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CMS announces DMEPOS competitive bidding timeline

HME News - Fri, 12/12/2014 - 10:52
12/12/2014HME News Staff

BALTIMORE – Registration for the Round 2 recompete opens Dec. 18, and the bid window opens Jan. 22, 2015, CMS announced yesterday.

“Today marks another step forward in ensuring access to quality health care for millions of Medicare beneficiaries, stated CMS Acting AdministratorMarilyn Tavenner.

The seven product categories included in the Round 2 recompete are: enteral nutrients and equipment; general home equipment; nebulizers; negative pressure wound therapy pumps; respiratory equipment; standard mobility equipment; and transcutaneous electrical nerve stimulation devices.

The Round 1 recompete has saved Medicare $580 million over three years, according to CMS. Round 1 and the national mail-order program for diabetes supplies have saved Medicare $2 billion during the first year.

Round 2 recompete timeline:

  • 12/18/2014

            Registration for user IDs and passwords opens

  • 1/6/2015

            Authorized officials are strongly encouraged to register no later than this date

  • 1/20/2015

             Backup authorized officials are strongly encouraged to register no later than this date

  • 1/22/2015

            CMS opens bid window for Round 2 recompete and the national mail-order recompete

  • 2/17/201

            Registration closes

  • 2/23/2015

            Covered document review date for bidders to submit financial documents

  • 3/25/2015

            Bid window closes

  • Winter 2016

            CMS announces single payment amounts, begins contracting process

  • Spring 2016

            CMS announces contract suppliers, begins contract supplier education campaign

  • Spring 2016

            CMS begins supplier, referral agent, and beneficiary education campaign

To enroll, suppliers must provide the following on their CMS -855S application:

  • Contact information (name, social security number, and date of birth) for authorized official(s) and correspondence address.
  • Products and services furnished by the enrolled location(s).
  • Each state in which the enrolled location(s) provides items and services.
  • Complete listing of authorized officials.

For CMS’s fact sheet: http://www.cms.gov/Newsroom/MediaReleaseDatabase/Fact-sheets/2014-Fact-s...

AHP rumored to explore sale

HME News - Thu, 12/11/2014 - 15:01
12/11/2014HME News Staff

BRENTWOOD, Tenn. – American HomePatient (AHP) is reportedly considering a sale.

The Deal has reported that the provider has retained Jefferies & Co., to explore a sale.

AHP was acquired by Highland Capital Management in 2010 in an effort to avoid bankruptcy. At the time, it had $226 million in debt.

Like many companies in the HME industry, AHP has struggled with reduced reimbursement rates.

Founded in 1983, the provider offers respiratory services, HME and home infusion services through 250 locations to more than 1 million patients nationwide.

In January 2014, Mark Lamp took over as president and CEO, replacing longtime head Joseph Furlong, who retired.

Stakeholders run with new Senate bill

HME News - Fri, 12/05/2014 - 14:43
12/05/2014Theresa Flaherty

WASHINGTON – Drop everything, pick up the phone and ask your senator to sign onto a new Senate companion bill that seeks to improve the competitive bidding program.

That’s the message AAHomecare has for the HME industry.

“There’s no tomorrow,” said Tom Ryan, president and CEO of AAHomecare. “We have a very, very short window. We need to get senators lined up on the bill.”

The Competitive Bidding Improvement Act, S. 2975, introduced Dec. 4 by Sens. Rob Portman, R-Ohio, and Ben Cardin, D-Md., is similar to H.R. 4920. It has three key components: Providers need to prove they are licensed before they submit bids; bidders would be required to obtain bid bonds; and bonds will be forfeited if the bidder declines the contract and was at or below the bid price. 

“The bid bond gets rid of the ability of speculative bidders to just throw in bids across the country when they may have no intention of fulfilling those contracts,” said Cara Bachenheimer, senior vice president of government relations at Invacare.

With just a few weeks left of the current legislative session—and the Round 2 recompete looming—there is no time to waste. There are three options for the bill: getting it passed as a standalone bill; getting it passed as part of a larger piece of legislation; or getting it placed on the suspension calendar.

