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Invacare announces restructuring plan

HME News - Thu, 08/21/2014 - 09:25
08/21/2014HME News Staff

ELYRIA, Ohio – Invacare will reduce its workforce by almost 200 employees as part of a restructuring plan, it announced yesterday.

The company will cut 150 employees and 40 temporary employees from its North America/Home Medical Equipment, Institutional Products Group and Asia/Pacific divisions, according to a press release.

About 60 of those employees work at the Elyria corporate headquarters and the Taylor Street manufacturing plant, according to Crain’s Cleveland Business.

The cuts will save $14 million to $15 million annually, according to the release.

“While the decision to downsize our workforce is extremely difficult, it is a necessary step in light of our financial results for the first six months of 2014 and the slow sales start to the third quarter,'' said Robert Gudbranson, interim president and CEO.

Invacare recently reported a loss in net earnings of $31.6 million for the first half of the year compared to net earnings of $22.7 million for the same period last year. It reported net sales of $640.4 million vs. $676.2 million.

For North America/HME, the company reported a loss in net revenues of $28.4 million, excluding restricting charges, for the first six months of the year compared to $19.8 million for the same period last year. It reported net sales of $267.8 million vs. $311.2 million.

Invacare has struggled under the weight of a consent decree with the Food and Drug Administration (FDA) that has limited manufacturing at the Taylor Street plant. The company is trying to complete a third and final audit to comply with FDA regulations.

 

NST patients use app to ‘master’ sleep therapy

HME News - Tue, 08/19/2014 - 10:50
08/19/2014HME News Staff

BOSTON – National Sleep Therapy (NST) has developed a proprietary iPad app to train new sleep therapy patients on how to use their CPAP devices, the provider announced this month.

“Educators have shown that people retain new information better when: (1) they’re able to proceed at their own pace; (2) they learn and retain better with visuals; (3) they feel they’re in control; (4) they’re engaged and feel special; and (5) they can hold the teaching device in their own hands,” stated Eric Cohen, co-founder and president of NST, in a release.

Cohen, a trained engineer, developed the app.

Respiratory therapists (RTs) will oversee patient use of the app.

“Our RTs methodically guide patients through the training,” Cohen said. “As the patient becomes comfortable with each section, they check off the boxes. Items left unchecked are revisited, so the clinician can explain, answer questions, and visually demonstrate. The RT asks the patient to show they’ve mastered their CPAP.”

The app will be instrumental in ensuring patients are trained consistently, thoroughly and correctly in the use, care and maintenance of their CPAP machines, Cohen says.

“Doctors are often on a tight schedule so they can’t always spend 60-90 minutes with a patient,” he said. “We have carefully orchestrated every minute of the setup process to maximize engagement and retention.”

NST believes this approach is applicable to other types of chronic conditions, such as diabetes.

Legislative update: Industry hits the road

HME News - Fri, 08/15/2014 - 14:06
08/15/2014Theresa Flaherty

WASHINGTON – It’s game time for the industry’s efforts to reform the audit and competitive bidding programs, industry stakeholders say.

“We need to do everything we can to build support for our bills to put ourselves in the best possible position to be attached to a moving vehicle prior to the end of the year,” said Seth Johnson, vice president of government relations for Pride Mobility. “There’s plenty of opportunity to address all our issues.”

To that end, during the August legislative recess, stakeholders are talking up H.R. 5083, a bill to reform the audit program, and H.R. 4920, a bill to require binding bids as part of the competitive bidding program to lawmakers in their districts. The bills, introduced earlier this summer, have 14 and 29 co-sponsors, respectively.

Case in point: Karyn Estrella is spending August crisscrossing New England. She has meetings scheduled with 19 of the 21 congressional offices in those six states. The executive director of the Home Medical Equipment and Services Association of New England (HOMES) says there’s much more interest in the industry’s issues this year.

“They really seem to understand the burden that’s been put on the industry,” she said. “When we start talking about audits and they hear that people have to wait two years or more, they just can’t believe it.”

Stakeholders report successful meetings in several states, including Montana, where providers visited with Republican Rep. Steve Daines last week.

“He was focused on what our ‘ask’ was going be and that is to stop the roll out of bidding nationwide,” said John Gallagher, vice president of government relations for The VGM Group, who attended the meeting. “He’s also getting engaged on audits. His folks are talking (about) signing onto H.R. 5083 when he gets back.”

Following the August recess, the House Ways and Means Committee is planning a hearing on audits. A report released last week by the Government Accountability Office (GAO) says CMS needs to provide audit contractors with additional guidance and oversight.

“That adds more fuel to the fire of why we need guidance and regulation in terms of the audit legislation,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “I think momentum will increase with the report out.”

Lawmakers are due back in Washington, D.C., on Sept. 8, but with the looming elections, they will be in and out—mostly out, stakeholders predict. That’s not necessarily a bad thing, stakeholders say.

“I always find, as we get closer to an election, where all of the House and one-third of the Senate will be standing for election, they tend to be a little more attuned to their constituency and what they can do to help to ensure that they will vote to re-elect them,” Johnson said.

CMS answers questions about PMD demo

HME News - Fri, 08/15/2014 - 14:04
08/15/2014Leah Hoenen

WASHINGTON – CMS officials assured providers during a Special Open Door Forum last week that there won’t be any surprises when the PMD demo rolls into 12 new states Oct. 1.

Coverage and documentation requirements will be the same as in the seven original states, they said.

“The question is, ‘What’s new in this expansion?’ and the answer is, ‘Just the additional states,’” said Dr. Dan Schwartz, chief medical officer of the Survey and Certification Group at CMS. 

The expansion will require prior authorization requests for PMDs in Arizona, Maryland, Georgia, Indiana, New Jersey, Kentucky, Louisiana, Missouri, Ohio, Pennsylvania, Tennessee and Washington. The original states are not affected by the expansion.

