Feed aggregator

CMS touts prevention efforts

HME News - Wed, 07/20/2016 - 13:34
07/20/2016HME News Staff

WASHINGTON – CMS’s efforts to reduce improper payments have saved nearly $42 billion, according to a new report.

The savings, from Oct. 1, 2012, to Sept. 30, 2014, equate to an average savings of $12.40 for every dollar spent, according to a new report form the Center for Program Integrity.

The CPI’s efforts include making sure enrolled healthcare providers are properly screened; using predictive analytics to prevent fraud, waste and abuse; and coordinating anti-fraud efforts with federal and external partners, including state Medicaid and agencies and law enforcement agencies.

“CMS’s efforts to proactively prevent potentially fraudulent and improper payments from being made have been increasingly effective, moving our efforts away from the ‘pay-and-chase’ method of recovering payments after they had already been made,” the agency stated in a press release.

In fiscal year 2013, savings from prevention activities represented 68% of total savings; that rose to nearly 74% in fiscal year 2014.

“CMS is dedicated to promoting better care, protecting patient safety, reducing healthcare costs, and providing people with access to the right care, when and where they need it,” the agency stated. “This includes continually strengthening and improving Medicare and Medicaid programs that provide vital services to millions of Americans.”  

CMS will release fiscal year 2015 numbers later this year.

Hard-fought bid delay fails

HME News - Fri, 07/15/2016 - 12:28
07/15/2016HME News Staff

WASHINGTON – Congress has failed to pass a bill that would delay a second round of Medicare reimbursement cuts for three months, until Sept. 30.

In the days before a long recess that kicked off July 15, the Senate had begun a “hotline process” to pass an amended version of H.R. 5210, which had already been passed by the House of Representatives earlier in the month.

As part of the process, the bill was introduced and distributed to all 100 offices of the Senate. If there were no objections within 24 hours, it would be considered passed. But somewhere along the line, the process failed.

“We were told last night that the hotlined bill was put on hold,” The VGM Group stated in a “Legislative Update” to its members on Friday. “We are still trying to confirm which senator placed the hold.”

The second round of reimbursement cuts—which, together with the first round of cuts that went into effect Jan. 1 represent, on average, a 51.1% decrease in reimbursement—went into effect July 1.

The Senate passed a bill, S. 2736, in late June that would have delayed the second round of cuts for one year, until July 1, 2017. But the pay-for for the bill—speeding up plans to match the federal portion of Medicaid allowables to bid-adjusted Medicare allowables from Jan. 1, 2019, to Oct. 1, 2018—was considered “toxic” by some lawmakers.

So, ultimately, the Senate ran with the House bill, which has a shorter delay but a non-HME specific pay-for, with plans to take up the issue again in September when it returns from its summer recess.

VGM says industry leaders will meet with their champions to determine action items for when Congress resumes business in September.

“We appreciate all your grassroots efforts the past 12 months,” VGM stated in the update. “The calls, personal visits and emails to your members of Congress did not go in vain. Both the Senate and House passed separate bills earlier this month. The fact that we had not one, but three, unanimous consent hotlined in the Senate is unheard of and an impressive feat! Unfortunately, if only takes on Senator to stop our efforts.”

Bill seeks improvements to vent category

HME News - Fri, 07/15/2016 - 12:27
07/15/2016Theresa Flaherty

WASHINGTON – A bill that would create medical necessity standards and boost payments for ventilators was introduced in the Senate July 14.

The “Beneficiary Respiratory Equipment Access and Transparency to Home Ventilator Care (BREATH) Act of 2016” was introduced by Sens. Bill Cassidy, D-La., and Chuck Grassley, R-Iowa.

“This is a simple bill,” said Stephen Cooper, counselor at K&L Gates, which helped draft the legislation.“It requires CMS to implement medical necessity standards and to increase payments next year. It’s not more complicated than that.”

In response to a spike in utilization for vents—from 60,000 beneficiaries in 2010 to 178,000 in 2014—CMS has overhauled the product category, reducing the number of codes from five to two, and reducing payments by about 33%.

At the core of the issue: CMS believes HME providers have been wrongly using ventilators, instead of CPAP machines, to treat sleep apnea patients, says Cooper.

“Part of the problem is we don’t have good medical necessity standards,” he said. “(The bill requires) standards that say, ‘We’ll pay for the vent when the patient has these clinical indications.’”

The policies and standards for appropriate use of ventilators would be developed in consultation with medical experts. Cooper says he believes that the standards would help reduce utilization by 20%.

The bill would also increase payment amounts by 20% on Jan. 1, 2017.

“We tried to be conservative,” said Cooper, of the decision to not seek a full increase of 33%. “It has to be budget-neutral. If the use of vents doesn’t go down 20% in 2017, then the industry’s rates will be cut in 2018 by the difference between 20% and the actual decrease.”

Lawmakers broke for summer recess July 15. When they return in September, they will likely take up some Medicare provisions in a bill that the BREATH Act could get included in, says Cooper.

“From what staff tells me, they would like to do a fairly modest but bi-partisan Medicare bill in the lame-duck session,” he said.