“We’re pulling out all the stops,” said Jay Witter, senior vice president of government relations for AAHomecare. 

Although the industry has seen several House bills over the years, this is the first time legislation has been introduced in the Senate. Both Portman and Cardin, members of the powerful Senate Finance Committee, represent states that have seen firsthand the problems associated with the bidding program. For example, *Maryland saw more than 100 contract suppliers in Round 2 without proper licensure.

“Once they saw the problems, there was a dramatic shift (in attitude toward the program),” said Witter.

 

 

 

http://www.hmenews.com/article/number-unlicensed-contract-suppliers-tops...

Health system snaps up Klingensmith

HME News - Fri, 12/05/2014 - 14:41
12/05/2014Theresa Flaherty

PITTSBURGH, Pa. – With its acquisition of Klingensmith Healthcare, Allegheny Health Network (AHN) has a “key piece” in its mission to expand health care beyond hospital walls.

“We aim to provide services to all of our patients and this was one of the key missing pieces to be able to really wrap total-home based services around patients,” said Brian Holzer, senior vice president of diversified services for AHN. “We get the highest level of clinical quality and infrastructure that Klingensmith has built and merge it with our complex patient profile.”

Per the deal, AHN acquired a majority ownership of the Ford City, Pa.-based Klingensmith and Johns Hopkins Home Care Group has acquired a minority stake. Klingensmith is one of the largest independent providers in western Pennsylvania, offering HME, respiratory and rehab services to more than 9,000 patients annually throughout the region, which includes parts of West Virginia and Ohio.

Of particular attraction for AHN: Klingensmith has been ahead of the curve in developing programs to reduce hospital readmissions for respiratory diseases like COPD and CHF. Unfortunately, that level of service and infrastructure can be hard to sustain, said Holzer.

“They are really doing the compliance program the right way but you don’t necessarily get paid for it,” he said. “To be unaffiliated with a healthcare system puts you in a difficult spot where you don’t have the sustainable volume to support your investment.”

The deal is part of a larger plan on the part of AHN to build a continuum of home-based health services, said Holzer. In November, AHN announced a joint venture with Celtic Healthcare, a large provider of home health and hospices services in the region. 

Down the road, AHN may use Klingensmith as a platform to add new services, or may form additional strategic partnerships with other companies, he said.

To the extent that hospitals can reduce readmissions and manage patients better, getting into home-based health care can be of great financial benefit, and it’s a trend analysts say they are seeing.

“Some hospitals have been getting away from the ancillary services business,” said Jonathan Sadock, managing partner/CEO of Paragon Ventures. “Others are absolutely looking to bring health care in its totality under their wings. What you are seeing is not just a vertical integration of providers but also horizontal across sectors.”

 

CPAP bundling: ‘Fix’ for non-existent problem

HME News - Fri, 12/05/2014 - 14:40
12/05/2014Theresa Flaherty

WASHINGTON – Providers don’t know what to make of CMS’s plan to implement bundled payments for CPAP, but say they doubt it’s a good thing.

“There’s nothing to go by yet, but the sheer concept is counterintuitive as far as patient care,” said Chris Rice, CEO of Riverside, Calif.-based Diamond Respiratory Care. “We want to keep them compliant and keep good supplies on them, but now we are flipping the coin and creating an incentive to provide fewer supplies.”

CMS has yet to release any further information about bundling, including identifying the 12 demo areas and what codes will be included.

One big question: how to account for supplies. Current Medicare guidelines allow supplies like cushions, headgear, tubing and filters to be replaced every three months. 

But every patient is different, say providers.

“You never have any idea of the frequency of supplies for specific people,” said Erik Parkhill, vice president of clinical operations/corporate compliance for Home Medical Professionals in Gainesville, Ga. “One may have so many a year and another may have three times as much. You’d have to do a lot of research back through the years and figure out your usage so that part is complicated.”

Bundling could also complicate basic business practice, say providers.

“It gives us less ability to see margins and it will make it impossible to figure out what’s making us money and what’s not,” said John Eberhart, president of Farmington, N.M.-based Eberhart Home Health. “It’s just another way to cut into reimbursement.”

