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Cures Act passes House

HME News - Thu, 12/01/2016 - 10:32
12/01/2016HME News Staff

WASHINGTON – The House of Representatives yesterday passed the 21st Century Cures Act, which includes important HME-related provisions, by a margin of 392 to 26.

The legislation would roll back a second round of Medicare reimbursement cuts that went into effect this year in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016. It would also further delay Medicare’s plan to use bidding-derived prices for accessories for complex power wheelchairs until July 1, 2017.

“This is a great first step,” said Tom Ryan, president and CEO of AAHomecare. “Once you have statute, it’s easier next time around to get an extension.”

The legislation also requires the Department of Health and Human Services to conduct a study on the impact of the bidding program on the overall number of HME providers and the availability of home medical equipment during 2016. New data shows a decrease in PTANs and a 37% decrease in tax ID numbers for HME providers, according to AAHomecare.

While the legislation only provides temporary relief, stakeholders say it buys time for a more permanent fix under the new administration.

“While AAHomecare and other HME stakeholders advocated for a longer delay for the second phase of bidding derived cuts, this legislation marks an important step in efforts to scale back the effects of the bidding program,” said AAHomecare in a bulletin. “Both chambers of Congress, along with party and committee leadership, have recognized that the home medical equipment community in rural areas needs relief and that the bidding program requires more scrutiny.”  

 

Coloplast to buy Comfort Medical for $160M

HME News - Wed, 11/30/2016 - 15:39
Views deal as ‘additional building block in U.S. strategy’11/30/2016HME News Staff

MINNEAPOLIS – Coloplast, which has its U.S. headquarters here but is based in Denmark, has entered into a definitive agreement to acquire Coral Springs, Fla.-based Comfort Medical for $160 million in cash, the company announced Nov. 30.

The deal, if completed and approved by authorities, combines a manufacturer of ostomy, urology, continence and wound care supplies with a provider of those supplies.

“The acquisition of Comfort Medical fits very well into our overall consumer ambition for Coloplast in the U.S., securing continued access to innovative technology for end users,” said Lars Rasmussen, Coloplast’s CEO, in a release. “Comfort Medical has a strong patient acquisition model and an efficient and scalable setup, in addition to a strong management team with a good cultural fit to Coloplast.”

Comfort Medical, a subsidiary of Liberty Medical, is expected to record sales of about $38 million for 2016, according to the release.

Coloplast plans to leverage Comfort Medical’s business model of capturing patients through direct response advertisement and physician referrals. It provides patients with products from a number of manufacturers, including Coloplast.

“I am excited about the future prospects of our U.S. business and view this acquisition as an additional building block in the implementation of our U.S. strategy,” Rasmussen said.

Earlier this year, Comfort Medical acquired Wheel:Life, a digital media publication and social community for wheelchair users with more than 26,000 followers on social media, further strengthening its ties to end users.

The deal is expected to close in the first quarter of 2016/17.

Coming soon: standards for adaptive equipment

HME News - Wed, 11/30/2016 - 15:37
11/30/2016HME News Staff

WASHINGTON – A bill that requires Veterans Affairs to establish quality and safety standards for adaptive equipment and vehicles is headed to the president’s desk for his signature.

The House of Representatives on Nov. 29 agreed to pass an amended version of the Veterans Mobility Safety Act previously passed by the Senate. The amended version of the bill allows independent providers to continue performing home installations and deliveries, and ensures a fair certification process.

“We have shown that Congress listens to small- and medium-sized businesses when the narrative is honest, forthright and consistent,” said Drew McCartney, CEO of Harmar, which led a coalition of providers and manufacturers working to amend an original version of the bill. “It took a lot of meetings, letters and emails, but we found willing listeners and rose to the occasion.”

At times leading up to the House and Senate passing the bill, Harmar’s coalition and the National Mobility Equipment Dealers Association were at odds over the scope and specifics of the bill.

More specifically, the bill requires the VA to establish quality and safety standards for adaptive equipment and vehicles, including equipment quality and safety; certification of providers by third-party manufacturers or other organizations; training for VA personnel administering the program; and allowances for home modifications.

The amendments to the bill were introduced by Sen. Jerry Moran, R-Kan.

Trump taps HME champion Price as HHS secretary

HME News - Tue, 11/29/2016 - 10:07
11/29/2016HME News Staff

WASHINGTON – President Elect Donald Trump has named Rep. Tom Price, R-Ga., a long-time champion of the HME industry and its efforts to reform Medicare’s competitive bidding program, as the next secretary of the Department of Health and Human Services, according to news reports.

Price, a six-term congressman, is a vocal critic of the Affordable Care Act and, according to The New York Times, has been studying how to dismantle and replace Obamacare for the past six years. He serves on the influential Ways and Means Committee in the House of Representatives.

Earlier this month, Price was at Medtrade in Atlanta to update attendees on efforts to roll back a second round of reimbursement cuts in non-bid areas. Industry stakeholders, including Tom Ryan of AAHomecare and John Gallagher of The VGM Group, gave him an award for his work championing the HME industry on the Hill.

Price has introduced bills to create an alternative to the competitive bidding program, called the market-pricing program. Tenets of MPP include requiring providers to fulfill their contracts and putting out to bid only two product categories per bid area (with the remaining product categories adopting the price submitted by contract suppliers in other areas of equal size).

Price has also introduced bills to soften the blow of the recent national roll out of competitive bidding by providing a 30% increase in reimbursement over the bidding-derived prices and a four-year phase-in period, and reinstating the bid cap at the unadjusted fee schedule amount.

Before coming to Washington, D.C., Price was an assistant professor at Emory University School of Medicine and the medical director of the Orthopedic Clinic at Grady Memorial Hospital, where he taught resident doctors in training.

Price, who lives in Roswell, Ga., with his wife, Elizabeth, worked in private practice as an orthopaedic surgeon for nearly 20 years.

Trump has also named Seema Verma, founder and president of health policy consulting firm SVC, as the next administrator of CMS. Verma is a Medicaid policy expert and the architect of the Healthy Indiana Plan, the nation’s first consumer-directed Medicaid program.