Providers also wanted to know more about the timing of the demo’s start.

“We can’t submit the paperwork until Oct. 1 and can’t deliver until after Oct. 1,” said Stacy Lewis of CG Medical Family Health. “Do we make the beneficiaries wait, or submit prior to that and deliver later?”

A CMS official’s response: The demo applies to all seven-element orders signed by doctors on or after Oct. 1.

CMS officials also reviewed the logistics of the demo. The DME MACs have 10 business days to postmark their written decisions to prior authorization requests, and 20 days to consider and make determinations on resubmissions of denied requests.

A provider asked if the demo would provide protection from post-payment audits. Generally, the prior authorization process would exclude a provider from post-payment audits, Schwartz said.

Inogen reports big gains, improves outlook

HME News - Fri, 08/15/2014 - 14:02
08/15/2014Liz Beaulieu

GOLETA, Calif. – Inogen’s focus on direct-to-consumer sales is paying off, CEO Ray Huggenberger says.

The company has enjoyed double-digit increases in total revenues for two quarters in a row now: 50.8% for the second quarter ended June 30, 2014, and 50.1% for the first quarter ended March 31, 2014.

“We made a shift in focus starting at the beginning of this year to focus more on cash sales,” Huggenberger said during a conference call last week to discuss Inogen’s financial results for the second quarter. “We weren’t quite sure how that would turn out. The first quarter was very encouraging; the second quarter is confirming those numbers and that trend. I don’t want to call one quarter a trend. I’m going to be cautious calling two quarters a trend.” 

Inogen reported total revenues of $30.4 million for the second quarter. Net income was $2.3 million compared to $2 million for the same period last year. Sales revenues were $20.5 million vs. $12.8 million, and rental revenues were $9.9 million vs. $7.4 million.

Inogen now plans to double down on the direct-to-consumer market by expanding its sales force, Huggenberger says.

“We were able to drive some substantial growth without purely relying on increased headcount to drive growth,” he said. “Now…I think it is time to invest in more capacity to do more of it.”

Business-to-business sales continue to be Inogen’s fastest growing segment (it saw an 88.8% increase in the second quarter), but Huggenberger believes it’s enjoying some “pull through” from the company’s direct-to-consumer advertising.

“I think the bigger driver of the business to business success in the second quarter is that we’re educating patients about this technology,” he said. “Not every call goes to us. Many call their current provider and say, ‘Yes, this is what I want and if you don’t give it to me, I’ll go somewhere else.’” 

With two solid quarters under its belt, Inogen has revised its outlook for the rest of the year: It projects total revenues for 2014 to be in the range of $102 million to $106 million, instead of $92 million to $96 million; and net income to be in the range of $4.5 million to $5.5 million, instead of $4 million to $5 million.

Filling out this year, Inogen expects to begin shipping its new stationary concentrator, the Inogen At Home, in the fourth quarter. But it doesn’t expect the launch to have a material impact on revenues, Huggenberger says.

“We plan to test various marketing and sales strategies for the Inogen At Home before it is rolled out on a broad scale,” he said.

As for CMS’s proposals to expand competitive bidding pricing nationwide in 2016 and to use bundled monthly payments for certain DME—Inogen remains bullish. It expects the former to have a potential impact on revenues of 4% to 5%, and the latter to actually have a positive impact.

“It has the potential to add more patients and reduce complexity in the sales, setup and billing processes,” Huggenberger said.

Snug Seat looks to get back in saddle

HME News - Fri, 08/15/2014 - 14:01
Company has lost market share since FDA began detaining certain products08/15/2014Liz Beaulieu

MATTHEWS, N.C. – Snug Seat could soon resume distributing in the United States more than a dozen products manufactured in Denmark by R82.

The U.S. Food and Drug Administration (FDA) has scheduled a re-inspection of R82 in November to review changes the manufacturer has made since the agency inspected its facilities in 2010 and 2013, and found numerous violations.

“R82 is confident everything is in order and anticipates the FDA will release the detention within 45 to 50 days after the visit,” said Kirk MacKenzie, president of Snug Seat, which distributes seating, standing and walking aids for disabled children.

During previous inspections, the FDA found R82 violated six “good manufacturing requirements” of its quality system regulation, including failure to establish and maintain procedures for verifying or validating corrective and preventive action; failure to review and evaluate all complaints to determine whether an investigation is necessary; and failure to maintain device master records (DMRs).

Mackenzie characterized the violations this way: “There were no product problems or quality issues per see, but a lack of documentation needed for the products.”

The FDA has been refusing to allow 15 products—everything from the Cougar wheelchair to the Swan bath chair to the Rabbit mobile standing frame—to be imported.

The situation has taken its toll on Snug Seat—which has lost market share, especially for products like bath chairs—and its customers, Mackenzie acknowledges.

“We had a mother call us who, if she couldn’t get this device within 90 days, her child was going to need an operation,” he said. “It’s a specialized stander that no one else has. We managed to find a demo unit for the family to borrow.”

While R82 isn’t the only manufacturer to come under scrutiny by the FDA—it joins Invacare, for one—it’s unique in that the products in question are manufactured in Europe. Other companies that manufacture there should take heed, Mackenzie says.

“The requirements in Europe haven’t been that stringent, but they’re getting tighter,” he said. “It behooves those who manufacture in Europe to make sure their products have all the proper documentation.”

In brief: GAO weighs in on audits, Liberator’s investments pay off

HME News - Fri, 08/15/2014 - 13:59
08/15/2014HME News Staff

WASHINGTON – The Government Accountability Office (GAO) is calling on CMS to improve the efficiency and effectiveness of its post-payment review efforts by providing contractors with additional guidance and oversight.

The GAO reviewed MACs, ZPICs, RAs and CERT contractors because “questions have been raised about their effectiveness and efficiency, and the burden on providers.”