Stakeholders believe CPAP was targeted for bundling because of its high utilization rates, but CMS already has safeguards in place to ensure providers aren’t billing for excess supplies, say providers.

“We already have to call patients and ask them about the functionality of each item and if they don’t need something we are finding that they don’t order it,” said Eric Cohen, president of Concord, N.H.-based National Sleep Therapy. “It seems like a fix for a problem that doesn’t really exist.”

 

Home Health Depot offloads complex rehab

HME News - Fri, 12/05/2014 - 14:37
12/05/2014Tracy Orzel

INDIANAPOLIS – Home Health Depot (HHD) took the phrase, “Jack of all trades, master of none” to heart when it sold its complex rehab technology division to National Seating & Mobility. 

“Our company was being spread too thin,” said Nathan Feltman, president and co-owner of HHD.

Over the past few years, HHD had been actively looking to expand its complex rehab technology footprint, acquiring both Medical Mobility in Indiana and Advanced Rehab Technologies in Iowa in 2012, and opening a branch in Austin, Texas, in 2013. 

But, with six different divisions to manage, including hospice and respiratory, Feltman says it was time to become a little more focused and a little less diversified.

NSM, which has acquired several companies since 2013, was a good fit, he said.

“When we began to speak with NSM, we realized that, No. 1, they’re really good at what they do and No. 2, it would be a good home for our employees,” said Feltman.

The acquisition shouldn’t come as a surprise to anyone, said Bob Leonard, an analyst with The Braff Group in Pittsburgh. It’s difficult for smaller complex rehab companies to stay on top of reimbursement and attract skilled practitioners

“Complex rehab is a very specialized business and only a couple of large players are staying the course,” Leonard said. “Everybody’s a seller at some point.”

Moving forward, HHD plans on channeling its energy into respiratory services, including ventilators and oxygen concentrators, hospice equipment services, and developing partnerships with hospitals. HHD currently has several preferred provider arrangements with hospitals in Georgia and Indiana.

“We think that’s where the business is going,” said Feltman.

The terms of the deal were not disclosed.

In brief: New enrollment provisions, new partnership

HME News - Fri, 12/05/2014 - 14:36
12/05/2014HME News Staff

BALTIMORE – CMS has tightened its enrollment guidelines in a final rule issued Dec. 3. New provider enrollment provisions include: adding the ability to deny the enrollment of providers, suppliers, and owners affiliated with an entity that has unpaid Medicare debt; adding the ability to deny the enrollment or revoke the billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses; and permitting CMS to revoke billing privileges of providers and suppliers that have a pattern or practice of billing for services that do not meet Medicare requirements. In August, CMS announced that it would begin implementing fingerprint-based background checks for certain providers in the high-risk category.

Pharmaceutical firm partners with AAHomecare

WASHINGTON – Sunovion Pharmaceuticals is now a Silver Level Corporate Partner with AAHomecare, the association announced today. Sunovion specializes in treatments for central nervous system and respiratory disorders. “Sunovion brings a depth of experience in patient care, and we value the support that leading companies bring to the homecare community,” said Robert Steedley, chairman of the AAHomecare Board of Directors. AAHomecare has 11 corporate partners, including Invacare, Brightree, Drive Medical and Apria.

Respiratory provider settles allegations

WASHINGTON – North Atlantic Medical Services, DBA Regional Home Care, has agreed to pay $852,378 to settle allegations that it violated the False Claims Act, according to a release from the Department of Justice (DOJ). The company was accused of billing Medicare and Medicaid for respiratory services provided by unlicensed personnel from September 2010 to January 2013. Regional Home Care is based in Massachusetts, which requires respiratory therapists to be licensed.  “To safeguard patient health and ensure that taxpayer money is spent well, Medicare and Medicaid require providers of respiratory care services to follow state licensure rules,” said Special Agent in Charge Phillip M. Coyne for the U.S. Department of Health and Human Services Office of Inspector General.  “Companies seeking to boost profits by using unlicensed personnel will be held accountable for their actions.”

