in fees when compared to the lead item.

In the most recent round of bidding, Round 1 2017, providers saw an overall reduction in reimbursement of 5.2% from the Round 1 re-compete. The Round 1 re-compete saw an overall reduction in reimbursement of 37%.

In the most recent round of the national mail-order category for diabetes supplies, providers saw the reimbursement for a box of test strips decrease by about 21%—from $10.41 to $8.32—compared to the previous round.

UPDATE: Republicans push Price’s confirmation through committee

HME News - Wed, 02/01/2017 - 10:52
02/01/2017HME News Staff

WASHINGTON – The 14 Republican members of the Senate Finance Committee have voted to confirm Rep. Tom Price, R-Ga., as secretary for the Department of Health and Human Services, according to news reports.

Price’s confirmation now goes to the Senate floor for a full vote, likely next week.

Democrats on the committee tried to block the confirmation for a second day by boycotting the vote, but Republicans changed the rules that required Democrats to be present for a quorum, Reuters reported.

Democrats made headlines on Jan. 31, when they boycotted the vote on Price scheduled to take place at 10 that morning, saying they wanted more time to ask questions about his background. An article in the Wall Street Journal this week reported that Price received a special discounted rate for stocks of an Australian pharmaceutical company named Innate Immunotherapies.

Price, the architect of an alternative to Medicare’s competitive bidding program called the market-pricing program, is a popular choice among HME stakeholders. His long-standing desire to repeal and replace the Affordable Care Act, popular with President Donald Trump and Republicans, also resonates with stakeholders.

Eighty-five percent of respondents to a recent HME Newspoll said having Price as secretary would be positive for the HME industry. Fifty-six percent said his first priority should be repealing the bid program and replacing it with MPP, followed closely with 28% saying it should be repealing and replacing the ACA.

In overseeing HHS, Price would manage an annual budget of more than $1 trillion. The agency encompasses CMS, the Centers for Disease Control and Prevention, and the National Institutes of Health, the Food and Drug Administration, among others.

Price has endured long and grueling hearings before not only the Senate Finance Committee on Jan. 24 but also the Senate Health, Education, Labor and Pensions Committee, known as HELP, on Jan. 18.

Invacare reduces workforce again

HME News - Wed, 02/01/2017 - 10:49
Layoffs have occurred in each of the past four years02/01/2017HME News Staff

ELYRIA, Ohio – Invacare will reduce its workforce by about 100 associates, a move that will generate about $6.6 million annually in pre-tax savings, the company announced late on Jan. 31.

The reduction in workforce is necessary to realign Invacare’s infrastructure, says said Matt Monaghan, chairman, president and CEO, in the wake of efforts in 2016 to recruit associates to the North America commercial team as part of its transformation from a generalist DME to a more clinical company.

“These changes, while difficult, are an essential part of our transition to becoming a more sustainably profitable, growing business,” he said.

As a result of the reduction, Invacare expects to incur restructuring charges of about $2.2 million on a pre-tax basis, the company says.

The 100 associates come from across Invacare’s North America business and are all salaried or hourly employees, according to Lara Mahoney, senior director of investor relations and corporate communications.

Invacare still has about 4,600 associates globally, Mahoney said.

Layoffs are becoming an annual event at Invacare. In a conference call in November to discuss its third quarter financial results for 2016, Monaghan noted Invacare’s decision in October to “right-size” certain parts of the North America/HME business in line with shifts in staffing needs, a move that saves about $2.6 million annually.

Invacare also reduced its workforce in 2015, when the company laid off 30 employees, 20 at its North Ridgeville campus in Elyria, and in 2014, when it laid off 190 associates, 60 at the North Ridgeville campus.

Shortly after taking the reins at Invacare in April of 2015, Monaghan laid out a three-phase transformation for the company. During the call in November, Monaghan said the company was in the first phase of the transformation, which entails strengthening the balance sheet, developing and expanding talent, accelerating quality efforts, strengthening the North America commercial team, shifting product mix and restarting the innovation pipeline.