Joint mobility conference breaks records

HME News - Fri, 07/15/2016 - 12:25
07/15/2016Tracy Orzel

ARLINGTON, Va. – The decision to combine two mobility-related conferences involving three organizations has paid off, organizers say.

“The conference is a big step closer in coordinating between (RESNA, NCART and NRRTS),” said Don Clayback, executive director of NCART. “People are talking more broadly about advocacy on some of the issues that everyone has in common. That was one of our objectives, so (it’s great) to see that going on at the conference.”

More than 600 complex rehab and assistive technology stakeholders attended the joint event, held July 12-14 at the Hyatt Regency Crystal City in Arlington, Va. That’s triple the number at last year’s complex rehab conference hosted by NCART and NRRTS.

The joint conference allowed attendees to see a wider breadth of technology and encouraged them to think outside the box.

“I think (the conference) gives us a lot of resources in one place, which is really great,” said Jenny Siegle, a consumer advocate. “There was a workshop for adaptive gaming—that’s something I’ve never even thought of and I’ve been in a wheelchair for 33 years.”

As part of the conference, stakeholders met with a record-breaking 260 congressional offices to advocate for access. Topping the list of their priorities: adding co-sponsors to a pair of bills that would prevent CMS from applying competitive bid pricing to accessories used on complex rehab power wheelchairs.

Stakeholders also asked Congress to co-sponsor and pass H.R. 1516/S.1013, which would create a separate benefit for complex rehab, as well as to support full funding for the Assistive Technology Act.

While stakeholders have their work cut out for them between election year politics, fewer legislative vehicles and a dwindling number of legislative days, the feedback from the meetings has been positive, says Clayback.

“The meetings went very well and we expect to see a significant increase in co-sponsors,” he said. “There were several members that committed on the spot and then there was a wide variety that said, ‘We definitely think we’ll be signing on, we just need to talk to our boss to verify.’”

As for whether there will be a repeat collaboration next year, organizers say they’ll have to see what makes the most sense “logistically.”

“We’ll definitely consider it,” said Mike Brogioli, executive director of RESNA. “We’re committed to a hotel in New Orleans for 2017, but we’ll certainly look at it and see what’s logistically feasible and what makes long-term sense.”

 

Whistleblower details alleged fraud at Lincare

HME News - Fri, 07/15/2016 - 12:23
07/15/2016HME News Staff

CLEARWATER, Fla. – A former employee says Lincare has been knowingly defrauding the government of millions of dollars by allegedly billing false claims to Medicare.

“(Lincare) has engaged in a scheme to wrongfully enrich itself at taxpayers’ expense by fraudulently billing Medicare for equipment rental for which either the patients or the equipment were not reimbursable by Medicare, by failing to provide services to patients it was obligated to provide, and by retaining overpayments to which it new it was not entitled,” alleges Rebecca Saiff in a whistleblower lawsuit unsealed July 1 by the U.S. District Court for the Middle District of Florida in Tampa.

Saiff worked for Lincare as a Medicare billing specialist at the corporate headquarters from January to July of 2013, and at its Largo, Fla., regional billing and collection office from August of 2013 until February 2014. She filed her lawsuit under seal in April 2014.

More specifically, Saiff alleges that Lincare:

·      Improperly adjusts billing dates to bill Medicare for equipment rental on days during which patients were not using the equipment (i.e. days when patients were in a skilled-nursing facility or hospital);

·      Circumvents the competitive bidding program by submitting claims in areas for which it did not have a contract;

·      Retains overpayments made by Medicare for equipment that has already reached the 36-month cap on payments;

·      Refuses to perform its contractual obligations to repair rental equipment for five years after its provision to beneficiaries; and

·      Bills Medicare for equipment rented to beneficiaries who did not qualify for such equipment.

Saiff alleges that Lincare provides incentives to employees to submit false claims to its billing offices.

“Lincare has achieved this by instituting a policy that store managers and/or sales persons are entitled to be paid commission once a claim is submitted to the accounts receivable department (i.e. before any determination has been made as to whether the relevant insurer will actually pay the claim),” the lawsuit states. “This has led to an overwhelming number of submissions from the stores that are plainly deficient on their face.”

Saiff seeks, among other relief, $5,500 to $11,000 for each violation of the False Claims Act, plus three times the amount of damages the U.S. has sustained because of Lincare’s alleged misconduct.

In brief: Growth in healthcare spending lower than average, CMS backs unique device identifiers

HME News - Fri, 07/15/2016 - 12:21
07/15/2016HME News Staff

WASHINGTON – Total healthcare spending growth is expected to average 5.8% annually over 2015-2025, according to a report published July 13 by Health Affairs and authored by CMS’s Office of the Actuary. Projected healthcare spending growth remains lower than the average over previous two decades before 2008 (nearly 8%). “The Affordable Care Act continues to help keep overall health spending growth at a modest level and at a lower growth rate than the previous two decades,” said CMS Acting Administrator Andy Slavitt in a press release. “Per-capita spending and medical inflation also remain at historically very modest levels, demonstrating the importance of continuing to reform our delivery systems.” Overall, national health expenditures are estimated to have reached $3.2 trillion in 2015, according to the report.