CPAP website gets facelift

ASHVILLE, N.C. – CheapCPAPSupplies.com is showing off its new and improved website. “The new site will further advocate the mission of CheapCPAPSupplies.com and Aeroflow Sleep Apnea,” said Josh Hill, director of business development. The new interface features an intuitive shopping layout, easier site navigation, a centralized blog, advanced shopping cart, and optimized search functions. In 2012, the site was updated with new images, content and inventory.

Jurisdiction B reviews for power wheelchairs and catheters

INDIANAPOLIS –A claim review of power wheelchair-related options and accessories (K0820-K0829) from July 1, 2014, to Sept. 30, 2014, showed a denial rate of 81%. In the previous quarter, the rate was 84%. The most common reasons for denial:The face-to-face examination did not support why a manual wheelchair or a power operated vehicle wouldn't meet the beneficiary's mobility needs in the home; face-to-face examination did not support the beneficiary's mobility limitation…Also under claim review arecatheters (A4353) for same time period, and which showed a denial rate of 93%. In the previous quarter, the rate was 91%. The most common reasons for denial: The beneficiary did not meet one out of five criteria per local coverage determinations (LCD) for coverage of intermittent catheter kits (A4353); the supplier did not document a valid refill request from the beneficiary.

Exhibitors lining up for Medtrade Spring

LAS VEGAS – More than 150 manufacturers and providers have registered for the three-day conference, which is slated for March 30–April 1 at the Mandalay Bay Convention Center in Las Vegas. Registration opened last week. Among the 150 exhibitors already signed up is Ontario-based Broda. “From a regional perspective, we are quite interested in meeting with customers all across North America,” said Sue Wilson, vice president of customer care, in a press release. This year’s format has been redesigned to reduce overlap between conference sessions and expo floor time, by moving a majority of educational sessions to Monday, allowing attendees to browse the expo floor most of Tuesday and Wednesday.

ResMed unveils AirCurve 10

SAN DIEGO – ResMed debuted its new AirCurve 10 series, which includes three bilevel devices and an adaptive servo-ventilation device for patients with central sleep apnea or Cheyne-Stokes respiration. "We've developed the AirCurve 10 series for patients who need truly personalized support," said Greg Peake, president of ResMed’s sleep-disordered breathing global business unit. The AirCurve 10 includes built-in wireless connectivity and works with ResMed’s patient monitoring software, ResMed’s Airview.

NHIA opens registration for annual event

ALEXANDRIA, Va. – Early bird registration has opened for the 2015 National Home Infusion Association’s (NHIA) Annual Conference & Exposition. The event takes place March 23–26 in Phoenix. It will feature a full slate of educational programs, including an executive pre-conference, roundtables, networking and an exhibit hall. For more information, call 703-838-2663 or email gabriela.miranda@nhia.org.

Inogen to hold investor meeting

GOLETA, Calif. – Inogen will host an investor and analyst meeting and live webcast Dec. 15, from 11:30 a.m. to 3 p.m. EST. The meeting will include presentations from company executives and industry expert Thomas Williams, founder and managing director of Strategic Dynamic, according to a release. The webcast begins at noon and can be accessed at www.inogen.com/investor.

Senate companion bill introduced

HME News - Thu, 12/04/2014 - 13:10
12/04/2014HME News Staff

WASHINGTON – Senators Rob Portman, R-Ohio, and Ben Cardin, D-Md., today introduced a bill that seeks to improve Medicare’s competitive bidding program.

The Competitive Bidding Improvement Act, a companion bill to H.R. 4920, has three key components: Providers need to prove they are licensed before they submit bids; bidders would be required to obtain bid bonds; and bonds will be forfeited if the bidder declines the contract and was at or below the bid price.

“Because of loopholes in the Medicare bidding process, speculative bidders were allowed to game the system,” said Tom Ryan, president and CEO of AAHomecare, in a release. “This bill will help restore accountability, alleviate artificially low prices and deter unlicensed providers.”

The bidding program has been plagued with issues such as unlicensed providers winning contracts, contracts being awarded to companies located hundreds, and in some cases, thousands of miles from the bid area, and bidders submitting low-ball bids and then not accepting contracts.