While CMS has taken steps to prevent contractors from conducting duplicative post-payment claims reviews, the GAO found, “CMS neither has reliable data nor provides sufficient oversight and guidance to measure and fully prevent duplication.”

Specifically, the GAO called on CMS to:

·      monitor the Recovery Audit Data Warehouse to ensure contractors are submitting required data and that the data in the database are accurate and complete;

·      develop complete guidance defining contractors’ responsibilities regarding duplicative claims reviews, including specifying whether and when MACs and ZPICs can duplicate other contractors’ reviews;

·      regularly assess whether contractors are complying with CMS requirements for the content of correspondence sent to providers; and

·      clarify current requirements for content of additional documentation requests and results letters, and standardize the requirements as much as possible for greater consistency.

The Department of Health and Human Services agreed with the GAO’s recommendations and noted plans to improve CMS guidance and oversight.

Investments pay off at Liberator Medical

STUART, Fla. – Liberator Medical has reported $11.75 million in gross profits for the third quarter of 2014 compared to $10.89 million for the same period last year, a 7.6% increase.  Net sales increased 6.2% to $18.58 million as a result of a direct response advertising campaign to new customers and an emphasis on customer service to maximize reorders. “During our fiscal third quarter, we made key investments in our organizational infrastructure to improve the efficiency and performance of our customer-facing staff,” said Mark Libratore, president and CEO, in a press release. “We are investing in acquiring and serving our customers, which is central to our mission as a healthcare products provider and to achieving the maximum return on our advertising expenditures.” Net income, however, dropped 1.5% to $1.98 million. For the nine months ended June 30, 2014, Liberator reported gross profits of $34.42 million, a 5.9% increase over the same period last year; net sales of $54.83 million, a 5.9% increase; and net income of $5.72 million, a 19.4% increase.

ResMed launches comprehensive platform for sleep therapy

SAN DIEGO – ResMed announced last week the launch of Air Solutions, a connected care platform for treating sleep disordered breathing from diagnosis to treatment to compliance management to patient engagement. Two components of the solution: The AirSense 10 series of flow generators and the AirFit family of masks. The AirSense 10 CPAP and APAP devices will be available in the U.S. on Aug. 18. The AirFit masks were launched earlier this year. Other components include ApneaLink Air, a home sleep testing device, and AirView, a monitoring and compliance management system that provides data on demand.

MED schedules fly-in

LUBBOCK, Texas – The MED Group, in conjunction with AAHomecare, will host a legislative fly-in at the W Hotel in Washington, D.C., on Sept. 10. The focus of the fly-in in will be to promote H.R. 4920 and H.R. 5083, bills to reform the competitive bidding and audit programs, respectively. The fly-in will kick off with a pre-meeting on Sept. 9 from 7 p.m. to 9 p.m. for attendees to pick up lists of appointments and leave-behind information. “This legislative fly-in is open to all DME providers so that industry stakeholders can show solidarity on these issues,” stated Jeff Woodham, senior vice president and general manager of The MED Group, in a press release. To register, call MED at 800-825-5633 and ask to speak to a customer support representative.

PHS offers homecare education to students

ST. PAUL, Minn. – Pediatric Home Service (PHS) has launched partnerships with area colleges and universities to educate students about homecare services. The provider believes educating students about home care is just as important as hospital care. “Through these opportunities, students can see the benefits and complexity of home care firsthand,” stated Judy Giel, senior vice president of clinical service, in a press release. “We’re dedicated to expanding students’ knowledge base and their understanding of how these services are provided at home.” Fields of study include respiratory therapy, infusion nursing, homecare nursing, nutrition service and social work.

The road to Medtrade: Audit sessions and call for presentations

LAS VEGAS – Medtrade has no fewer than 10 audit-related sessions planned for the Oct. 20-23 event in Atlanta. “Our surveys revealed that attendees wanted more educational sessions dealing with audits,” stated Group Show Director Kevin Gaffney in a press release. “We responded in a big way.” See a complete schedule of these and other sessions at www.medtrade.com… Show organizers are already gearing up for Medtrade Spring: They’ve put out a call for presentations for the March 31-April 1 event in Las Vegas. Interested speakers must submit their ideas by Aug. 22; show organizers will notify selected speakers by Dec. 1. Go here to submit: http://n2b.goexposoftware.com/events/cfp/goExpo/public/form.php?fi=1006.

Dr. Comfort steps out for diabetes

MILWAUKEE – Dr. Comfort, a manufacturer of therapeutic footwear, has committed to raising $100,000 in 2014 as a National Team for the American Diabetes Association’s Step Out: Walk to Stop Diabetes. Dr. Comfort’s employees, friends, family members, customers and vendors are invited to join the company’s corporate team in participating in any of the 110 Step Out events nationwide. Every mile walked and dollar raised supports the ADA’s research and advocacy efforts to improve the lives of those affected by diabetes. In addition to participating in the walks, Dr. Comfort is donating to the ADA $10 from the sale of every pair of shoes from its athletic shoe line.

Diabetes risk increases sharply

NEW YORK — The risk of diabetes has doubled, with 40% of Americans born between 2001 and 2011 at risk of developing the disease, according to a new study published in The Lancet Diabetes & Endocrinology. For minorities, the risk is higher: More than half of all Hispanics and non-Hispanic black women will develop diabetes. For black men, the risk is 5%. “That’s a very real statistic not only for the public but also for the people treating and trying to prevent diabetes,” said Edward Gregg, the lead study author and an epidemiologist at the U.S. Centers for Disease Control and Prevention. “I hope this will be a stimulus really to find ways to prevent diabetes in the first place and reduce incidence.”

IntelliWheels receives grant

CHAMPAIGN, Ill. — IntelliWheels has secured a $1.5 million grant to further its development of ultra-lightweight, multi-geared wheels for manual wheelchairs. “By using simple gearing we can create a more dynamic method of mobility, providing wheelchair users greater ability to interact in their environment,” said Marissa Siero, co-founder of IntelliWheels, in the release. The grant was awarded by the National Institutes of Health, National Center for Medical Rehabilitation Research at the Eunice Kennedy Shriver National Institute of Child Health & Human Development.