Senators introduce bill to preserve access to diabetes supplies

HME News - Tue, 11/29/2016 - 10:05
11/29/2016HME News Staff

WASHINGTON – Sens. Dan Coats, R-Ind., and Mark Warner, D-Va., have introduced a bill that they believe would help ensure that all Medicare beneficiaries have access to their preferred brand of diabetes test strips.

The senators introduced the bill, the Diabetes Supplies Act, on Nov. 16 in response to Medicare’s national mail-order program for diabetes testing supplies. As a result of the program, they say, the most commonly purchased brands of test strips are no longer available to Medicare beneficiaries through mail-order suppliers.

“All diabetes patients should have access to the same market of products, regardless of whether they receive Medicare benefits,” Coats said in a statement. “Diabetes patients deserve the right to choose what products will best help them manage their disease. Our legislation will improve quality and access for all diabetes patients.”

The bill would strengthen consumer protections by ensuring beneficiaries are informed of their rights to obtain their preferred products and by preventing auto-refills of unwanted products.

Additionally, the bill would ensure that suppliers seeking to supply diabetes test strips have demonstrated an ability to obtain the products included in their bids, and it would reinforce the authority of the Department of Health and Human Services to terminate suppliers who fail to comply with the terms of their bids.

The bill is supported by the American Association of Diabetes Educators, the American Association of Clinical Endrocrinologists and the Diabetes Access to Care Coalition.

Industry buys time for rural providers, complex rehab accessories

HME News - Mon, 11/28/2016 - 10:58
‘It’s just the first step, but an important one,’ AAH’s Ryan says11/28/2016HME News Staff

WASHINGTON – The HME industry now has a vehicle in Congress for rolling back a second round of Medicare reimbursement cuts that went into effect in non-competitive bidding areas on July 1, AAHomecare reports.

A draft of the 21st Century CURES bill that will be considered by lawmakers this week has language that would roll back the cuts for six months. It paves the way for providers in non-bid areas to recoup reductions for items with dates of service from July 1 to the end of 2016, says Tom Ryan, president and CEO of the association.

“This legislation will help HME providers in rural areas stay in business and serve their communities, while we continue to work for a more realistic and sustainable pricing environment for all HME providers,” he said. “It’s just the first step in efforts to protect the rural HME infrastructure, but it’s an important one.”

Per the bill, the second round of cuts would again go into effect Jan. 1, 2017.

The bill also has language that would further delay Medicare’s plan to use bidding-derived pricing for accessories for complex power wheelchairs for another six months, until July 1, 2017. It extends an original 12-month delay granted by Congress in December 2015.

“This legislation will also ensure that individuals with significant disabilities continue to receive the specialized technology they depend on while we continue to advocate for a permanent fix that will keep CRT accessories outside the purview of the bidding program,” Ryan said.

Other proposals in the bill include:

·      Speeding up plans to limit state Medicaid reimbursement amounts for HME to the Medicare fee-for-service rates, including applicable bid rates, from January 2019 to January 2018.

·      Instructing the Department of Health and Human Services to conduct a study on the impact of the bid program on the overall number of HME providers and the availability of products over the course of 2016.

·      Requiring HHS to reissue payment regulations for items and services furnished on or after Jan. 1, 2019, with adjustments to the non-bid fee schedule in some areas based on stakeholder input, costs, volumes and the number of suppliers serving those areas.

AAHomecare expects the House of Representatives to take up the bill this week, followed by the Senate next week.

Military precision: Barber DME at ease on base

HME News - Wed, 11/23/2016 - 10:38
11/23/2016Theresa Flaherty

FORT BELVOIR, Va. – As a U.S. Air Force veteran, provider Tim Barber knew the military could benefit from his HME business, even if it was a hard sell to the military itself.

“We met with a lot of resistance—it took three years to crack that door,” said Barber, president of Barber DME, which he founded in 2012 with a “civilian” location in Chantilly, Va. “They finally granted us an award and we opened at Fort Belvoir in April 2015.”

The store proved so successful that the Army & Air Force Exchange Service, which oversees on-base commercial enterprises like food services, the PX and chain restaurants, subsequently put out to bid a national contract.

In October, Barber DME won that contract, which initially calls for nine stores. The first will open in January at Nellis Air Force Base near Las Vegas, with the remaining eight slated to open by September.

“We will be operating on bases from Florida to Washington state, and the contract can grow as bases want to add locations,” he said.

Fort Belvoir is the one of the largest employers in Northern Virginia and one of the largest military hospitals in the country. Barber DME offers DME, enteral feeding, breast pumps, mastectomy items and compression garments to service members and their families, and military retirees. Mobility items like wheelchairs and knee walkers are among its best sellers.

“We serve people from all over Maryland, Virginia and Washington D.C.,” said Barber, who primarily relies on Tricare, but accepts Medicare, as well. “Wherever there is military, they are coming to us.”

Like many payers, Tricare has lowered some reimbursements, which makes it challenging, says Barber.

“There are many items we provide where the reimbursement doesn’t cover the cost,” he said. “But these soldiers and sailors need the stuff we provide.”

In brief: Judge blocks overtime rule; Lincare, InfuSystem face legal action

HME News - Wed, 11/23/2016 - 10:35
11/23/2016HME News Staff

WASHINGTON – A federal judge in Texas on Nov. 22 blocked a new overtime rule from going into effect on Dec. 1. The rule would require employers to pay overtime for more than 40 hours of work per week for all employees earning up to $913 per week or $47,476 per year. The current threshold: $455 per week or $23,660 per year. The judge, Amos L. Mazzant III of the Eastern District of Texas, ruled that the Obama administration had exceeded its authority by raising the overtime salary limit so significantly. The Labor Department says it “strongly disagreed” with the decision and was “considering all of our legal options,” raising the possibility of an appeal, according to The New York Times. While the injunction is only a temporary measure that suspends the rule until the judge can issue a decision on the merits, his language indicates he will likely strike down the rule, the Times reported.