“Providing strong financial incentives for bidders to honor their bids, and having an outside third party financially vet bidders will significantly strengthen the Medicare bidding program,” said Cara Bachenheimer, senior vice president of government relations at Invacare.

H.R. 4920, introduced June 19 by Reps. Pat Tiberi, R-Ohio, and John Larson, D-Conn., currently has 64 co-sponsors, including Rep. Mark, Amodei, R-Nev., who signed on Dec. 2.

Medicare outlines new enrollment provisions

HME News - Wed, 12/03/2014 - 15:55
12/03/2014HME News Staff

BALTIMORE – CMS has tightened its enrollment guidelines in a final rule issued today.

In February 2011, CMS revised its enrollment policy to increase the integrity of the Medicare program, as required by the Affordable Care Act.

New provider enrollment provisions include:

• Adding the ability to deny the enrollment of providers, suppliers, and owners affiliated with an entity that has unpaid Medicare debt. This will help prevent individuals and entities from being able to incur substantial debt to Medicare, leave the Medicare program and then re-enroll as a new business to avoid repayment of the outstanding Medicare debt.

• Adding the ability to deny the enrollment or revoke the billing privileges of a provider or supplier if a managing employee has been convicted of certain felony offenses. 

• Permitting CMS to revoke billing privileges of providers and suppliers that have a pattern or practice of billing for services that do not meet Medicare requirements.

In August, CMS announced that it would begin implementing fingerprint-based background checks for certain providers in the high-risk category.

Healthcare network buys Klingensmith

HME News - Tue, 12/02/2014 - 13:41
12/02/2014HME News Staff

PITTSBURGH, Pa. – Klingensmith Healthcare has been acquired by Allegheny Health Network (AHN).

AHN announced today that it has taken a majority ownership in Klingensmith while partner, the Johns Hopkins Home Care Group, has acquired a minority share, according to a release. 

The Ford City, Pa.-based Klingensmith is a large independent provider of HME and respiratory services, with 195 employees serving more than 9,000 patients in Western Pennsylvania and parts of West Virginia and Ohio.

Klingensmith has been ahead of the curve in the push to reduce hospital readmissions. In 2009, it launched a disease state management pilot program for COPD.

“Klingensmith has invested heavily in developing outstanding clinical platforms and advanced technological capabilities over the past several years," said Brian Holzer, MD, senior vice president of diversified services for AHN. "By merging these critical, existing capabilities with the considerable home and community-based care needs of AHN's growing patient population, we have the opportunity to establish a model program for out-of-hospital chronic disease management that greatly improves the patient experience and promotes clinical interventions at more effective and appropriate sites of care.”

The deal is part of a strategy for AHN to provide a continuum of care outside of the hospital. In November, AHN announced a joint venture with Celtic Healthcare, a provider of home health and hospice services.

Terms of the deal were not disclosed.

 

Industry presses for details on bundling

HME News - Wed, 11/26/2014 - 12:31
11/26/2014Theresa Flaherty

WASHINGTON – Industry stakeholders are seeking answers to a laundry list of questions regarding CMS’s “incredibly vague” plan to bundle payments for standard power wheelchairs and CPAP.

“We’ve posed several questions already and will submit about a dozen more,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “CMS has indicated they are compiling the questions and will respond to the industry. CMS knows the bundling thing is incredibly vague.”

Among the unanswered questions: how will CMS calculate the bid ceiling, what codes are included in the bundles, how will CMS deal with documentation issues, and what is the timeframe for implementing bundled payments.

“My bet is on 2017,” said Brummett. “We’ve got the Round 2 recompete, the expansion into non-bid areas. To pile bundling on top of that—there’s no way they’ll be able to get it all done.”

Also unknown: the 12 CBAs included in the demonstration and whether the CBAs will be the same for both product categories.

Although the industry is used to CMS seeking to rein in costs by lowering payments, lumping multiple codes—there are a couple of hundred codes for accessories for standard power wheelchairs—into a single payment is a concern. Wheelchairs and CPAP were likely targeted because CMS considers them overutilized, not because they make the most sense to bundle.