Good works: Invacare, CareTouch

Invacareserved as a national host sponsor for the 34th National Veterans Wheelchair Games, Aug. 12-17 in Philadelphia. Invacare has been a supporter of the Games since 1981 and has also supported similar events. In addition to financial support, the manufacturer provided assistance with transporting veterans and their luggage from the airport and performing maintenance throughout the games…CareTouch has raised $1,000 to support the Butterfly Program of Porter Hospice Hike for Hospice event and is now aiming to double that by the Sept. 14 event. A team of CareTouch employees will participate in the hike.

Short take: Invacare

The board of directors of Elyria, Ohio-based Invacare has declared a cash dividend of $.0125 per share on its common shares and $.011364 per share on its Class B common shares payable Oct. 10, 2014, to shareholders on record on Oct. 2, 2014. Invacare recently reported a net loss in earnings of $13.6 million for the second quarter compared to a loss of $12.5 million for the same period last year. It also announced recently that Rob Gudbranson would become its interim president and CEO.

People in the news

AAHomecare has added Mina Uehara as a regulatory affairs associate. Uehara recently received a Master of Public Policy from American University. Her graduate work there focused on Medicaid. Uehara will work closely with Kim Brummett, vice president of regulatory affairs, on the association’s regulatory initiatives.

Audits: GAO weighs in on duplicative reviews

HME News - Fri, 08/15/2014 - 10:24
08/15/2014HME News Staff

WASHINGTON – The Government Accountability Office (GAO) is calling on CMS to improve the efficiency and effectiveness of its post-payment review efforts by providing contractors with additional guidance and more oversight.

The GAO reviewed MACs, ZPICs, RAs and CERT contractors because “questions have been raised about their effectiveness and efficiency, and the burden on providers.” 

While CMS has taken steps to prevent contractors from conducting duplicative post-payment claims reviews, the GAO found, “CMS neither has reliable data nor provides sufficient oversight and guidance to measure and fully prevent duplication.”

Specifically, the GAO report called on CMS to:

• monitor the Recovery Audit Data Warehouse to ensure contractors are submitting required data and that the data in the database are accurate and complete;

• develop complete guidance defining contractors’ responsibilities regarding duplicative claims reviews, including specifying whether and when MACs and ZPICs can duplicate other contractors’ reviews;

• regularly assess whether contractors are complying with CMS requirements for the content of correspondence sent to providers; and

• clarify current requirements for content of additional documentation requests and results letters, and standardize the requirements as much as possible for greater consistency.

The Department of Health and Human Services agreed with the GAO’s recommendations and noted plans to improve CMS guidance and oversight.

Inogen repeats double-digit increase

HME News - Wed, 08/13/2014 - 14:06
08/13/2014HME News Staff

Inogen repeats double-digit increase

GOLETA, Calif. – Inogen increased total revenues 50.8% in the second quarter of 2014, the company reported this week.

For the three months ended June 30, revenues were $30.4 million compared to $20.2 million for the same period in 2013.

Sales revenues were $20.5 million, a 60.5% increase compared to the $12.8 million for the same period last year. Total units sold were 9,200, an increase of 67.3%.

Rental revenues also increased, although that growth was offset by reimbursement cuts related to Medicare’s competitive bidding program. Rental revenues were $9.9 million for the second quarter, up from $7.4 million in 2013.

"We are very encouraged with the level of productivity and traction we've seen throughout the first half of this year,” said President and CEO Raymond Huggenberger in a release. "We intend to continue to execute on our strategy to both raise awareness of our oxygen-therapy products and leverage the investments made in sales and marketing to drive demand. We also plan to increase our go-to-market resources to drive future growth and prepare for additional activities, such as the commercial launch of our Inogen At Home product later this year."

Inogen received FDA 501(k) clearance for the Inogen at Home in June.

The manufacturer increased total revenues 50.1% in the first quarter of this year.

RACs are back

HME News - Fri, 08/08/2014 - 13:12
08/08/2014Liz Beaulieu

WASHINGTON – CMS announced last week that the recovery audit contractors (RACs) will restart some of their reviews, but industry stakeholders don’t expect any curveballs.

Due to delays in awarding new contracts, the agency is giving the RACs the green light to get back to work on automated reviews and, on a limited basis, complex reviews.

“It doesn’t sound like they’re authorizing new audits, just reactivating the audits that they previously allowed,” said Andrea Stark, a reimbursement consultant with MiraVista. “It’s new claims, but not new concepts.”

The RACs have been on hiatus from sending post-payment additional documentation requests (ADRs) since February, as part of CMS’s transition to new RACs.

While stakeholders agree that the bulk of the reviews affecting DME will likely be automated reviews (for example, a patient was in a skilled-nursing facility on the date of service), they’re not ruling out complex reviews.

“CMS has done so many things with the RACs to make it clear that DME is a focus, my guess is, if they’re going to pick one area to reinstate complex reviews, DME is an easy target,” said Wayne van Halem, president of The van Halem Group, a division of The VGM Group.

In the past, the RACs have performed complex reviews on respiratory assist devices (RADs) and power mobility devices (PMDs), stakeholders say.

“With so much focus on the prior approval process for PMDs, hopefully, they’ll shy away from those,” said Kim Brummett, senior director of regulatory affairs for AAHomecare.

In the wake of the news, stakeholders were keeping an eye on the RAC websites, where they’re obligated to detail their activities.

“The decision to restart the reviews isn’t illogical,” Brummett said. “The RACs aren’t making money if they’re not auditing claims.”

As always, documentation is the best defense against audits, stakeholders remind providers.

“The RACs go where the money is,” van Halem said.

CMS says it still expects to award new contracts some time this year.