CMS backs unique device identifiers

WASHINGTON – CMS has endorsed the use of unique device identifiers in billing records for medical devices, according to the Wall Street Journal. The ID numbers have been advocated by lawmakers and the U.S. Food and Drug Administration for years, but never by Medicare. The idea: Because the ID numbers would appear in databases of hospitals and big insurers, including Medicare, they would help the FDA to quickly find malfunctioning devices and order a recall if necessary, the Journal reports. CMS Acting Administrator Andrew Slavitt endorsed the use of ID numbers in a letter this week to a committee of the medical-billing industry, writing they would improve patient safety, according to the Journal.

Power soccer returns to Medtrade

ATLANTA – The United States Power Soccer Association returns to Medtrade this year. The USPSA will play two games on the show floor on Nov. 1, once in the morning and once in the afternoon. Exact times are to be determined. “These are skilled individuals, and everyone who watched the power soccer demo back in 2014 can attest to that,” said Kevin Gaffney, group show director of Medtrade. “I encourage Medtrade attendees to check it out this year.” Medtrade exhibitor MK Battery is a main sponsor for the USPSA and has been for many years. In a recent guest blog, Wayne Merdinger, executive vice president and general manager of MK Battery, called on others in the industry to sponsor USPSA, which will host the FIPFA World Cup of Soccer in Kissimmee, Fla., next year. Medtrade takes place Oct. 31-Nov. 3 at the Georgia World Congress Center.

Short takes from AAHomecare

Healthcare consulting firm Dobson DaVanzo & Associates will open the DME Industry Cost Analysis Study the week of July 18. The study, sponsored by AAHomecare, will look at the cost of providing HME in multiple product categories under threat by competitive bidding. There is no fee to participate and the data submitted is kept confidential…Providers can submit their second quarter audit data to the HME Audit Key starting July 15. The HME Audit Key requires providers to submit cumulative counts on pre- and post-payment audits and appeal claim outcomes under DME MAC, RAC and SMRC reviews. AAHomecare has two quarters of data collected so far…Noridian has been awarded the Unified Program Integrity Contract, or UPIC. The 10-year contract is part of CMS’s efforts to consolidate existing multiple integrity contracts. The UPIC is intended to integrate the work of the Zone Program Integrity Contractors or ZPICs, Program Safeguard Contractors or PSCs, Medicare-Medicaid Data Match or Medi-Medi, and Medicaid Integrity Contractors or MICs.

GPO contracts with Ossur for orthopedic products

CLEVELAND and FOOTHILL RANCH, Calif. – CHAMPS Group Purchasing has re-launched its custom contract with Ossur Americas for its osteoarthritis and injury solutions bracing and support products. The Ossur contract gives 7,000-plus CHAMPS members nationwide the opportunity to streamline products, according to a press release. “With this contract, our GPO contract price has expanded significantly and now covers Ossur’s entire catalog, including orthopaedic soft goods, braces, cold therapy and casting supplies,” said Jan Elder, director of contracting services for CHAMPS. The contract extends through December 2018.

Infusion foundation launches satisfaction survey

ALEXANDRIA, Va. – The National Home Infusion Foundation will launch a survey to develop a standardized set of patient satisfaction questions for home infusion providers to use in organizational assessment tools. The Patient Satisfaction Survey Study will help pave the way for improved quality of care, NHIF said in a press release. “Patient satisfaction surveys have gained increasing attention as essential sources of information for identifying gaps and developing effective action plans to improve overall quality of care in organizations across the health care continuum,” said NHIF Vice President of Research Connie Sullivan, R.Ph. A panel of home infusion professionals will finalize a set of validated questions. The Patient Satisfaction Survey Study builds on the National Home Infusion Association’s multi-phase Industry-Wide Data Initiative.

NCPA announces seminar lineup

ALEXANDRIA, Va. – The National Community Pharmacists Association has announced its 2016 lineup of seminars aimed at helping community pharmacies hone their merchandising and marketing skills. The one-day Front-end Profit Building Seminars offer CEUs and tackle topics like curb appeal, floor plans, cross-merchandising and inventory management. “In a world of shrinking profit margins and fierce competition from the big boxes, it is more critical than ever for community pharmacies to diversify their business to grow and thrive, and the pharmacy front end provides an excellent starting point,” said NCPA President Bradley Arthur, RPh, co-owner of Black Rock Pharmacy and Brighton-Eggert Pharmacy in Buffalo, N.Y. The seminars are sponsored by Good Neighbor Pharmacy.

Organizers announce ‘world changing’ speaker

WATERLOO, Iowa – Organizers of Essentially Women’s Focus Conference have announced best-selling author, entrepreneur and cancer survivor David Wagner as keynote speaker. Wagner will discuss how one encounter led him to initiate the pay-it-forward global movement “Daymaking.” “Our industry is becoming increasingly more challenging,” said Cindy Ciardo, manager of vendor relations for Essentially Women. “David will put our jobs back into perspective and remind us about what really matters, motivating us to make the world a better place by following his lead.” Wagner’s presentation, “Change the world—one person at a time—through simple acts of kindness,” will take place at 8 a.m. on Sept. 25. The full conference takes place Sept. 24-26 at the Sheraton Myrtle Beach Convention Center Hotel in Myrtle Beach, S.C.