“They think those are overused and overpaid and think doing this will drive down the costs,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Boiling down the bid system to bidding and billing for far fewer codes then they use today is scary.”

Bundling 'problematic' for power wheelchairs

HME News - Wed, 11/26/2014 - 12:29
11/26/2014Tracy Orzel

WASHINGTON – HME stakeholders are deeply concerned about CMS’s plan to bundle payments for power wheelchairs and the impact that will have on patients and providers’ bottom lines. 

In a final rule issued Oct. 31, CMS stated that it would implement a demo project in 12 competitive bid areas, in which providers would submit a single bid for furnishing standard power wheelchairs, related accessories and services needed on a monthly basis. 

Bundling is not an unreasonable concept, but CMS’ application of it could be, says Don Clayback.

“Bundling could probably work in certain situations, but when you look at products that have a wide variety of configurations and a wide variety of situations that you’re trying to meet, such as with power wheelchairs, I think it just becomes extremely problematic,” said Clayback, executive director of NCART.

Due to the “variety of configurations,” stakeholders are wondering exactly what HCPCS codes CMS plans to include in the bundling. 

“It’s like going to the hospital and saying, ‘You have all these different surgeries and it’s really hard to sort them out, so we’re just going to create one code for all these surgical procedures and then we’re going to ask you to give us one price,’” said Clayback.

The inclusion of repairs in bundling adds another layer of complexity. It’s almost impossible for providers to estimate the average cost for potential repairs because patients and their needs change over time, says Peter Rankin, manager of government affairs for AAHomecare. One year you could have a beneficiary who is still getting used to their chair and staying home and the next year, they’re all over town. 

“You have a significant cost difference if that patient changes drastically,” said Rankin.

In addition to bundling, the final rule includes an expansion of competitive bid pricing to non-bid areas in 2016. The new pricing will be phased-in over the course of six months. In rural areas, the payment amount will be based on 110% of the average of regional prices.

“I think it’s going to create unfairness in the pricing because you’re using pricing for a populated area and you’re applying that to pricing for an unpopulated area and they’re not the same animal,” said Clayback. 

Jackie Semrad is the owner of Reliable Medical in Brooklyn Park, Minn. and chair of the AAHomecare Complex Rehab and Mobility Council. As a provider, she’s worried about how the application of bid rates in rural areas will affect beneficiaries. 

“They already have a difficult time getting serviced,” said Semrad. “If you have to drive 80 miles one way, if you’re losing money just by driving out there, you’re not going to be driving out as often.” 

 

Social media 'ultimate grassroots tool'

HME News - Wed, 11/26/2014 - 12:25
11/26/2014Tracy Orzel

WASHINGTON – NCART recently asked CRT stakeholders to tweet to key Congressional offices in an effort to pass its two bills. 

“I think it’s going well,” said Executive Director Don Clayback. “Our objective really is to make sure that were reaching out to the offices of Congress and whatever avenues they monitor.”

To maximize exposure, NCART has created a list of Congressional twitter handles and hashtags to use in tweets. Its key message: “Help people with disabilities get needed specialized equipment. Pass #HR942 & #S948 this year!”

“We’ve used Twitter before in limited situations, to let people know what’s going on relative to NCART, and also to highlight some other industry issues, but we’re looking at using it more frequently to get people engaged in outreach activities,” said Clayback.

It’s just one example of how HME stakeholders are ramping up their use of social media as a way to engage users and enact change.

Social media is the ultimate grassroots campaign tool, said Lisa Wells, president of Get Social Consulting, who manages Save My Medical Supplies (SMMS), an AAHomecare consumer education website.

“Today, more than ever, people are more easily educated and able to tell their friends and family about issues and political matters that impact them on a personal level,” said Wells. 

Although providers and manufacturers may secretly hope for instant results, building relationships with patients through social media can take time, says Lalaina Rabary, a communications and marketing specialist for People for Quality Care (PFQC), the advocacy division of The VGM Group. In a perfect world individuals would take it upon themselves to mobilize and take action.  