Legal action: Lincare, InfuSystem

MIAMI – The plaintiffs in a whistleblower lawsuit against Lincare have asked the court to overturn the decision.

The whistleblowers, Gerry Phalp and Matt Peoples, claim that unsolicited calls from Diabetic Experts of America, a Lincare subsidiary, violated Medicare statute, which forbids such calls unless the beneficiary has bought something from that company within the past 15 months.

In July 2015, U.S. District Judge Kathleen Williams sided with Lincare, ruling that Diabetic Experts is a subsidiary of Lincare, not a separate entity; therefore, because the beneficiaries had received oxygen supplies from Lincare within the 15-month time period before the calls, the calls did not violate the False Claims Act.

In arguments before the Eleventh Circuit on Nov. 16, however, the attorney for the whistleblowers, Simon Paris, argued that the court was wrong to conclude the definition of DME was ambiguous and that blood-testing supplies were, therefore, exempt from the statute.

Also during those arguments, Weili Justin Shaw, an attorney with the U.S. Department of Justice, told the court that Williams made the right decision, but used the wrong reasoning. He said that could damage future cases by allowing a defendant to dodge liability for violation of a regulatory requirement by proposing a reasonable alternate interpretation of the requirement, regardless of the defendant's intent.

Class action lawsuit filed against InfuSystem

DALLAS – A class action lawsuit has been filed against InfuSystem Holdings, alleging violations of the Securities Exchange Act of 1934.

The lawsuit alleges that, between May 12, 2015, and November 7, 2016, InfuSystem and several officers and directors used false and misleading statements and/or failed to disclose that the company lacked effective internal control over financial reporting.

It also alleges that the company’s financial statements from the start of 2015 overstated estimated accounts receivables collections and, in turn, overstated revenues and pre-tax income by a corresponding amount. As a result, those statements were materially false and misleading, and could not be relied on, the lawsuit alleges.

Following that announcement, InfuSystem stock dropped significantly, according to a press release from The Briscoe Law Firm, which is representing the class action.

Veterans Mobility Safety Act clears another hurdle

WASHINGTON – Both the Senate and House of Representatives have now passed a version of the Veterans Mobility Safety Act, the VGM Group reported on Nov. 22.

The bill requires Veterans Affairs to establish quality and safety standards for adaptive equipment and vehicles, including equipment quality and safety; certification of providers by third-party manufacturers or other organizations; training for VA personnel administering the program; and allowances for modifications at the veteran’s residence.

The Senate passed the bill passed by the House, H.R. 3471, but with an amendment to ensure the certification process is not limited to one specific organization.

“VGM, Accessible Home Improvement of America (AHIA) and U.S. Rehab have put a great amount of effort into these changes,” VGM stated. “AHIA is in the process of creating a new training program on hitch-mounted lifts to address this need.”

With two slightly different versions of the bill, it now returns to the House.

Once the bill passes the House, it will head to President Obama’s desk to be signed into law.

Previous versions of the bill divided the manufacturers and providers in the market.

FRA to release advisory on importance of sleep apnea screening, treatment

WASHINGTON – The Federal Railroad Administration is expected to issue a safety advisory to push railroads to address worker fatigue and accelerate their installation of inward- and outward-facing cameras, the agency announced Nov. 16. The FRA made the announcement in response to a train crash* in Hoboken on Sept. 29 that killed a woman and injured more than 100 others. The train’s engineer revealed recently that he has severe sleep apnea. The advisory will stress the importance of sleep apnea screening and treatment, according to news reports. The advisory, akin to a strong recommendation, is a stopgap measure while regulators draft rules that would require railroads to screen engineers for sleep apnea, reports say.

HME provider opens health and wellness store

FLETCHER, N.C. – Remedy Health & Wellness, a new store focused on preventative health products, as well as traditional HME, will hold an opening reception on Dec. 8. Marcus Suess, the CEO of All-States Medical Supply, is behind the new store. “By offering an extensive inventory of health and wellness supplies, our team at Remedy Health & Wellness look forward to helping people of all ages and abilities live fulfilled lives,” he said. The reception will include a ribbon cutting by the Asheville Area Chamber of Commerce (feel free to avoid this, Suess said), followed by food and refreshments (make sure not to avoid this, he said). “We are very excited about this new venture and the opportunity to fill a need in the community,” he said. Remedy Health is online at www.RemedyHW.com and on Facebook at www.Facebook.com/RemedyWH.

Numotion nearly doubles size of facility

CAPE GIRARDEAU, Mo. – Numotion has relocated and expanded its Southeast Missouri branch, according to the Southeast Missourian. The 9,000-square-feet facility is nearly twice the size of the company’s previous facility and will allow it to expand office and service and repair space, and provide additional storage space, the newspaper reported. Numotion’s Cape Girardeau branch is one of seven in the state and one of 120 across the country.

Product news: ResMed, SnooZeal

ResMed’s AirFit F20 full-face mask and N20 nasal mask are now available in the United States, the San Diego-based company announced Nov. 22. The AirFit 20 series introduces a new InfinitySeal silicone cushion that adapts to the unique facial contours of each patient and is designed to provide a universal fit for all patients, regardless of face shape or size, the company says. The masks also feature magnetic clips for easy fit and removal. ResMed expects mask and accessories growth in the Americas to rebound with the launch of the AirFit 20…The anti-snoring and sleep apnea device from Seattle-based SnooZeal has scored a CE mark, making it the first commercially available over-the-counter device that targets the underlying cause of snoring, Fierce Biotech reported Nov. 21. The device addresses the excessive relaxation and loss of tongue muscle tone during sleep. Worn for 20 to 25 minutes twice a day over six weeks, it delivers electric pulses to the back of the tongue to increase muscle tone. Patients use a smartphone app to control their treatment.