 

Hard-fought bid delay fails

HME News - Fri, 07/15/2016 - 10:58
07/15/2016HME News Staff

WASHINGTON – Congress has failed to pass a bill that would delay a second round of Medicare reimbursement cuts for three months, until Sept. 30.

In the days before a long recess that kicked off July 15, the Senate had begun a “hotline process” to pass an amended version of H.R. 5210, which had already been passed by the House of Representatives earlier in the month.

As part of the process, the bill was introduced and distributed to all 100 offices of the Senate. If there were no objections within 24 hours, it would be considered passed. But somewhere along the line, the process failed.

“We were told last night that the hotlined bill was put on hold,” The VGM Group stated in a “Legislative Update” to its members on Friday. “We are still trying to confirm which senator placed the hold.”

The second round of reimbursement cuts—which, together with the first round of cuts that went into effect Jan. 1 represent, on average, a 51.1% decrease in reimbursement—went into effect July 1.

The Senate passed a bill, S. 2736, in late June that would have delayed the second round of cuts for one year, until July 1, 2017. But the pay-for for the bill—speeding up plans to match the federal portion of Medicaid allowables to bid-adjusted Medicare allowables from Jan. 1, 2019, to Oct. 1, 2018—was considered “toxic” by some lawmakers.

So, ultimately, the Senate ran with the House bill, which has a shorter delay but a non-HME specific pay-for, with plans to take up the issue again in September when it returns from its summer recess.

VGM says industry leaders will meet with their champions to determine action items for when Congress resumes business in September.

“We appreciate all your grassroots efforts the past 12 months,” VGM stated in the update. “The calls, personal visits and emails to your members of Congress did not go in vain. Both the Senate and House passed separate bills earlier this month. The fact that we had not one, but three, unanimous consent hotlined in the Senate is unheard of and an impressive feat! Unfortunately, if only takes on Senator to stop our efforts.”

Vent bill drops in Senate

HME News - Thu, 07/14/2016 - 12:52
07/14/2016HME News Staff

WASHINGTON – A bill that seeks to preserve access to ventilators for Medicare beneficiaries was introduced in the Senate today.

The “Beneficiary Respiratory Equipment Access and Transparency to Home Ventilator Care (BREATH) Act of 2016,” introduced by Sens. Bill Cassidy, D-La., and Chuck Grassley, R-Iowa, seeks to establish policies and standards for appropriate use of ventilators in consultation with medical experts; and to increase reimbursement rates for home ventilation by 20%.

In response to a spike in utilization for non-invasive vents, CMS has made sweeping changes to the product category, including reducing the number of codes from five to two, and reducing reimbursement by about 33%.

In May, the DME MACs released guidance that removed the so-called “imminent death requirement,” which stated that patients must need a ventilator 24/7 for coverage.

Lawmakers run with three-month delay

HME News - Thu, 07/14/2016 - 07:55
07/14/2016HME News Staff

WASHINGTON – A bill passed in the House of Representatives last week that would delay a second round of Medicare reimbursement cuts is going through a “hotline” process in the Senate, AAHomecare announced yesterday at 5:30 p.m.

As part of this process, the bill has been introduced and has been distributed to all 100 offices in the Senate. If there is no objection to the bill within 24 hours, it will be considered passed with no objections, the association says.

“With Congress set for a lengthy recess at the end of this week, passing this legislation would give our champions in the House and Senate more time to work out a longer delay when they return to work in early September,” AAHomecare stated. “The legislation will also require the approval of President Obama to become law.”

The bill would delay a second round of reimbursement cuts that went into effect on July 1 until Sept. 30. Along with a first round of cuts that went into effect Jan. 1, the cuts represent a 51.1% reduction compared to the 2015 fee schedule, according to an analysis by AAHomecare.

The bill would also instruct the Department of Health and Human Services to study the impact of bidding-derived payment adjustments on beneficiary access and providers by September 2016.

The Senate in June passed a bill that would delay the second round of cuts for one year, until July 1, 2017.

Because the House and Senate passed different versions of the bill, stakeholders were working with lawmakers to come to a compromise before their recess on July 15.

Whistleblower details alleged fraud at Lincare

HME News - Tue, 07/12/2016 - 13:15
07/12/2016HME News Staff

CLEARWATER, Fla. – A former employee says Lincare has been knowingly defrauding the government of millions of dollars by allegedly billing false claims to Medicare.

“(Lincare) has engaged in a scheme to wrongfully enrich itself at taxpayers’ expense by fraudulently billing Medicare for equipment rental for which either the patients or the equipment were not reimbursable by Medicare, by failing to provide services to patients it was obligated to provide, and by retaining overpayments to which it new it was not entitled,” alleges Rebecca Saiff in a whistleblower lawsuit unsealed July 1 by the U.S. District Court for the Middle District of Florida in Tampa.