“Obviously our goal is to fire everybody up about what’s happening (with Medicare) and we do want them to say, ‘Hey what can we do?’ but that often times takes a lot of conversation to get to that point,” said Rabary. 

Even so, Clayback says it would behoove providers and manufacturers to follow NCART’s lead.

“Social media plays an important role in people’s daily lives, to both inform them, and sometimes spur them to action,” he said. “It’s important to make it part of the process, in terms of maximizing your success. I think that needs to be a part of your strategy.”

 

VGM poised for growth with new Emerging Markets division

HME News - Wed, 11/26/2014 - 12:23
11/26/2014Jeff Rowe

WATERLOO, Iowa – When change is upon you, the choice is either to resist it or commit to making it work. That’s one way of looking at the choice facing HME providers in the wake of, among other things, recent CMS reimbursement cuts and the resulting shifts in the marketplace.

Mike Mallaro, CFO of The VGM Group, said his organization has chosen to commit to change by launching a new division, VGM Emerging Markets.

“As we’ve grown and kept identifying new opportunities, we’ve tended to be short on the resources and people necessary to move new ideas forward at the rate we wanted to,” he said. “So we decided to create a separate organization within VGM to handle those opportunities.”

VMG Emerging Markets will allow the member services organization to focus more fully on CPAP re-supply services and online education services for HME, nursing and other sectors.

“We search out many opportunities,” he said. “Some we pursue, some we don’t. Now, however, we’ll be able to be much more aggressive.”

As Mallaro sees it, the new, more proactive approach that VGM Emerging Markets will enable is just part and parcel of how HME providers need to view their involvement in the healthcare market moving forward.

“You have to be integrated within the healthcare continuum,” he explained. “Given changes in regulations, market forces and overall trends, you can’t operate in a bubble. There’s a lot of change going on all across healthcare.”

Despite constant changes and challenges for HME providers, Mallaro says he is “incredibly optimistic” about their prospects.

“I see the market growing dramatically, with growing issues such as obesity and aging and the cost of healthcare, and the fact that home-related healthcare is cheaper,” he said.

 

In brief: OIG report, accessory code

HME News - Wed, 11/26/2014 - 12:22
11/26/2014HME News Staff

WASHINGTON – Three types of diabetes test strips account for 58% of the Medicare mail-order market share, according to a study released Nov. 25 by the Office of Inspector General (OIG). The OIG examined 1,210 claims from the three-month period of October 2013 through December 2013. This is the third of three reports released in 2014 that the OIG has released to ensure that winning bidders are meeting the 50% market share requirement required by the Medicare Improvements for Patients and Providers Act. The study found that two types of strips accounted for 44% of the market and 10 types accounted for 91%. The Prodigy Autocode, from Prodigy Diabetes Care, has 26.9% of the market share. That’s an increase over a previous report, released in June, that found the Prodigy Autocode accounted for 23.9% of the market. By contrast, the same product comprised only 2.4% of the market for the three months ended December 2009.

Van Halem adds Medicare talent

ATLANTA – The van Halem Group has expanded, adding six full-time employees, it announced today. Among those joining the group are Lucretia LaFavor, a former operations manager with CGS Administrators, who will serve as a project manager; two former RAC clinical auditors, Karen Greco and Cheryl Wilkerson, as well as Donna Youngblood, a former reconsideration specialist, have also joined the team as clinical consultants. “There is no team in the industry that has more Medicare experience than ours,” says Wayne van Halem, president of The van Halem Group. “That knowledge and expertise is invaluable to our clients as we navigate complex issues related to audits, appeals, and compliance.” The van Halem Group merged with The VGM Group in June.

CPAP Planet debuts new site

FLOWOOD, Miss. – CPAP Planet’s new website, www.cpapplanet.com, features an online store for sleep apnea treatments and CPAP machines, and the company intends to add more in the future. Owner Rob Hines says the site has been well received. “It is the goal of CPAP Planet to become the leading resource for reliable information on issues impacting Sleep apnea sufferers,” he said. The company is asking visitors to give feedback for future improvements and updates.