Mobility providers balk at single code system

HME News - Fri, 08/08/2014 - 13:10
08/08/2014Leah Hoenen

YARMOUTH, Maine – Mobility providers aren’t lining up to support a CMS proposal to describe, and pay for, standard manual and standard power wheelchairs each under a single code.  

Ninety-five percent of the 98 respondents to a recent HME NewsPoll say they don’t like the plan. There are too many differences between wheelchairs—combining them under a single code would encourage the use of cheap products with few options, they say.

“There are too many variations based on the individual patient,” said E. Patrick Smith, president of Community Medical Supply. “You have to have a way to identify those variables.”

CMS proposed the single code system on July 11 as part of another proposal to implement bundled monthly payments for wheelchairs and other DME.

Shalon James, a coding and billing specialist for South Tyler, Texas-based Access2Mobility, is one of the 5% of respondents backing the plan, at least for standard manual wheelchairs.

“Medicare should take a page out of Texas Medicaid’s book on the manual wheelchair coding,” James wrote. “There are a lot of different codes available on the standard wheelchairs, but it cuts down on the number of line items on your claim.”

Respondents were split evenly over whether the coding system should be changed at all—49% said yes for manual wheelchairs and 47% said yes for power wheelchairs.

CMS’s last significant change to the coding system: About 10 years ago, it broke up four power wheelchair codes into 61 codes.

“(A single code) is not the answer, but 50 codes is not the answer, either,” wrote Dan Lipka, a former NRRTS president. “Changes are needed, but the July 11 proposal is like jumping out of the proverbial frying pan and into the fire.”

Other stakeholders agree it’s time for changes. One respondent says there are too many power wheelchair codes, but not enough manual wheelchair codes.

“The manual wheelchair codes are too few, are archaic and do not reflect the breadth of available technology,” the respondent said. “The power codes are too numerous.”

Hospice business is down, HME providers say

HME News - Fri, 08/08/2014 - 13:09
08/08/2014Leah Hoenen

YARMOUTH, Maine – Hospice agencies are under the microscope as CMS pays closer attention to how patients are admitted. That translates into fewer hospice patients for HME providers, they say.

“Medicare has gone out and done a lot of surveys and audits and found that a lot of hospice agencies have been keeping their patients on too long,” said Tony Myrell, president of Colton, Calif.-based Premier Medical. “They’ve gone back to those agencies and said, ‘You should pay us back for those patients, it was inappropriate hospice.’”

In June, the Huffington Post published an investigation into the hospice industry, which, according to the article, has quadrupled since 2000.

An increase in the allowed diagnoses has led to a boom of patients entering hospice care, say HME providers.

“Years ago, a relatively stable COPD patient who was on home oxygen wouldn’t have a need for hospice service, but at some point, the inclusion of COPD as an admitting diagnosis for hospice really opened up their ability to garner new patient admissions based on that,” said Woody O’Neal, vice president of Pelham, Ala.-based O2 Neal Medical, whose company stopped taking new hospice patients because of declining reimbursement rates over the past five years.

CMS is also focusing on the services that hospice agencies are providing, or rather, aren’t providing, said William Deary, CEO of Jackson, Miss.-based Great Lakes Caring.

“While reimbursement may not necessarily be declining, the bottom line is changing,” he said. “CMS is getting much more attuned to ensuring that hospices are providing all the services and support items, such as HME or pharmacologicals, they are required to provide.”

For example, some hospice agencies may have had patients pay for medications through their Part D plans, Deary explained.

The increased attention gets to the heart of responsible hospice, Deary said.

“Are you protecting the Medicare trust fund, which is one of your responsibilities as a Medicare provider, and are you admitting patients appropriately?” he said. “I think, basically, what’s going on in the hospice industry is hospice is getting more scrutiny under CMS than it’s received in the past and I’m going to say appropriately so.”

Provider flips ACO model

HME News - Fri, 08/08/2014 - 13:08
08/08/2014Theresa Flaherty

WESTMINSTER, Md. – HME provider Randy Weston wants to break the mold of the traditional accountable care organization (ACO) model.

Although most models are physician or hospital based, he is developing an ACO based on ancillary services, such as HME, pharmacy, nursing and lab testing. The ACO, called Valley ACO, was recently approved by Medicare.

“We think by flipping it upside down we will be successful and more flexible,” said Weston, CEO of Mobility Rehabilitation Products and The Weston Group.

The Affordable Care Act of 2010 called for a reduction in hospital readmissions for Medicare beneficiaries. That includes the formation of ACOs, in which healthcare providers work together to provide high quality, coordinated care.

Valley ACO’s next step: attracting a network of participants, including physician and hospital groups. So far, feedback has been positive, says Weston.

“The physicians get to participate in the ACO and share in some of the possible revenue savings, which is nice, and they still own their practice,” he said. “They also get access to other potential referral sources.”

Forming an ACO isn’t all that much of a stretch for Weston, whose portfolio of healthcare businesses covers assisted living, skilled nursing, nursing, hospice, pharmacy and lab, in addition to DME. Looking to the long term, Weston envisions a very streamlined healthcare model.

“We’d like to design an electronic medical records system that will include all the ancillary participants and offer everybody (access to) that system,” said Weston. “If a therapist gets a referral from a physician, I don’t have to fax him six times or do a lot of the stuff we have to do now in the DME world.”

Although Weston’s model is the exception rather than the rule, it’s an avenue worth pursuing, says consultant Greg Shockey. Post-acute care providers offer valuable experience with the target patient populations, he says.

“Most of these big ACOs are focusing on the 5% of patients that are responsible for 50% of hospital charges,” said Shockey, managing member of Accountable Care Expos. “For post-acute care providers, that’s nearly all of their patients. The bottom line is, you have to do something different.”