Saiff worked for Lincare as a Medicare billing specialist at the corporate headquarters from January to July of 2013, and at its Largo, Fla., regional billing and collection office from August of 2013 until February 2014. She filed her lawsuit under seal in April 2014.

More specifically, Saiff alleges that Lincare:

  • Improperly adjusts billing dates to bill Medicare for equipment rental on days during which patients were not using the equipment (i.e. days when patients were in a skilled-nursing facility or hospital);
  • Circumvents the competitive bidding program by submitting claims in areas for which it did not have a contract;
  • Retains overpayments made by Medicare for equipment that has already reached the 36-month cap on payments;
  • Refuses to perform its contractual obligations to repair rental equipment for five years after its provision to beneficiaries; and
  • Bills Medicare for equipment rented to beneficiaries who did not qualify for such equipment.

Saiff alleges that Lincare provides incentives to employees to submit false claims to its billing offices.

“Lincare has achieved this by instituting a policy that store managers and/or sales persons are entitled to be paid commission once a claim is submitted to the accounts receivable department (i.e. before any determination has been made as to whether the relevant insurer will actually pay the claim),” the lawsuit states. “This has led to an overwhelming number of submissions from the stores that are plainly deficient on their face.”

Saiff seeks, among other relief, $5,500 to $11,000 for each violation of the False Claims Act, plus three times the amount of damages the U.S. has sustained because of Lincare’s alleged misconduct.

AAH’s Tom Ryan: ‘We’re not there yet’

HME News - Fri, 07/08/2016 - 12:14
07/08/2016Liz Beaulieu

WASHINGTON – The HME industry may be up against its toughest challenge yet in its bid to slow down the spread of competitive bidding.

Now that both the House of Representatives and the Senate have passed bills to delay a second round of Medicare reimbursement cuts that went into effect in non-bid areas on July 1, leadership in both chambers is trying to hammer out a final bill—and fast.

“The biggest constraint we have now is time,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Congress plans to recess on July 15 and not return until September.

As part of hammering out a final bill, leadership must decide on the length of the delay (the House bill calls for three months; the Senate bill calls for one year) and the pay-for. Only the Senate bill included an HME specific pay-for: speeding up plans to match the federal portion of Medicaid allowables to bid-adjusted Medicare allowables from Jan. 1, 2019, to Oct. 1, 2018.

“There are political issues beyond us that are involved with this,” Bachenheimer said. “There are powerful people in the House that continue to be staunchly opposed to a Medicaid pay-for. We need to get agreement on a pay-for, or get another one going.”

So in a final push, stakeholders are asking providers to pressure their lawmakers, particularly those on the Energy and Commerce Committee in the House, to come to an agreement before the upcoming recess.

“The message is, ‘It’s too quick,’” Bachenheimer said. “No one has even had time to assess the initial cut, which is significant. We’re not stopping the program altogether. We’re just taking a breath.”

The first round of cuts that went into effect Jan. 1 in non-bid areas represented cuts of, on average, 25%. The two rounds of cuts together represent cuts of, on average, 51.1%, according to an analysis by AAHomecare.

Among the scenarios that could play out by July 15, stakeholders say: Best case, leadership decides to go with the Senate bill; worst case, they can’t come to an agreement and the bills stall. Somewhere in between: Leadership decides to go with the House bill, ideally with the promise of extending the delay when Congress is back in session in September.

“The good news is that we’ve shown that in both chambers there is a want and need to get something accomplished,” said Tom Ryan, president and CEO of AAHomecare. “We’ve been working 18 months for this, and what we’ve accomplished is tremendous, but we’re not there yet.”

Because there are politics at play that the industry can’t control, it must control what it can: leveraging the grassroots lobbying that has gotten it this far.

“We need to raise the noise level,” Ryan said.

Sleep program pushes culture change

HME News - Fri, 07/08/2016 - 12:13
07/08/2016Theresa Flaherty

BROOMFIELD, Colo. – A new sleep apnea pilot program aims to nudge patients along the “patient pathway” using a digital platform.

“We’ve always been aiming at that complete patient pathway, from awareness all the way through ongoing therapy and maintenance,” said Doug Hudiburg, CEO of TotalCare eHealth, a three-year-old technology startup. “This is more than just CPAP.”

The Sleep Apnea Continuum of Care Program, which launched in June, allows clinicians, providers and patients to communicate in a HIPAA-compliant closed network via private messaging. The system can also send notifications via email or automated telephone calls, and patients can also speak with someone on the phone if they choose.

Automating as much of the process as possible reduces overall time and costs, and allows for greater focus on patient engagement, says Hudiburg.

“A lot of patients don’t get any attention,” he said. “The platform gives them a home and brings them into the fold so they have resources available.”

The pilot launched with a few hundred patients at the Lafayette, Colo.-based South Pointe Clinics, which offers a range of primary care services. Getting patients at the very beginning is key— that’s where they need to be managed, Hudiburg says.

“We want to change the culture, put a kiosk in the waiting room with the goal of targeting all adult patients for screening,” he said.

That culture change includes a shift toward self-pay, says Hudiburg, who describes the Sleep Apnea Continuum of Care Program as a retail self-pay model.