Inventory Solutions updates price guide

NEW YORK – Inventory Solutions has released its Refurbished Equipment Price Guide for 2015. The guide includes pricing for many respiratory product categories, including vents, apnea monitors, pulse oximeters and concentrators. “Though the market has changed significantly since I started the company 14 years ago, our goal remains the same,” said President and Founder John Wittenberg. “We want to offer cost effective, reliable and affordable refurbished options to increase our customer’s bottom line.” For more information, www.invsol.com.

CMS adds accessory code

BALTIMORE – A new wheelchair accessory code, E2378 (power wheelchair component, actuator, replacement only) has been retroactively added to the group codes that were reclassified as the capped rental payment category, effective April 1, 2014. These codes can be billed as a purchase if used with a complex rehab wheelchair (K0835—K0864). If there is no indication that the E2378 is being used with a complex rehab wheelchair, it will be denied if billed as a purchase.

Invacare announces quarterly dividend

ELYRIA, Ohio – Invacare announced a quarterly dividend last week. A cash dividend of 0.0125 per share will be payable Jan. 14 to shareholders of record on Jan. 5. Invacare’s founder, Mal Mixon, has decided to step down as executive chairman of the Board of Directors, effective Dec. 21. 

VMI teams up with USAA

PHOENIX – VMI and USAA are making it easier for USAA members to get a wheelchair accessible vehicle (WAV) by applying directly to USAA for financing. “For over a quarter century, VMI has led the charge to help disabled American veterans regain their mobility with the wheelchair accessible van they deserve,” said Doug Eaton, president of VMI. “We’re honored to work with USAA.” USAA members with approved credit can fast track delivery of their Toyota, Honda or Chrysler minivan with a VMI ramp conversion or use their loan to purchase a new or used wheelchair accessible van at VMI dealerships.

FreeRider offers new scooters

RANCHO CUCAMONGA, Calif. – FreeRider USA has added three new mobility scooters to its product line: the Luggie Classic, the FR168-4S, and the FR510-F. Powered by lead acid batteries, the Luggie Classic is a lightweight, compact and easy-folding mobility scooter. Designed for safety, FR168-4S holds up to 350 pounds and includes a dual electronic braking system and solid tires, while the FR510-F, carries up to 450 pounds and drives up to 18 miles.

 

OIG report: Prodigy gains further market share

HME News - Wed, 11/26/2014 - 11:34
11/26/2014Theresa Flaherty

WASHINGTON – Three types of diabetes test strips account for 58% of the Medicare mail-order market share, according to a study released Nov. 25 by the Office of Inspector General (OIG).

The OIG examined 1,210 claims from the three-month period of October 2013 through December 2013. This is the third of three reports released in 2014 that the OIG has released to ensure that winning bidders are meeting the 50% market share requirement required by the Medicare Improvements for Patients and Providers Act.

The study found that two types of strips accounted for 44% of the market and 10 types accounted for 91%. The Prodigy Autocode, from Prodigy Diabetes Care, has 26.9% of the market share. That’s an increase over a previous report, released in June, that found the Prodigy Autocode accounted for 23.9% of the market. By contrast, the same product comprised only 2.4% of the market for the three months ended December 2009.

Advanced Directives, Fiduciaries, Guardianship, and Power of Attorney

Long Term Care Link - Sun, 11/23/2014 - 20:00
It is common, as time goes along, for the elderly to become unable to make sound decisions about a variety of issues includes finances, health care and managing themselves at home.

Did You Know There is a New Vaccine Recommendation for Adults Age 65 and Older

Long Term Care Link - Sun, 11/23/2014 - 20:00
Adults 65 years of age or older are at increased risk for pneumococcal disease.

10 Tips to Keep in Mind While Helping Aging Parents

Long Term Care Link - Sun, 11/23/2014 - 20:00
Getting old is financially scary. No matter how much money one may have, thinking about covering the expenses associated with aging or dealing with the unknown can be extremely scary.

Guide to Long Term Care Planning

Long Term Care Link - Sun, 11/23/2014 - 20:00
Aging seniors and their family caregivers often become overwhelmed by the myriad of issues they face as their health declines and they lose their ability to remain independent. Losing independence generally happens gradually, but can come quickly without warning.
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