In brief: Contractors clarify delivery policy, PFQC launches interactive map

HME News - Fri, 08/08/2014 - 13:06
08/08/2014HME News Staff

WASHINGTON – The DME MACs have issued clarifying guidance on written order prior to delivery (WOPD) document corrections and proof of delivery (POD) requirements. For WOPD, if errors are found before delivery, suppliers may amend the WOPD or create a new one to send to the physician for signature and date, the MACs say. If an error is discovered prior to claim submission, the original supplier may recover the item(s); obtain a compliant, complete WOPD; and re-deliver the item. If an error is found after a claim is submitted, the original supplier can recover the item(s) and a new supplier must complete the transaction after complying with all requirements. As for proof of delivery (POD), the date element may be entered by the beneficiary/designee or the supplier, the MACs say, but the beneficiary/designee is not required to personally fill in the date element. Additionally, the date entered must be the actual date of delivery. In the event that the supplier’s delivery documents have both a supplier entered date and a beneficiary/designee entered date, the beneficiary/designee entered date is considered to be the delivery date and thus the date of service.

People for Quality Care launches interactive map

WATERLOO, Iowa – People for Quality Care has launched an interactive map with data on Medicare patient complaints across the United States. Features of the map include the latest number of patient complaints (updated daily), the ability to filter complaints by medical equipment type and state, and an online form for visitors to add complaints. People for Quality Care has collected 3,200 patient complaints in one year through its Medicare Beneficiary Complaint Hotline. “We created this tool so Congress and the public can see the unfortunate reality—Medicare’s competitive bidding program is not working,” stated Kelly Turner, director of advocacy, in a press release.

Advanced Home Care adds Central Georgia Home Care

HIGH POINT, N.C. – Advanced Home Care and Macon, Ga.-based Central Georgia Home Care Services have merged, the providers announced last week. Central Georgia Home Care Services, a provider of home medical equipment, home infusion and specialty pharmacy services to a 20-county region of central Georgia, will become a branch of Advanced Home Care. The merger allows Advanced Home Care, which has already partnered with 13 other health systems and hospitals, to further strengthen its presence in the Southeast. It allows Central Georgia Home Care to provide additional services to the communities and patients it serves. Advanced Home Care will continue to operate Central Georgia Home Care’s location in Macon. Advanced Home Care also has locations in Norcross and Marietta.

CMS schedules special forum on PMD demo

WASHINGTON – CMS will host a Special Open Door Forum on Aug. 12 to allow DMEPOS suppliers and others to ask questions about the expanding PMD demon. The agency plans to expand the demo, which requires suppliers to submit prior authorizations, to 12 additional states on Oct. 1. The demo was first implemented in seven states Sept. 1, 2012. CMS previously held a forum on the PMD demo in June. This latest forum is scheduled for 2 p.m. to 3:30 p.m. EST. To participate, call 800-603-1774 and use the ID 70084507.

MESA asks: Can providers get off set to respond to audits, too?

ORLANDO, Fla. – The Medical Equipment Suppliers Association (MESA) has heard back from CMS about why DME providers, unlike hospitals, aren’t reimbursed for the costs of providing copies of records to respond to audits. Following a Senate roundtable on audits in July, where it was revealed that the RACs pay hospitals up to $25 per audit, the association recommended the agency change the policy. Acting Director of the Provider Compliance Group Melanie Combs-Dyer told Executive Director Liz Moran in an Aug. 6 letter: “Suppliers under the fee schedule, such as DMEPOS suppliers, generally do not receive additional payments for copy and mailing expenses, as these are included in the indirect costs associated with the fee schedule amount.” MESA was encouraged, however, that Combs-Dyer also stated, “Regarding your recommendations that CMS direct recovery auditors to compensate DMEPOS suppliers for submitting medical records, I have directed my staff to further research this issue and explore the possibility of revising future recovery auditor contracts as you suggest.”

Know a Homecare Champion?

WASHINGTON – AAHomecare is calling for nominations for its Homecare Champion Award, which recognizes those making a significant impact in the HME community. “The Homecare Champion Award is the opportunity to honor and thank someone in our community for their hard work and dedication,” the association stated in a bulletin. AAHomecare is also reminding providers to sign up for its Stand Up for Homecare fundraising reception at Medtrade in October. The Homecare Champion will be named and honored at the event.

Physicians release guidelines for diagnosing sleep disorders

PHILADELPHIA – The American College of Physicians, in a clinical practice guideline published Aug. 5 in the Annals of Internal Medicine, recommends a sleep study for patients with unexplained daytime sleepiness. It also recommends polysomnography for diagnostic testing in patients suspected of obstructive sleep apnea. It recommends portable sleep monitors in patients without serious comorbidities as an alternative to polysomnography when polysomnography is not available for diagnostic testing. The group grades the first recommendation “weak” with low-quality evidence and the second “weak” with moderate-quality evidence. “Considerable controversy surrounds the type and level of respiratory abnormality, the presence and type of signs or symptoms, and the most appropriate sleep monitoring device for diagnosing OSA,” the group states. “The purpose of this guideline is to address the screening and diagnosis of OSA by presenting a comparison of the effectiveness of the available diagnostic methods.”

BioScrip’s home infusion revenues jump nearly 50%

ELMSFORD, N.Y. – BioScrip has reported revenues of $247.1 million and a net loss of $18.6 million for the second quarter of 2014. Total revenues increased by $74.8 million or 43.4% compared to the same period last year. Revenues from home infusion, specifically, increased $74.6 million or 47.8%. The growth in home infusion was driven primarily by continued strong double-digit organic growth and the acquisition of CarePoint Partners, the company stated.

ResMed officials sell shares

SAN DIEGO – ResMed Director Peter Farrell on Aug. 1 sold 25,000 shares of stock at an average price of $49.04 for a total transaction of about $1.23 million. Farrell now owns 279,990 shares valued at about $13.73 million. Also on Aug. 1, COO Robert Andrew Douglas sold 8,000 shares at an average price of $48.95 for a total transaction of $391,600. The day before the transactions, ResMed reported earnings for the fourth quarter and fiscal year ended June 30.