“If we are going to focus on the patient, we need to make it affordable,” he said. “From the beginning, dismal third-party reimbursement has been responsible for a lot of the low compliance and lack of follow-up. That’s a mistake.”

‘So comfortable he fell asleep’

HME News - Fri, 07/08/2016 - 12:11
ATP at Trucare customizes ultimate wheelchair for boy with CP07/08/2016Liz Beaulieu

MOUNT PLEASANT, Texas – The story of Jairo Torres, a 13-year-old boy who cried every time he was put in his wheelchair, finally has a happy ending.

Torres, who has athetoid cerebral palsy, was never comfortable in a “normal” wheelchair because he’s most comfortable in a prone position. He was so uncomfortable in a wheelchair, in fact, that he spent most of his time at school on his stomach on a beanbag.

“You can take Jairo and force him into a normal sitting position, but you have to do it slowly, and he screams in pain the entire time,” said Jeremy Redfearn at ATP at Trucare Medical, a full-line HME provider with a soft spot for complex rehab.

After years of trying various “normal” wheelchairs, Redfearn teamed up with Barbara Rule, a physical therapist, Key Mobility and Matrix Seating USA to come up with a customized solution that would allow Torres to lie in a prone position, with his feet at the push handles and his head at the front.

It has made all the difference in the world for the junior high schooler.

“The first time he was in it, he was so comfortable he fell asleep,” Redfearn said.

Indeed, school is now a much more pleasant experience for everyone involved, including Torres’ bus driver and teachers.

“Every morning the bus driver would call the teacher five minutes before arriving to let her know they were on their way, so she could help him with Jairo, and there would be crying in the background,” said Sharon Ortega, manager at Trucare Medical. “The first day Jairo used the new wheelchair, the teacher didn’t get a phone call. The bus driver just rolled him into the classroom and everyone was happy.”

Redfearn says he finally feels like he did his job.

“For years, everything I tried was not working and he was constantly in pain,” he said. “I felt like I didn’t do my job—you take it personally. So the sense of satisfaction of seeing him smile in this wheelchair can’t be explained. It’s probably the biggest perk of my job.”

Philips Respironics, Circadiance target pediatric market

HME News - Fri, 07/08/2016 - 12:10
07/08/2016Kathy Dion

MURRYSVILLE and TURTLE CREEK, Pa. – Two players have launched new pediatric nasal masks, a market that is currently under-served but growing rapidly with the rising awareness of obstructive sleep apnea and other breathing difficulties in very young children.

Philips Respironics and Circadiance, which both already offer lines of nasal masks for older youth and adults, are now introducing pediatric versions for the smallest of patients, ages 2-7.

Philips launched the Wisp Pediatric Nasal Mask on June 13. With its giraffe-fabric print, accompanying stuffed animal and animated video, the company is hoping the mask will engage young children in their own therapy, helping smooth the transition from hospital to home care.

The Wisp Pediatric mask also features an “infant-centric” design and Leak Correction Dial that allows caregivers to fix small leaks without waking the child.

Circadiance recently launched the SleepWeaver Advance Pediatric Soft Cloth CPAP Mask in the U.S., after launching the product successfully in Europe a few months ago. The smaller-sized Advance is a model designed for smaller facial features and is not as big as the company’s original one-size-fits-most device.

While masks designed for older youth and teenagers might be adjusted to fit smaller faces, they don’t work as well on infants and very young children. The pediatric masks are smaller in all dimensions and the ratio of length to height has been adjusted, says Philips Chief Medical Liaison Teofilo Lee-Chiong, MD.

“You don’t want pressure on a face that is still developing,” he said.

Lee-Chiong believes that educating caregivers on how to use the mask is a big part of children adhering to therapy, so the Wisp mask comes with resources designed specifically for them.

Circadiance Founder and CEO David Groll says making the masks approachable for children and their caregivers is important to therapy.

“If someone approaches them with a medical-looking device and tells them to put it on, they will be afraid,” he explained. “Then the child won’t wear it.”

In brief: HME Audit Key builds strong case, National HME furthers reach

HME News - Fri, 07/08/2016 - 12:08
07/08/2016HME News Staff

WASHINGTON – Results are in for the AAHomecare HME Audit Key survey for the first quarter of 2016.

Sixty-nine percent of completed MAC prepayment audits nationwide were paid upon review, according to the survey, which included additional documentation requests from Oct. 1, 2015, through March 31, 2016.

Other results from the survey:

·      the average rate of audits denied increased 5% between the fourth quarter of 2015 and the first quarter of 2016, with the average percent of audits denied by net revenue ranging from 13% to 40%;

·      companies with net revenues from $3.6 million to $10 million had significantly higher denial rates—three times that of companies with net revenues from $0 to $1 million

While the survey is gaining momentum, industry stakeholders say increased participation is needed to gain support on Capitol Hill to create “smarter and fairer policies.”

“If future data on overturn rates confirms results like the ones we’re starting to see here, I believe we can make the case for reforms that both decrease the audit burden on suppliers and make better use of government resources,” said Kim Brummett, vice president of regulatory affairs for AAHomecare.  “What we need now is for more suppliers to join the program and complete the next survey round." 