 

Judge blocks overtime rule

HME News - Wed, 11/23/2016 - 10:11
11/23/2016HME News Staff

WASHINGTON – A federal judge in Texas on Nov. 22 blocked a new overtime rule from going into effect on Dec. 1. The rule would require employers to pay overtime for more than 40 hours of work per week for all employees earning up to $913 per week or $47,476 per year. The current threshold: $455 per week or $23,660 per year. The judge, Amos L. Mazzant III of the Eastern District of Texas, ruled that the Obama administration had exceeded its authority by raising the overtime salary limit so significantly. The Labor Department says it “strongly disagreed” with the decision and was “considering all of our legal options,” raising the possibility of an appeal, according to The New York Times. While the injunction is only a temporary measure that suspends the rule until the judge can issue a decision on the merits, his language indicates he will likely strike down the rule, the Times reported.

Legal action: Lincare, InfuSystem

HME News - Wed, 11/23/2016 - 10:09
11/23/2016HME News Staff

MIAMI – The plaintiffs in a whistleblower lawsuit against Lincare have asked the court to overturn the decision.

The whistleblowers, Gerry Phalp and Matt Peoples, claim that unsolicited calls from Diabetic Experts of America, a Lincare subsidiary, violated Medicare statute, which forbids such calls unless the beneficiary has bought something from that company within the past 15 months.

In July 2015, U.S. District Judge Kathleen Williams sided with Lincare, ruling that Diabetic Experts is a subsidiary of Lincare, not a separate entity; therefore, because the beneficiaries had received oxygen supplies from Lincare within the 15-month time period before the calls, the calls did not violate the False Claims Act.

In arguments before the Eleventh Circuit on Nov. 16, however, the attorney for the whistleblowers, Simon Paris, argued that the court was wrong to conclude the definition of DME was ambiguous and that blood-testing supplies were, therefore, exempt from the statute.

Also during those arguments, Weili Justin Shaw, an attorney with the U.S. Department of Justice, told the court that Williams made the right decision, but used the wrong reasoning. He said that could damage future cases by allowing a defendant to dodge liability for violation of a regulatory requirement by proposing a reasonable alternate interpretation of the requirement, regardless of the defendant's intent.

Class action lawsuit filed against InfuSystem

DALLAS – A class action lawsuit has been filed against InfuSystem Holdings, alleging violations of the Securities Exchange Act of 1934.

The lawsuit alleges that, between May 12, 2015, and November 7, 2016, InfuSystem and several officers and directors used false and misleading statements and/or failed to disclose that the company lacked effective internal control over financial reporting.

It also alleges that the company’s financial statements from the start of 2015 overstated estimated accounts receivables collections and, in turn, overstated revenues and pre-tax income by a corresponding amount. As a result, those statements were materially false and misleading, and could not be relied on, the lawsuit alleges.

Following that announcement, InfuSystem stock dropped significantly, according to a press release from The Briscoe Law Firm, which is representing the class action.

CMS revokes Arriva’s billing privileges

HME News - Tue, 11/22/2016 - 12:21
11/22/2016HME News Staff

CORAL SPRINGS, Fla. – Arriva Medical’s contract for CMS’s national mail-order program for diabetes supplies is in question.

CMS has revoked Arriva’s billing privileges, alleging the provider submitted 211 claims for deceased patients between April 15, 2011, and April 25, 2016, according to a statement from parent company Alere.

“However, the CMS letter only identifies a sample of 47 such patients, upon which our review was based,” reads the statement. “The 211 claims allegedly at issues constitute approximately .00038% of Arriva’s nearly 5.8 million total claims during that period.”

Alere cites “CMS system challenges” as the problem. In August 2015, CMS “unilaterally” shut off Arriva’s access to the HIPAA Eligibility Tracking System, which is used to determine beneficiary eligibility, because the high volume of use by Arriva was crashing the system, according to Alere. That in turn, limited Arriva’s ability to verify eligibility.

With Arriva serving about one-half of the Medicare beneficiaries under the mail-order program, the move by CMS puts the future of the program at risk, states Alere. There are currently 11 mail-order contract suppliers listed on the Medicare supplier directory, down from about 18 in the previous round of the program.

This recent news is not the only hiccup between Arriva and CMS. In July, the company’s name disappeared from Medicare’s supplier directory, sparking rumors that its provider number had been revoked by the National Supplier Clearinghouse. On July 21, Alere said it was a misunderstanding and that matter had been cleared up.

Alere has stated that Arriva will continue to furnish covered services to beneficiaries until its case with CMS is resolved.

Respondents report growing pains in sleep market

HME News - Mon, 11/21/2016 - 15:08
11/21/2016HME News Staff

NEW YORK – HME providers report significantly slower patient volume growth for sleep therapy devices in the fourth quarter “HME Sleep and Oxygen Survey” conducted by investment bank Needham & Co. and HME News.

Respondents saw sleep patient volume grow 0.8% in the last 12 months, compared to 3.6% in the previous survey period. They expect volume to grow 2.5% in the next 12 months, compared to 6% in the previous survey period.

Respondents also indicated that flow generator prices declined 3.8% over the long term, compared to 3.2% in the prior survey period, and mask prices declined 4.4% vs. 2.4%.

“We think this is the result of the latest Medicare reimbursement cuts, and we expect pricing to continue to worsen given the additional cuts that occurred in the second half of 2016,” wrote Mike Matson, an analyst at Needham, in a report.

Additionally, for the first time in seven surveys, respondents report higher ratings for Respironics flow generators than ResMed flow generators. They expect ResMed’s share of flow generator purchases to decrease by 6.1% and its share of mask purchases to decrease by 4.8%. They expect Respironics’ share of flow generator purchases to decrease by 1.1% and its share of mask purchases to increase by 0.7%. Other small companies are expected to increase their share of flow generator purchases by 7.5% and their share of mask purchases by 5.2%.

For vents, respondents expect a recent Office of Inspector General report detailing a spike in billing to slow growth in the product category. They reported Respironics has the most market share in vents (52%), followed by ResMed (40%) and other manufacturers (8%).

For oxygen therapy devices, respondents expect POCs to increase from 18.6% to 27% of the market over the next 12 months. Inogen’s G3 was the highest rated POC by respondents with a score of 6.3 out of 7.

The survey was based on 81 respondents.

