ATLANTA – Medtrade has announced five winners for this year’s Innovative HME Retail Product Awards.
The winners are Core Products, for its WiTouch Wireless TENS Unit; TheraPeaz for its TheraPeaz Hot/Cold Therapy; Golden Technologies, for its Shiatsu Lift Chair; Motivo, for its Motivo Tour (Walker); and SCA Personal Care for its TENA Skincare System.
Motivo is a first-time exhibitor at Medtrade, which takes place next week, Oct. 20-24, at the Georgia World Congress Center.
“Medtrade gives us a great opportunity to launch our all new Motivo Tour walker by connecting directly with the dealers and allowing them to touch and feel the innovation in person,” says Jeremy Knopow, co-founder.
The awards highlight a growing interest in retail-oriented items.
“Medtrade is the absolute best place to find solutions in this tough new HME world,” said Jim Greatorex, president of Portland, Maine-based Black Bear Medical. “Where else can you find new and alternative product offerings to off-set lost revenue?”
Greatorex will host an education session at the show on Wednesday, Oct. 22 from 9:15 to 10 a.m. Each winner will get five minutes to talk.
The products will be on display in the manufacturers’ individual booths as well as at the Ideas in Retail Display (booth 744).
This retail awards were created in 2013.
ORLANDO – AeroCare has merged with MergeWorthRx and will become a publicly traded company, it was announced today.
Under the terms of the agreement, MergeWorthRx, a special purpose acquisition company, will issue approximately 11.3 million new shares and .5 million options to existing AeroCare stockholders, according to a press release. Those stockholders will own 53% of the company, and will have the right to receive up to $30 million of additional shares of MergeWorthRx common stock.
"This is an exciting time for AeroCare,” stated Steve Griggs, CEO and founder. “The agreement with MergeWorthRx and AeroCare's emergence as a public company will increase our visibility in the market and provide the capital we will need to accelerate our growth and take further market share."
The provider plans to achieve growth through organic growth, strategic acquisitions and opening new locations. In 2013, AeroCare acquired 23 companies.
“We are eager to support the AeroCare management team as they execute on their strategic growth initiatives as a prime consolidator of this large, growing, and highly fragmented market," stated Stephen Cichy, MergeWorthRx’s cofounder, president and COO.
AeroCare was launched in 2002 and has grown at an annual compounded rate of 31%. The provider offers respiratory products and services to more than 150,000 patients through 175 locations in 20 U.S. states. AeroCare generates about $150 million in annual revenues, according to the release.
The deal is expected to close by the end of 2014.
FLORHAM PARK, N.J. – As the paradigm in health care shifts, Managed Health Care Associates (MHA), the parent company of The MED Group, wants to make sure its post-acute care provider members, including those in HME, are armed with the information they need to make the right business decisions.
That’s one reason why MHA teamed up with Leavitt Partners this month to publish an 11-page report, “The Right Care for the Right Cost: Post-Acute Care and the Triple Aim,” that discusses: What does post-acute care entail; why do accountable care organizations (ACOs) need to consider partnerships with post-acute care providers; and how do these partnerships fit into evolving healthcare models?
“We wanted to get everyone talking,” said Michelle Templin, vice president of strategic business development for MHA. “For post-acute providers, we wanted them to look to see where they stand in the spectrum.”
Starting from square one
Initially, there was little knowledge—let alone recognition— among ACOs of the role of post-acute providers, Templin says.
“When we started meeting with hospitals, they had no idea,” she said. “So we had to step back and do some education.”
ACOs are quickly trying to get up to speed, though, Templin says.
“They’re starting to look at readmissions and they’re realizing that these are frail and elderly patients,” she said. “They’re realizing there’s an opportunity for coordinated care and delivery.”
Flexing your muscles
No ACO is created equally, especially at this still early phase, so as post-acute care providers look to see what role they can play in this new paradigm, they need to be flexible, Templin says.
“You could have five ACOs within a marketplace, and the processes and protocols for dealing with each of them is different,” she said. “It’s not cookie cutter. I hear from customers, ‘This ACO wants this, and that ACO wants that.’ There’s no way around it. They need to do an assessment of where their market sits right now and an assessment of what they can do.”
HITting it hard
With health information technology (HIT) one of the primary drivers behind successful ACOs, post-acute care providers will want to make sure they can talk their language, Templin says.