Providers can begin submitting data for the second quarter of 2016 on July 15.

National HME furthers reach

NEW YORK – Allcare Medical has merged with National HME, a portfolio company of Tailwind Capital. The acquisition will further National HME's reach in South Carolina and Georgia as a provider of technology-enabled DME for the hospice industry. "This key acquisition aligns with our vision for the continued growth of National HME, and further expands our ability to provide the most comprehensive DME solution to any hospice in the country," said Geoffrey Raker, partner at Tailwind Capital, a private equity firm and lead investor in National HME. This is second acquisition this year for National HME. In January, the provider acquired Springfield, Mo.-based Therapy Support, which has 21 branches in seven Midwestern states.

AAHomecare commissions cost analysis study 

WASHINGTON – AAHomecare has commissioned Dobson DaVanzo & Associates to conduct a study of provider’s fixed and variable costs for providing DME. The study will focus on respiratory products, wheelchairs, hospital beds and walkers. While previous cost studies have been conducted, this will be the first to consider categories under threat by competitive bidding. AAHomecare encourages all providers to participate in the survey, which will later be analyzed and shared with policymakers. “This is our opportunity to provide hard numbers industry-wide to Congress and CMS to explain the depth of cuts we are receiving compared to the actual cost of doing business,” said Laura Williard, senior director of payer relations for AAHomecare, in a press release.

NightBalance prepares to enter U.S. market

DELFT, Netherlands – NightBalance BV, a manufacturer of obstructive sleep apnea devices, has announced the completion of a EUR 12.5 million Series B financing round led by INKEF Capital and Gilde Healthcare Partners. The proceeds will allow NightBalance to intensify and expand commercial activities for its Sleep Position Trainer in Europe, and to prepare for the company’s entry into the U.S. market. The manufacturer is also planning further clinical studies in the U.S. and filing for 510(k) clearance with the U.S. Food and Drug Administration. John Lipman, former vice president of marketing and commercial development of Apnicure, has been appointed COO U.S. to head NightBalance’s operations here. The Sleep Position Trainer, worn around the upper body, measures the sleep behavior of the patient. Once a patient turns into the supine position, the device gives a gentle vibration, prompting the patient to change sleeping position, all without disrupting the “natural sleeping architecture,” according to the company.

Quantum Rehab launches enhanced website

EXETER, Pa. – Quantum Rehab has launched a “technologically enhanced” website to meet the expanding content and application needs of complex rehab consumers, clinicians and providers. “Our customers shared with us that they wanted unprecedented virtual access to our products, from technical specifications to 360-degree views, videos and beyond,” said Jim Schreiber, vice president of digital and product marketing. “Their input told us that no matter if it’s a consumer, clinician or provider, all wish an exceptionally content-rich site that places product information and resources in one, easy-to-navigate website.” The result is a website with expanded product pages that not only include added product information and materials, but also interactive color palettes. Users can request to be contacted by providers with a click of a button. Clinicians and providers also have their own resource areas.

GCE enters U.S. POC market

DALLAS – GCE Group has entered the U.S. and Canadian homecare markets with its GCE Healthcare range of respiratory care products. Effective immediately, the GCE portable oxygen concentrators under the Zen-O brand will be marketed to U.S. and Canadian customers. During the coming months, other products, including oxygen conserving devices, oxygen regulators and high purity gas control products, will also be marketed. GCE has tapped Jim Clement as general manager of GCE Healthcare to head up U.S. and Canadian operations. He’s formerly with DeVilbiss Healthcare.

Alliqua, BSN hammer out deal

YARDLEY, Pa., and CHARLOTTE, N.C. – Alliqua BioMedical, a provider of wound care products, has signed a definitive agreement with BSN Medical for the exclusive distribution rights for its Sorbion, Sachet and Sorbion Sana primary dressings in the U.S., Canada and Latin America. Per the agreement, BSN will pay Alliqua $4.4 million to purchase the rights of Alliqua’s existing distribution agreement with Sorbion GmbH & Co KG, now owned by BSN Medical. “The sale of Alliqua’s exclusive distribution rights for the Sorbion dressing products represents an opportunity for us to add important growth capital to our balance sheet and to focus our future investments on commercializing our own highly differentiated advanced wound care and regenerative technologies,” said David Johnson, CEO of Alliqua.

GF Health partners with Mercy Ships

ATLANTA – GF Health Products has agreed to donate medical equipment to Mercy Ships, a volunteer-based international charity that delivers free health care to Africa and other medically underserved nations. Mercy Ships, which operates the largest non-governmental hospital ship in the world, has performed more than 79,000 life-saving surgeries and docked in more than 580 ports since 1978.“We are proud to partner with Mercy Ships and its 1,400 volunteers in their mission to make health care accessible to developing nations,” said Ken Spett, CEO of GF Health, in a press release. “We are specifically supporting their ophthalmic surgery projects in impoverished communities with in-kind donations of our Hausted stretchers.”