Bid relief ‘in the mix’

HME News - Fri, 11/18/2016 - 14:19
11/18/2016Theresa Flaherty

WASHINGTON – Amid the chaos in Washington, D.C., industry stakeholders have been crisscrossing the Hill to ensure relief from Medicare’s competitive bidding program doesn’t get lost in the shuffle.

Members of AAHomecare, The VGM Group and others made at least 16 visits in two days last week, and also have spoken with the office of House Speaker Paul Ryan.

“The feedback from Speaker Ryan’s staff is that it’s in the mix, but they can’t give us a specific vehicle or any clarity to the issue,” said Jay Witter, senior vice president of public policy for AAHomecare. “He’s still negotiating with his caucus. There’s all sorts of people vying for power.”

Ryan in September offered assurance that bid relief would be taken up in the lame-duck session, which may end sooner rather than later on Dec. 9.

As to a vehicle, there are a few opportunities, say stakeholders.While it looks unlikely that there will be any sort of Medicare package passed before the end of the year, stakeholders say language addressing bid relief could get included in the 21st Century Cures Act or in an omnibus spending bill.

In lieu of an omnibus bill, lawmakers could pass a continuing resolution to keep the government funded through March. That would, however, lessen the industry’s chances of being included, because House Republicans have indicated they would like the CR to be “clean,” stakeholders say.

“This is a critical time,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Decisions are being made and as soon as they come to an agreement on the budget, that’s going to drive the timing. Then things will happen very, very quickly.”

Another less likely option, say stakeholders: getting legislation passed by unanimous consent. In July, the Senate began 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, but that effort failed.

“That’s the most difficult play,” said Tom Ryan, president and CEO of AAHomecare.“We have gotten everybody lined up and we continue to lobby.”

In their conversations with lawmakers since the elections, stakeholders are hearing that grassroots efforts to raise the noise level are making it to the ears of lawmakers. A new weapon in the toolbox: data highlighting a 39% decrease in PTANs and a 37% decrease in tax ID numbers for HME providers, said Ryan.

“That was an ‘a-ha’ moment for many of the legislators,” he said. “There’s significant loss in the infrastructure of this industry and they said they want CMS to respond to those statistics.”

Expect a mixed bag in 2017, respondents say

HME News - Fri, 11/18/2016 - 14:17
11/18/2016Tracy Orzel

YARMOUTH, Maine – Respondents to a recent HME Newspoll are split over whether 2017 will be a better year for the HME industry, with 51% saying they expect market conditions to worsen and 49% saying they’ll improve.

2017 will be the year of consolidation and closures, according to one respondent. 

“My company has already laid off 20% of its workforce and closed five of the 65 locations we have,” the respondent said. “We are looking to close an additional three locations in 2017 and lay off another 10% of the workforce. All these closure are in rural markets.”

A number of respondents cited shrinking reimbursement rates and the rollout of competitive bid rates to rural areas as a major concern, along with the “monkey see, monkey do” effect on non-Medicare payers.

“Now that most insurance companies have rolled out new fee schedules based in whole or in part on the Medicare competitive bid rates, there is not reason to think they’ll ever go back to higher rates,” said one respondent.

Others are more optimistic, saying 2017 will be a “comeback” year now that reimbursement rates have finally hit rock bottom.

“I know I’ve been saying this for years, but I seriously don’t see how it can possibly get any worse,” wrote one respondent. “We are finally getting some traction in Congress.”

In light of the fallout from competitive bidding, some say the industry will experience a period of stability as providers restructure by offering new cash oriented products and service lines that have been developed over the last few years.

It’s also impossible to look ahead without considering the implications of a Trump presidency on the HME industry. Many, like Laurence von Euw, manager of Lockport Home Medical in Lockport, N.Y., are encouraged by the president-elect’s business-friendly platform.

“Trump’s campaign ran on promises of lower taxes, including decreasing corporate tax rates to about 15% from the current 35% rates, and doing away with onerous regulations on small business,” said von Euw. “This will increase retail sales.”

Meanwhile, Ricky Hubbard, general manager of Zurcare in Starkville, Miss., which is slated to close its doors Nov. 30, says 2017 will be a mixed bag.

“With the nomination of a new Republican president and Congress’ intentions to repeal or replace Obamacare, the HME industry’s future is looking up,” he said. “However, I do not believe there will be improvements above and beyond the cuts we received in January 2016. I also believe that the current policies CMS has in place, including the audit process, will not change in HME’s favor.”

Providers prep for return of RAC

HME News - Fri, 11/18/2016 - 14:16
New contract, however, means several improvements to process11/18/2016Liz Beaulieu

LIVERMORE, Calif. – Providers should strap in: After a protracted lull, RAC audits will likely pick back up in January, now that CMS has tapped Performant Recovery, based here, to perform post-payment reviews for DME and home health/hospice claims nationwide.

Stakeholders say Performant will likely kick-start its efforts with reviews* it had previously been performing as the RAC for Jurisdiction A—reviews whose targets were everything from vacuum erection devices to respiratory assist devices to portable oxygen systems to vents.

“I think one thing that we can glean is that, because the RACs need CMS approval for their reviews, to get started right away, they will carry over a lot of those previous reviews,” said Wayne van Halem, president of The van Halem Group.

CMS’s award to Performant signals the agency’s move to a single RAC for DME claims for all four jurisdictions. It initially planned to have this new structure in place in 2014, but it has been slowed down* by pushback surrounding changes* to the new contract and several protested awards, including an award to Connolly* in December of 2014.

Because Performant will be conducting post-payment reviews of DME claims paid during a three-year span, providers should be on the lookout that the RAC applies the correct coverage policies, stakeholders say.

“The biggest risk is, what version of the LCD are they looking at?” said Kim Brummett, vice president of regulatory affairs for AAHomecare. “For repeat rentals and supplies patients, (the contractor) needs to be very aware of what’s required when the patient actually received the services.”