“IT is the biggest barrier,” she said. “Post-acute care is such a fragmented industry—you have people writing things down, you have some pretty fancy systems, and you have everything in between. The data that’s required continues to be a challenge. This is a big focus for us. Can we provide tools to link them in without it being a huge investment?”
CONCORD, N.H. – National Sleep Therapy (NST) seeks to provide CPAP users with an opportunity to interact with fellow sufferers by sponsoring a free monthly virtual support group called, “CPAP Talk – Live!”
“We wanted to create a community where patients could learn and interact with one another and find creative solutions to common problems as well as keep abreast of the latest products, technologies and CPAP tips,” said Eric Cohen, president.
Launched in March for National Sleep Therapy patients, the support group has since seen a rise in participation from non-customers over the past two months, thanks in large part to email marketing, calendar listings, social media and word-of-mouth. The sessions have attracted as many as 60 CPAP users.
Each month, NST invites board-certified sleep physicians, sleep technicians and representatives from various CPAP manufacturers to provide participants with up-to-date information. Participants are also invited to send questions in advance to be discussed during the next session.
Topics range from ways in which patients can become more engaged in therapy to new insurance requirements to how to combat skin irritation, dryness, mask leak and other common CPAP issues.
“The support groups are focused on patient education and an unbiased presentation of new products that are available on the market,” said Cohen.
Amy Michaud, territory manager for Maine and New Hampshire at ResMed, joined an Oct. 1 call to discuss the features and benefits of three new ResMed masks and field questions about existing products.
“It’s important for us to follow up and really help the patients because compliance is really the biggest obstacle when it comes to any type of therapy,” said Michaud.
While CPAP support groups are nothing new, it’s become increasingly more difficult for HME providers to host them, says Cohen.
“We all know how busy everyone is these days, and we wanted an educational and community based platform whereby geography or mobility is not an issue, and anyone with a telephone could become part of this community,” he added.
VIENNA, Va. – After working within the HME sector from many angles—provider, manufacturer, member services organization—Joseph Lewarski has added consultant to his resume. In that role at GRQ, a boutique healthcare consulting firm based in Vienna, Virginia, he will help create sound strategic and business development plans for companies trying to navigate the evolving healthcare landscape. Here’s what Lewarski, most recently vice president of clinical affairs at Invacare, had to say about where he hopes to steer those companies.
HME News: Why have you stuck with this field?
Joseph Lewarski: I’ve always believed, even when I first got into home care in the 90s, that it would become the primary place to provide health care. That’s becoming more and more true with the focus on wellness, clinical outcomes and cost effectiveness. Hospitals and acute care will always exist, but there are many new models of care developing, some we don’t even know about yet. For me, it’s understanding this on a macro level, and applying it on a micro level with different organizations and trying to align them all.
HME: As you’re surveying the evolving landscape, what kinds of questions are you asking of yourself and your clients?
Lewarski: Everyone is looking at ways to be more holistic in the management of patients and health care overall. From a strategic perspective, where is health care going to be provided? What role will different organizations play in the delivery of care?
HME: We’ve written a lot about how HME providers are changing course in the face of this changing landscape, but what about HME manufacturers?
Lewarski: Technology needs are definitely going to change. Insurance companies are creating plans to accommodate cost and they’re shifting more of the out-of-pocket expenses to the user. As consumers have more skin in the game, they become more active in the process. So there’s a greater level of consumerism. If you look at non-medical devices, look at Fitbit (a device that allows users to track daily activity, calories burned, sleep and weight). It’s $100. The whole space is changing.
HME: What does this greater level of consumerism mean for HME manufacturers specifically?
Lewarski: In the next decade, I think they need to be thinking about how products get to patients differently. There are going to be different business models that come out of this. I’m not saying one will go away or will be replaced, but there will be different business models. The current method has too many levels and too much cost, and everyone sees it. Certain therapies are service intensive—they require a human touch—so I don’t think everything will become a remote business model, but there are things that can be done differently.
HME: Traditionally, the HME industry hasn’t been one to change course quickly.
Lewarski: The companies that are coming into health care from the technology space or the industrial space—they don’t have the prior biases about how care is supposed to be delivered and they’re coming up with better mousetraps. You need to be building an idea and a strategy around change. The things that got us here may not be what drives us in the future.