Patient sues NSM, Invacare for damages

CHARLESTON, W.Va. – A West Virginia man has filed a lawsuit in Kanawha Circuit Court against National Seating & Mobility (NSM) and Invacare Outcomes Management, claiming their negligence is responsible for injuries he sustained from his power wheelchair. Terry Hicks claims the chair accelerated at an improper time, causing him to incur serious and permanent physical injuries, including a broken leg, and medical costs, according to local media reports. Hicks claims NSM had recently repaired the chair, for which Invacare had issued a recall and was aware of defects causing unintended acceleration. Hicks seeks judgment of unspecified compensatory damages.

Short takes

Life After Spinal Cord Injury (LASCI),a motivational program offered by Suwanee, Ga.-based UroMed, has hit 35,000 followers on Facebook. LASCI was created in 2010 to help people who use wheelchairs find more information about motivational speaking programs and other resources to assist them with daily living…Appleton, Wis.-based Bill-Ray Home Mobility, maker of “Friendly Beds,” has a new location at 3000 E Enterprise Avenue with a bigger display area. “Friendly Beds” is a bed mobility system that includes a transfer bar option for safe and independent transfers for those with no leg strength…Michael Johnson Racing will visit Home Care Medical’s Milwaukee retail store Aug. 13 from 11 a.m. to 1 p.m. Johnson was paralyzed from the mid-chest down in a 2005 dirt-track accident; he hopes to be the first paralyzed driver to race in the Indianapolis 500…HASCO Medical now has the rights to market BraunAbility and Vantage Mobility International wheelchair-accessible vans in Miami. The company plans to offer wheelchair lifts, transfer seating, hand controls, and wheelchair-accessible vehicle service and rentals at a new location there.

People news

Dave Cormack, president and CEO of Brightree, has been elected to the AAHomecare board of directors. AAHomecare President and CEO Tom Ryan said of Cormack, who has led Brightree since 2005: “He is exactly the kind of voice we need to hear more of in this organization as we navigate the rough terrain the HME industry faces.”…George Kucka, president of Schererville, Ind.-based Fairmeadows Home Health Center, has been appointed chairman of the Home Medical Equipment/Respiratory Therapy Council at AAHomecare. Kuchka is currently a member of the association’s board of directors…Heather Rider has been elected to Inogen’s board of directors, effective immediately. Rider, who fills a vacancy created by Charles Larsen’s resignation, has 25 years of experience in global human resources, having held executive level positions for Alphatec Spine, Sunrise Medical and Biosense Webster.

Contractors issue clarifying guidance on deliveries

HME News - Fri, 08/08/2014 - 11:20
08/08/2014HME News Staff

WASHINGTON – The DME MACs have issued clarifying guidance on written order prior to delivery (WOPD) document corrections and proof of delivery (POD) requirements.

For WOPD, if errors are found before delivery, suppliers may amend the WOPD or create a new one to send to the physician for signature and date, the MACs say.

If an error is discovered prior to claim submission, the original supplier may recover the item(s); obtain a compliant, complete WOPD; and re-deliver the item.

If an error is found after a claim is submitted, the original supplier can recover the item(s) and a new supplier must complete the transaction after complying with all requirements.

As for POD, the date element may be entered by the beneficiary/designee or the supplier, the MACs say, but the beneficiary/designee is not required to personally fill in the date element.

Additionally, the date entered must be the actual date of delivery. In the event that the supplier’s delivery documents have both a supplier entered date and a beneficiary/designee entered date, the beneficiary/designee entered date is considered to be the delivery date and thus the date of service.

Certain RAC reviews to resume

HME News - Wed, 08/06/2014 - 15:26
08/06/2014HME News Staff

WASHINGTON – CMS has announced that the current recovery audit contractors (RACs) will restart some of their reviews.

The RACs have been on hiatus from sending post-payment additional documentation requests (ADRs) since February, as part of the agency’s transition to new RACs.

But, apparently, that transition is taking longer than CMS anticipated.

“Due to the continued delay in awarding new recovery auditor contracts, CMS is initiating contract modifications to the current recovery auditor contracts to allow the recovery auditors to restart some reviews,” the agency states.

CMS did not describe the reviews in detail.

“Most reviews will be done on an automated basis, but a limited number will be complex reviews of topics selected by CMS,” the agency states.

CMS still expects to award new contracts this year.

Advanced Home Care adds Central Georgia Home Care

HME News - Tue, 08/05/2014 - 14:39
08/05/2014HME News Staff

HIGH POINT, N.C. – Advanced Home Care and Macon, Ga.-based Central Georgia Home Care Services have merged, the providers announced this week.

Central Georgia Home Care Services, a provider of home medical equipment, home infusion and specialty pharmacy services to a 20-county region of central Georgia, will become a branch of Advanced Home Care.

The merger allows Advanced Home Care, which has already partnered with 13 other health systems and hospitals, to further strengthen its presence in the Southeast.

It allows Central Georgia Home Care to provide additional services to the communities and patients it serves.

Advanced Home Care will continue to operate Central Georgia Home Care’s location in Macon. Advanced Home Care also has locations in Norcross and Marietta.

Providers mull mail-order bid

HME News - Fri, 08/01/2014 - 13:41
08/01/2014Theresa Flaherty

YARMOUTH, Maine – Will providers of diabetes testing supplies submit bids in the next phase of the national mail-order program? The verdict is mixed.

“We would love to have a mail-order contract,” said Kim Lynn, HME operations manager for Carolina Apothecary in Reidsville, N.C. “We lost a lot of customers because of competitive bidding.”

For providers, the big question is, how low will the reimbursement be? The single payment amount in the current mail-order program is $10.41 per box of 50 test strips—a 72% reduction from the fee schedule amount.