While post-payment reviews are never pleasant, changes to the new contract mean several improvements for providers, including a more meaningful discussion period, stakeholders say. Previously, providers had the option of a discussion period, but because the RAC immediately signaled the MAC to start the overpayment process, the only way they could hold onto their money was to file an appeal.

“This is a true passing of the baton,” said Andrea Stark, a reimbursement consultant for MiraVista. “You get the results of the review and then you can sit on it for 30 days. You can provide counter evidence or missing evidence, all the while avoiding an overpayment going to the MAC (right away). That should be more effective.”

Other changes to the new contract that benefit providers: Performant can’t collect contingency fees until the second level of appeals is exhausted, and it will be held to a 95% accuracy rate and a less than 10% turnover rate on appeal, stakeholders say.

“That forces them to be more comprehensive with their reviews,” van Halem said.

The only change to the new contract that could pose a problem for providers, stakeholders say: Performant is required to participate in 50% of hearings at the administrative law judge level, a provision CMS added as a result of the high overturn rate at the ALJ.

“When the contractor is there, there’s a vested interest that the claim remain unpaid,” van Halem said. “That will be more challenging for providers.”

 

https://www.performantrac.com/IssuesUnderReview.aspx

http://www.hmenews.com/article/cms-sets-timeline-new-rac

http://www.hmenews.com/article/new-national-rac-hme

http://www.hmenews.com/article/cms-kick-starts-new-audit-program

Numotion finds perfect fit with HME of Texas

HME News - Fri, 11/18/2016 - 14:14
CEO says complex rehab giant has ‘healthy pipeline’11/18/2016Tracy Orzel

ROCKY HILL, Conn. – Numotion has checked off a lot of wants and must-haves on its acquisition wish list with its purchase of Home Medical Equipment of Texas in November.

“We’ve been working with them for a few weeks and it’s proven to be more of a fit than even I anticipated," said CEO Mike Swinford.
The No. 1 draw: Location, location, location.

“We wanted to expand our coverage in Texas," Swinford said. "It's a huge market—it’s a growing market—and they've got a great business."
Founded in 1993 and based in Fort Worth, HME of Texas focuses primarily on complex rehab equipment—like Numotion—and offers respiratory, DME and mobility products. 

Other synergies include the Texas Department of Aging and Disability Services’ (DADS) Applied Income Program, which pays for equipment in nursing facilities.

“HME of Texas does a significant amount of business with it and they did it very well,” said Swinford. “They’re very efficient and they’re very effective for being a small provider, so their ability to really excel in this space was a unique opportunity.”

Numotion, which also does a significant amount of business with DADS, plans to apply HME of Texas’ best practices across its other nine locations in Texas.

Short term, HME of Texas’ 13 employees will continue to operate from its location in Forth Worth, but under the Numotion banner. Next year, that location, along with NuMotion’s location in Fort Worth, will move into a new facility to align resources and better serve customers.

It’s been a busy year for the complex rehab giant, which inked an exclusive U.S. distributor deal for SoftWheels in-wheel suspension technology in August and launched a new online retail store, www.shopnumotion.com, in September, and it could get busier.

“We have a healthy pipeline of potential acquisition targets,” says Swinford. “We’re in ongoing conversations and when we find the right fit and the right timing, as we did with HME of Texas, we certainly want to continue to grow.”

In brief: CQRC urges passage of bid-delay, Vertess closes three deals

HME News - Fri, 11/18/2016 - 14:11
11/18/2016HME News Staff

WASHINGTON – The Council for Quality Respiratory Care this week urged lawmakers to pass legislation that would delay steep cuts to reimbursement for home oxygen.

The Patient Access to Durable Medical Equipment Act would reinstate the phase-in period of cuts to soften the blow on suppliers.

“It’s time for leaders in the House and Senate to work together to enact the critical provisions of the bill,” said Dan Starck, CQRC chairman, in a release. “It remains clear that more time is needed to adequately measure and monitor the impact of earlier cuts that took effect on Jan. 1 before Medicare implements deeper cuts on home respiratory care.”

In July, the Senate began 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, but that effort failed.

Lawmakers, patient groups, physicians and health systems have voiced growing concerns with the impact of the program on beneficiary access.

Lincare hit with another overtime-related lawsuit

PHILADELPHIA – Jeffrey Sawyer has filed a class action lawsuit against Health Care Solutions at Home and Lincare, alleging the companies failed to properly compensate him for all the hours he worked, according to PennRecord.

Sawyer, who filed a complaint on Oct. 31 in the U.S. District Court for the Eastern District of Pennsylvania, alleges that he worked for more than 40 hours per week without being paid overtime compensation, and that the companies failed to properly figure base pay and maintain correct records, according to PennRecord, which cover’s Pennsylvania’s legal system.

Sawyer requests a trial by jury, and seeks damages, liquidated damages, court costs, interest and any further relief the court grants, PennRecord says.

This isn’t the first time Lincare has been hit with such a lawsuit: The U.S. District Court for the Eastern District of California ruled in August that non-exempt employees who work in California for Alpha Respiratory and Lincare could proceed with their lawsuit* as a class action. Honorable Judge Morrison England ruled that non-exempt employees who worked for the companies in California since Oct. 21, 2010, can seek back overtime wages and premiums for missed meal breaks.

The lawsuit in California alleges Alpha Respiratory and Lincare failed to pay their hourly employees in California overtime wages, failed to provide the legally mandated meal and rest breaks, and failed to provide accurate wage statements required by state law.

Vertess closes multiple deals in Q3

TUCSON, Ariz. – Vertess, a healthcare M&A advisory firm, closed two major healthcare transactions in the third quarter, it announced yesterday.

Vertess represented Metro-Med, Inc., a Burbank, Calif.-based specialty provider of respiratory equipment and related services, in an acquisition by Good Night Medical, LLC, a Cleveland-based DME company with additional operations in Arkansas, Texas and Massachusetts.

Vertess also represented Integrity Medical, a Savannah, Ga.-based provider of complex rehabilitation technology, in an acquisition by National Seating & Mobility, a national provider based in Franklin, Tenn.