Invacare is still in the process of trying to lift a consent decree with the U.S. Food and Drug Administration that has limited the company’s ability to manufacture and sell custom power wheelchairs and seating systems since 2012. Most recently, in June, the FDA outlined additional steps the company must take before completing the third and final phase of lifting the decree. Those steps include completing the remediation of certain design history files referenced in the FDA’s 2015 inspection report and in the decree.

Invacare is slated to release its fourth quarter and year-end 2016 financial results on Feb. 9.

Senate Democrats delay Price’s confirmation

HME News - Tue, 01/31/2017 - 13:59
01/31/2017HME News Staff

WASHINGTON – Democrats on the Senate Finance Committee have boycotted a vote on President Donald Trump’s nominee for secretary of the Department of Health and Human Services, Rep. Tom Price, R-Ga., according to news reports.

The committee was scheduled to vote at 10 a.m.

Democrats boycotted the vote due to “truly alarming news” of a Wall Street Journal report that Price received a special discounted rate for stocks of an Australian pharmaceutical company called Innate Immunotherapies, Sen. Ron Wyden, the top Democrat on the committee, told CNN.

“This is contrary to congressional testimony he gave,” he said.

Democrats say they will not vote to confirm Price until they can ask more questions about his background, the Associated Press reported.

Republicans on the committee have delayed the vote indefinitely, the AP reported.

Price, the architect of an alternative to Medicare’s competitive bidding program called the market-pricing program, is a popular choice among HME stakeholders. His long-standing desire to repeal and replace the Affordable Care Act, popular with President Donald Trump and Republicans, also resonates with stakeholders.

Eighty-five percent of respondents to a recent HME Newspoll said having Price as secretary would be positive for the HME industry. Fifty-six percent said his first priority should be repealing the bid program and replacing it with MPP, followed closely with 28% saying it should be repealing and replacing the ACA.

In overseeing HHS, Price would manage an annual budget of more than $1 trillion. The agency encompasses CMS, the Centers for Disease Control and Prevention, and the National Institutes of Health, the Food and Drug Administration, among others.

Price has endured long and grueling hearings before not only the Senate Finance Committee on Jan. 24 but also the Senate Health, Education, Labor and Pensions Committee, known as HELP, on Jan. 18.

Home infusion stakeholders: Fix the gap

HME News - Fri, 01/27/2017 - 13:46
01/27/2017Theresa Flaherty

WASHINGTON – Home infusion stakeholders want a fast fix for a payment gap that will limit patient access to therapy.

The National Home Infusion Association spearheaded a Jan. 26 letter, with more than 170 signatures, urging lawmakers to take “quick action” to address the payment gap.

“We can’t waste any time,” said Ken van Pool, vice president of legislative affairs for the NHIA. “Without a fix in the near-term, it just spirals out of control over time.”

As of Jan. 1, per a provision in the 21st Century Cures Act, Medicare pays for Part B infusion drugs under an average sales price model, a move that reduces payments so drastically that, essentially, they no longer cover services. Another provision in the act provides payments for these services, but not until 2021.

Signers to the NHIA’s letter ranged from providers and patient advocacy groups to prestigious healthcare systems, including the Cleveland Clinic, Johns Hopkins and Northwestern, said van Pool.

“I think this is sending a clear statement that this is a wide-ranging problem that’s been caused by the Cures bill,” he said.

Also last week, Option Care, a leading home infusion provider, along with NHIA and other industry leaders, launched Keep My Infusion Care at Home, a coalition charged with sharing stories of the impact of the changes, all with the patient front and center.

“These are patients that are late stage heart failure patients, or awaiting transplants or other procedures,” said Paul Mastrapa, CEO of Option Care. “The website for Keep My Infusion Care at Home makes it very easy for all involved to help make sure their representatives in Congress hear about this and address it as quickly as possible.”

There is already a “lot of noise” on the Hill about the payment gap, says Mastrapa.

“Leadership in the House and Senate are on record as recognizing that this is a problem and they are committed to fixing this issue,” he said.

With the new legislative session only a few weeks old, it’s too soon to identify a possible legislative vehicle for the issue, says van Pool. All eyes are currently on efforts to repeal and replace the Affordable Care Act.

“That’s the first train leaving the station, but we are looking for any train that could capture this,” he said. “That’s what we are working toward.”

Syndicate content