“You cannot go any lower then they are now,” said Jimmy Binson, vice president at Center Line, Mich.-based Binson’s Home Health Centers, which currently holds a mail-order contract. “You can’t expect us, as suppliers, to be able to ship the product for that price and you can’t expect the manufacturers to go lower—they are as low as they can go.”

Stakeholders note that providers should base their new bids on the fee schedule amount—currently about $34 for strips—plus an adjustment for inflation, not the single payment amount.

One thing that might help boost the single payment amounts in the next phase of the mail-order program: if CMS were to enforce its own guidelines, say providers. Program rules require bidders to offer brands with at least 50% market share.

“If they enforced the 50% rule, there wouldn’t be anyone in business,” said Robert Salmon, president and founder of The Diabetic Shoppe in Charleston, Miss. “There’s no way in the world you could do this if you were supplying people with Lifescan and other major brands.”

In addition to low reimbursement, there’s another thing that might keep some providers from bidding: licensure requirements. Because it’s a national contract, bidders have to ensure they meet any and all requirements in all 50 states, as well as Guam, Puerto Rico, the U.S. Virgin Islands and American Samoa. That’s a tall order for a small company, providers say.

“When you are an independent in a small town, you want to serve people in your area,” said Lynn. “We’re not interested in mailing strips to California.”

Other providers have no desire to get back into the Medicare diabetes market, they say.

“We bid the first time and are choosing not to bid again after seeing what happened,” said Dan Gooch, owner of Pal-Med in Columbia, S.C.“We are focused on our insulin pump business."

ResMed eyes improved performance in FY2015

HME News - Fri, 08/01/2014 - 13:40
08/01/2014Liz Beaulieu

SAN DIEGO – ResMed capped off a tough year in the Americas last week when it reported financial results for the fourth quarter ended June 30.

The company reported revenues of $214.9 million for the Americas, a 7% decrease compared to the same period last year. Sales of flow generators were $99.3 million, a 5% decrease; and sales of masks were $115.6 million, an 8% decrease.

CEO Mick Farrell said there were two main reasons for the decrease. The first: a lack of bulk orders in the fourth quarter, particularly by large customers.

“They’ve all faced the reality now of 12 months of competitive bidding Round 2 impact,” he said. “Everybody in the space is looking for ordering efficiency and making sure that operations are delivered to patients but that they don’t have excess inventory.”

The second: a rumor that it would introduce a new flow generator on July 1.

“It was clearly a false rumor,” he said. “But nevertheless, it caused some customers to hold off on ordering. When we are ready for full commercial launch, we will issue a press release. And before that, we will talk to our sales team so that they can talk to customers.”

Overall, ResMed reported net revenues of $415.2 million for the fourth quarter, flat compared to the same period last year, and $1.56 billion for fiscal year 2014, a 3% increase. It reported net income of $87.7 million for the fourth quarter, a 20% increase compared to the same period last year, and $345.3 million for the year, a 12% increase.

Also impacting sales for the fourth quarter in the Americas, particularly for masks: the impact of new pricing structures that were introduced in the third quarter, which continue to “wash through,” and the launch of the AirFit N10 and F10 nasal and full-face masks, respectively.

“(We) only got a half-quarter of sales or so from those two products in the category,” Farrell said.

Additionally, a reorganization of ResMed’s commercial and research and development teams in the Americas resulted in a $6.3 million expense related to employee termination benefits in the fourth quarter. The reorg affected about 1% to 2% of the company’s global workforce of about 4,000.

“The way to think about what we did was to align with the strategy,” said Jim Hollingshead, president of the Americas. “We made some changes and some additions to the sales force in preparation for the launch of Astral (ventilator) and then we made some changes to align across some business (units). So we’ve done some things to better align the marketing organization and also to create better alignment between sales and marketing.”

ResMed expects to put the bulk of these obstacles behind it in fiscal year 2015, buoyed by a stabilizing market and improving patient referral volumes.

“I’d like to emphasize that we believe that our performance in the U.S. will improve over the coming fiscal year,” Farrell said.

Q&A: The COPD Foundation’s Deb McGowan

HME News - Fri, 08/01/2014 - 13:39
With penalties approaching, improved communication needed to cut readmissions08/01/2014Leah Hoenen

WASHINGTON – If it takes a village to raise a child, it takes a community of healthcare providers to keep COPD patients out of the hospital. That will become even more critical Oct. 1, when hospitals start being penalized for excessive readmissions for COPD patients. Deb McGowan, senior director of health outcomes at The COPD Foundation, spoke with HME News about how hospitals and HME providers can work together to curb readmissions.

HME News: You participated in a readmissions survey with Carolinas Healthcare System. What are some of the challenges you found COPD patients face when they are discharged?

Deb McGowan:  Education is a big one: They really don’t understand their disease, and they don’t understand how to use their meds—in particular, nebulizers and inhalers. Lots of patients don’t have doctor’s appointments when they leave the hospital for follow-up. Financial constraints are always a big one, too: People say they can afford their meds but when they get to the pharmacy and they are $300, they can’t afford that. The DME is another piece. They struggle with oxygen and how to use it, when to use it, whether they can go out of their house with it.

HME: What role can RTs play in post-acute care?

McGowan: I’m a firm believer in RTs. I think they are so critical with the COPD patients. They can communicate better than any nurse I’ve seen. They know the inhaler demo better than nurses, better than pharmacists, because they’ve been teaching this for years.

HME: What should hospital RTs and home-based RTs do to best serve patients?

McGowan: In that transition and the handoff of any information, whether back to the primary care physician or specialist or home care or skilled nursing facility, it really has to be as a community unit. We have to share information differently, making sure education is all the same.

HME: How are transition teams doing with that?

McGowan: If we’re talking about probably the majority of people, I don’t think they’re communicating to each other at all—that’s where we saw a real gap. Even nurses to nurses, from hospital to skilled nursing facility, or the RTs at SNFs, we could have easily had that communication and we didn’t.

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