"Both of these acquisitions were very beneficial to our clients, as well as the buyers, who were able to strategically expand in core areas they had identified," said Bradley Smith, Vertess managing director/partner.

Also in the third quarter, Vertess represented Alpine Investors in its acquisition of Acumen, a provider of fiscal agent services based in Mesa, Ariz.

Vertess has expertise in diverse healthcare and human service verticals, ranging from behavioral healthcare, substance abuse treatment and cognitive disabilities, to DME, home care/hospice, urgent care centers and other specialized services and products.

Inogen makes list for third time

GOLETA, Calif. – Inogen has been named one of the 500 fastest growing technology, media, telecommunications, life sciences and energy tech companies in North Americaby Deloitte Technology. It’s the third year in a row that Inogen, which saw its revenue grow 227% between 2012 and 2015, has made the list. "It is an honor to be named to Deloitte’s Technology Fast 500 for the third year in a row,” said CEO Raymond Huggenberger in a release. “We believe that the awareness of our innovative oxygen concentrators continues to expand among oxygen therapy patients and homecare providers, and that is a primary driver fueling our growth across all of our sales channels."The company reported total revenues of $54.4 million for the third quarter of 2016.

Philips wants you to #BreatheBoldly

AMSTERDAM – In honor of World COPD Day on Nov. 16, Royal Philips has launched Breathe Boldly, a campaign that encourages people to post a photo or video of themselves on social media that shows them performing an activity while breathing through a straw. People are asked to use the hashtags #BreatheBoldly and #COPD. The campaign is meant to raise awareness of COPD and show support for those living with the disease, which causes more than 3 million deaths each year. “We’re hopeful that Breathe Boldly will not only increase global awareness of the disease, but also help people better identify symptoms of COPD, and gain a better understanding of what it is like to live with this disease that impacts so many people worldwide,” said John Frank, general manager for Philips Sleep & Respiratory Care.

Cryogenic to invest $1 million in Hoosier state

INDIANAPOLIS – Cryogenic Solutions announced this morning that it plans to double its footprint here, according to local news reports. The company says it will invest $1 million to increase its headquarters from 15,000 to 30,000 square feet and create up to 31 new jobs. The company, which repairs home medical equipment, in September acquired Inventory Solutions, a national supplier of refurbished respiratory products based in New York.

Inspire Medical raises $37M for sleep apnea device

MAPLE GROVE, Minn. – Inspire Medical Systems has accumulated $37.5 million in venture funding as it prepares to increase sales of its pacemaker-sized, implantable device used to treat sleep apnea. New York-based investor Amazak Health led the round of funding, CEO Tim Herbert told the Minneapolis/St. Paul Business Journal. Previous investors, including OrbiMed Advisors and Medtronic, also participated in the round. The company received $12.5 million a few weeks ago and will get the rest next year. In 2014, the Food and Drug Administration approved the device, which uses electrical pulses to prevent the tongue from collapsing and blocking a patient’s airway, for sale in the U.S. Inspire generated about $8 million in revenues last year and expects sales of $16 million in 2016. It has 80 employees.

Driver group seeks to halt sleep screening rule

WASHINGTON – The Owner-Operator Independent Drivers Association has filed a challenge against a 2015 U.S. Department of Transportation rule that altered the driver medical examination process to include sleep apnea screening, according to Overdrive Magazine. In a challenge filed Nov. 11 with the 8th Circuit Court of Appeals, OOIDA claims the DOT sidestepped the regulatory process for requiring sleep apnea screening by slipping a provision into the final rule but not the proposed rule, the magazine reported. OOIDA seeks to vacate the rule either in part or in whole, according to Overdrive. The rule was made final by the Federal Motor Carrier Safety Administration in April 2015, the magazine reported.

Hoboken train crash caused by driver’s undiagnosed sleep apnea

HOBOKEN, N.J. – The engineer of the NJ Transit train that killed one woman and injured more than 100 others when it slammed into Hoboken Station has severe sleep apnea, according to his lawyer. A spokesperson for the New Jersey Transit said he could not confirm whether or not Thomas Gallagher had sleep apnea, but that the agency had a sleep apnea screening program, according to news reports. Gallagher’s lawyer, Jack Arseneault, said, New Jersey Transit gave Gallagher a physical exam in July and declared him fit for duty, but that he was an “extremely heavy man” with a large neck circumference. “I believe common sense indicates that a person like that could be subject to suffering from adult sleep apnea,” Arseneault told the New York Times. The Federal Railroad Administration said it would soon issue a safety advisory to push railroads to tackle worker fatigue and to install cameras in locomotives.

Convaid seeks ambassadors

TORRANCE, Calif. – Convaid seeks applications to join its 2017 class of ambassadors. Ambassadors are volunteers who share insights and experiences with the greater Convaid community online, at school functions, at dealer events, in support groups, and at Abilities Expos or other special needs gatherings. “Our engagement as Convaid ambassadors has been a great opportunity for us,” said Ashley Cervara, whose daughter Sammy uses a Convaid Cruiser. “We met so many helpful people along the way and it has given us so many opportunities to help inform other families living within the autism spectrum.” The deadline to apply to be an ambassador is Dec. 31. Ambassadors serve a one-year term, then elect whether or not to continue as an ambassador emeritus.

Better management of diabetes leads to fewer re-admissions, study says

WALTHAM, Mass. – Two new studies validate the ability of Glytec’s eGlycemic Management System to reduce readmissions for patient populations at the center of new at-risk and value-based reimbursement models, the company says. Both studies, presented earlier this month at the Diabetes Technology Meeting, compare outcomes of cardiovascular patients receiving care with eGMS to outcomes of those receiving standard care. The data shows cardiovascular patients receiving care with eGMS return to the hospital far less frequently, with reductions in risk-adjusted 30-day readmissions as high as 68%. The basis for the studies was a system-wide glycemic initiative launched by Mountain States Health Alliance, which operates 13 hospitals. Like most health systems, the alliance has been challenged to initiate timely therapy for patients with undocumented, undiagnosed or stress-induced diabetes. One of the key benefits of eGMS is a GlucoSurveillance module that alerts care teams to patients with blood glucose outside a designated range. Glytec specializes in integrated inpatient and outpatient technologies for diabetes care.