Golden Technologies launches ‘extreme’ contest

OLD FORGE, Pa. – Golden Technology is giving away a new Golden Buzzaround Scooter as part of its “Golden Extreme Giveaway” contest. Consumers are encouraged to participate by sharing their story and a picture of their favorite Golden product on social media. “This contest is about celebrating how Golden products are changing people’s lives,” said Tim Robinson, director of digital media, in a release. “It’s not only a modern social media sharing contest, but it’s a great way to see the impact that these Golden products really have.”

VGM donates to flood victims

CHARLESTON, West Va. – The VGM Group has donated $1,000 on behalf of its membership in West Virginia in the wake of historic flooding that has impacted the state. The donation was made to the West Virginia Union Mission, which is providing clean drinking water, cleaning supplies and food, among other items, to residents. “It has been very difficult to see the images of the damage and pain caused by the flooding across the beautiful state of West Virginia,” VGM stated. “We hope this donation will provide some relief to the impacted residents.” VGM encourages others to donate to the mission or the American Red Cross.

Short Takes: BraunAbility, 3B Medical

FEV, the developer and provider of the wheelchair ramp gateway module used in BraunAbility-converted FCA vans, announced this week that it has hit the milestone of supplying 25,000 modules…Jeff Shields has been named vice president of sales at 3B Medical. He brings with him more than 30 years of HME manufacturer experience, including with ResMed and Inova Labs.

 

HME Audit Key data builds strong case

HME News - Thu, 07/07/2016 - 10:36
07/07/2016HME News Staff

WASHINGTON – Results are in for the AAHomecare HME Audit Key survey for the first quarter of 2016.

Sixty-nine percent of completed MAC prepayment audits nationwide were paid upon review, according to the survey, which included additional documentation requests from Oct. 1, 2015, through March 31, 2016.

Other results from the survey:

·      the average rate of audits denied increased 5% between the fourth quarter of 2015 and the first quarter of 2016, with the average percent of audits denied by net revenue ranging from 13% to 40%;

·      companies with net revenues from $3.6 million to $10 million had significantly higher denial rates—three times that of companies with net revenues from $0 to $1 million

While the survey is gaining momentum, industry stakeholders say increased participation is needed to gain support on Capitol Hill to create “smarter and fairer policies.”

“If future data on overturn rates confirms results like the ones we’re starting to see here, I believe we can make the case for reforms that both decrease the audit burden on suppliers and make better use of government resources,” said Kim Brummett, vice president of regulatory affairs for AAHomecare.  “What we need now is for more suppliers to join the program and complete the next survey round." 


Providers can begin submitting data for the second quarter of 2016 on July 15.

Bid delay bill passes in House

HME News - Wed, 07/06/2016 - 08:19
07/06/2016HME News Staff

WASHINGTON – Now that both the House of Representatives and the Senate have passed bills to delay a second round of Medicare reimbursement cuts, lawmakers have to hammer out the details—and fast.

The House yesterday passed a version of the bill that would delay the cuts that went into effect July 1 in non-bid areas for three months until Oct. 1. The Senate on June 24 passed a version of the bill that would delay the cuts for one year until July 1, 2017.

“Now the House and the Senate need to complete the process and send a bill to the president,” said Tom Ryan, president and CEO of AAHomecare. “With the new rates now going into effect, we need our champions in both the House and Senate to find a way to move forward immediately.”

Lawmakers are expected to begin a recess on July 15 and are not due to return until after Labor Day.

The bill passed in the House, an amended version of H.R. 5210, would also require the Department of Health and Human Services to conduct a study over the course of the three-month delay to identify issues related to patient access to DME.

Although the second round of reimbursement cuts has already gone into effect, the bill would reverse reimbursement back to the rates prior to July 1.

The cuts that went into effect July 1 effectively reduce reimbursement in non-bid areas by 51.1% when combined with a first round of cuts that went into effect Jan. 1.

House to vote on bid delay bill

HME News - Tue, 07/05/2016 - 09:33
07/05/2016HME News Staff

WASHINGTON – The House of Representatives plans to vote on a bill this afternoon that would hit pause on a second round of Medicare reimbursement cuts that went into effect in non-bid areas on July 1.

Lawmakers have placed the bill, H.R. 5210, on the suspension calendar for a vote at 2 p.m. EST, according to The VGM Group. Once the bill is passed in the House, it will move to the Senate for approval, VGM says.

The bill, known as the Patient Access to Durable Medical Equipment Act of 2016 or PADME, would delay the cuts—which, together with the first round of cuts, average 51.1% compared to the fee schedule amounts in 2015—for three months, until Oct. 1, 2016.

Before the July 4th recess, the Senate passed a bill that would delay the second round of cuts for one year, until July 1, 2017. The House, however, failed to pass its bill before the recess.

Live floor proceedings from the House can be viewed at www.houselive.gov.

Include End-Of-Life Planning When Anticipating Long Term Care

Long Term Care Link - Sun, 07/03/2016 - 19:00
A key deficiency in the process of planning for long term care occurs when seniors fail to provide for orderly distribution of assets at death and fail to let their family know what to do when the senior can no longer handle his or her own affairs.

Gut Health and Antibiotics

Long Term Care Link - Sun, 07/03/2016 - 19:00
Most people do not think about gut health. In fact, the majority of people don't know what gut health is.
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