Sleep apnea impairs blood pressure regulation

KELOWNA, British Columbia – Sleep apnea has an immediate negative impact on blood pressure, according to a new study. Just six hours of fluctuating oxygen levels associated with sleep apnea impairs the body’s ability to regulate blood pressure, say researchers at the University of British Columbia’s Okanagan campus. The study, in which healthy young adults wore ventilating masks for six hours and had their oxygen levels alternated to mimic apnea symptoms, also found damaging blood flow patterns in the legs, which could ultimately impact vascular health.

POC market poised to grow

VALLEY COTTAGE, N.Y. – The global portable oxygen concentrators market is projected to grow at a CAGR of 7.8% in terms of revenue over the forecast period 2016-26, according to Future Market Insights. “Rising prevalence of COPD, growing consumer awareness of oxygen therapy devices and changing consumer lifestyle are reasons (that) have escalated demand for portable oxygen concentrators in the near future,” the consulting firm says. Future Market Insights also credits adoption of new technologies and rising investment by companies manufacturing homecare products as reasons for the revved up growth. Among the various products in the POC market, pulse-flow POCs will grow at a CAGR of 9% and is the more preferred product. Some of the top companies operating in the POC market are Koninklijke Philips N.V., Inogen, Chart Industries, Resmed, Invacare, Drive DeVilbiss Healthcare, Precision Medical, Besco Medical Co., Oxus America, Foshan Keyhub Electronic Industries Co., O2 Concepts and GCE Group.

Short Takes: Wearever Incontinence, Kaiser Wells, Special Needs Group

Wearever Incontinence welcomed Marchese Medical Supplies to their office to help better understand how Prime Life Fibers markets the Wearever product line in the United States. Marchese, a Canadian distributor, recently added Wearever to its product offerings ... Kaiser Wells Pharmacy & Home Care is now Kaiser Community Pharmacy & Home Medical Equipment, a part of the Fisher-Titus Health system. Operating under the new name of Kaiser Community Pharmacy, pharmacists and other staff members will remain on staff. The business will continue to offer home medical equipment, home respiratory therapy and rehabilitation services, as well as a full-service pharmacy…Special Needs Group, an equipment rental provider, celebrated the fifth anniversary of its Certified Accessible Travel Advocate Program on Nov. 11. The program allows travel professionals to become knowledgeable about the accessible travel market segment through online study and testing. To date, 3,131 travel professionals are SNG Certified Accessible Travel Advocates.

 

CQRC urges passages of bid-delay

HME News - Fri, 11/18/2016 - 13:52
11/18/2016HME News Staff

WASHINGTON – The Council for Quality Respiratory Care this week urged lawmakers to pass legislation that would delay steep cuts to reimbursement for home oxygen.

The Patient Access to Durable Medical Equipment Act would reinstate the phase-in period of cuts to soften the blow on suppliers.

“It’s time for leaders in the House and Senate to work together to enact the critical provisions of the bill,” said Dan Starck, CQRC chairman, in a release. “It remains clear that more time is needed to adequately measure and monitor the impact of earlier cuts that took effect on Jan. 1 before Medicare implements deeper cuts on home respiratory care.”

In July, the Senate began 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, but that effort failed.

Lawmakers, patient groups, physicians and health systems have voiced growing concerns with the impact of the program on beneficiary access.

 

Vertess closes multiple deals in Q3

HME News - Wed, 11/16/2016 - 13:25
11/16/2016HME News Staff

TUCSON, Ariz. – Vertess, a healthcare M&A advisory firm, closed two major healthcare transactions in the third quarter, it announced yesterday.

Vertess represented Metro-Med, Inc., a Burbank, Calif.-based specialty provider of respiratory equipment and related services, in an acquisition by Good Night Medical, LLC, a Cleveland-based DME company with additional operations in Arkansas, Texas and Massachusetts.

Vertess also represented Integrity Medical, a Savannah, Ga.-based provider of complex rehabilitation technology, in an acquisition by National Seating & Mobility, a national provider based in Franklin, Tenn.

"Both of these acquisitions were very beneficial to our clients, as well as the buyers, who were able to strategically expand in core areas they had identified," said Bradley Smith, Vertess managing director/partner.

Also in the third quarter, Vertess represented Alpine Investors in its acquisition of Acumen, a provider of fiscal agent services based in Mesa, Ariz.

Vertess has expertise in diverse healthcare and human service verticals, ranging from behavioral healthcare, substance abuse treatment and cognitive disabilities, to DME, home care/hospice, urgent care centers and other specialized services and products.

Lincare hit with another overtime-related lawsuit

HME News - Tue, 11/15/2016 - 12:08
11/15/2016HME News Staff

PHILADELPHIA – Jeffrey Sawyer has filed a class action lawsuit against Health Care Solutions at Home and Lincare, alleging the companies failed to properly compensate him for all the hours he worked, according to PennRecord.

Sawyer, who filed a complaint on Oct. 31 in the U.S. District Court for the Eastern District of Pennsylvania, alleges that he worked for more than 40 hours per week without being paid overtime compensation, and that the companies failed to properly figure base pay and maintain correct records, according to PennRecord, which cover’s Pennsylvania’s legal system.

Sawyer requests a trial by jury, and seeks damages, liquidated damages, court costs, interest and any further relief the court grants, PennRecord says.

This isn’t the first time Lincare has been hit with such a lawsuit: The U.S. District Court for the Eastern District of California ruled in August that non-exempt employees who work in California for Alpha Respiratory and Lincare could proceed with their lawsuit as a class action. Honorable Judge Morrison England ruled that non-exempt employees who worked for the companies in California since Oct. 21, 2010, can seek back overtime wages and premiums for missed meal breaks.

The lawsuit in California alleges Alpha Respiratory and Lincare failed to pay their hourly employees in California overtime wages, failed to provide the legally mandated meal and rest breaks, and failed to provide accurate wage statements required by state law.

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