SAN DIEGO – ResMed is launching Better Sleep for Women, a new initiative to educate women about the importance of sleep, it announced recently. A recent ResMed survey of 500 women ages 40-65 found that fewer than 20% believed they need to make improvements in the quality of sleep, according to a press release. It will focus on sleep as the third pillar of health, alongside a healthy diet and regular exercise. The program will provide information, tips and resources about women and sleep through a robust online experience including a dedicated website and social media. "Many women resign themselves to experiencing daily fatigue, blaming it on demanding schedules and busy lifestyles," said Dr. Carmel Harrington, a leading sleep researcher and author of The Complete Guide to a Good Night's Sleep. "It is critical that women recognize that constant fatigue or loss of energy is something that warrants a conversation with their doctor.”
Rep. Ellmers pays visit
DUNN, N.C. – Family Medical Supply hosted Rep. Renee Ellmers, R-N.C., on Oct. 7. About 75 attendees, including providers and representatives from industry manufacturers and associations, discussed the effects of competitive bidding and audits. “The longer we can keep patients in the home and healthy, the better for saving Medicare dollars and the better for the patients overall well-being," said Ellmers. In July, Ellmers introduced H.R. 5083, which seeks to improve the audit process. It currently has 36 co-sponsors.
Another accolade for Breathe
IRVINE, Calif. – Breathe Technologies has been named to the 2014 FierceMedicalDevices Fierce 15. The designation recognizes companies with a potential to make an impact in the medical device field, according to a release. Breathe’s Non-Invasive Open Ventilation System (NIOV) received CE certification in September and has been recognized by the European Respiratory Society with a Product of Outstanding Interest (POINT) Award for 2014. "This accolade is a wonderful culmination to an outstanding six-month period in which we've received additional regulatory clearances in the U.S and in Europe and were also recently recognized by the European Respiratory Society for creating an innovative technology that solves a challenge of modern respiratory healthcare," said Larry Mastrovich, president and CEO.
Respira snags contract
WASHINGTON – Respira has been awarded a $10 million contract from the Department of Defense (DOD) United States Army Medical Command, it was announced Oct. 2. Under the five-year contract, Respira will support the Sleep Disorder Clinic at Walter Reed, providing care including compliance programs, CPAP, respiratory therapy and clinical research in sleep medicine, according to a press release. Respira was founded in 2001 and has grown to a $10 million respiratory, sleep medicine and home medical equipment company serving 60,000 patients.
Aeroflow takes to the airwaves
ASHEVILLE, N.C. – Aeroflow Healthcare has released a new television commercial aimed at potential power wheelchair users, it announced yesterday. The commercial will advise viewers that the provider’s certified mobility specialist can help them qualify for a power wheelchair. The spot will air from October 2014 through March 2015. Aeroflow is a full line provider of DME, mobility and respiratory equipment and services.
Community pharmacy earns honor
BROOKHAVEN, Pa. – Burmans Pharmacy has been voted one of the best pharmacies by readers of the Delaware County Daily Times. “We are honored that our reputation for going above and beyond the needs and expectations of patients was recognized by readers,” said Steve Burman, President & CEO of Burmans Pharmacy. “Patients and physicians have relied on Burmans dedicated and knowledgeable team to assist with every step, from prescribing to final delivery, for almost 50 years.” More than 100,000 Times readers voted for local businesses in more than 180 categories.
Prepay review for hospital beds headed for Jurisdiction D
INDIANPOLIS – National Government Services, the Jurisdiction B DME MAC, has announced a widespread prepay review of hospital beds. It includes the cods: E0294, E0260, E0301 and E0303. Data analysis has identified these codes as having a high comprehensive error rate testing (CERT). If you are selected, you will receive and additional documentation request letter asking for certain documentation.
E-commerce site adds pediatrics
DELRAY BEACH, Fla. – Discountmedicalsupplies.com has launched a pediatric division, it announced Oct. 6. The site will offer brand-name children’s medical supplies, including mobility, nutrition, diapers and orthopedics. Discountmedicalsupplies also announced that it plans to make “substantial” medical supply and financial donations to three South Florida children’s hospitals, up to $30,000 over the course of a year. "DiscountMedicalSupplies.com is now truly a one-stop shop and full-service website for entire families," says CEO John Solomon. The ecommerce site now offers more than 40,000 products.
New look at VGM Homelink
WATERLOO, Iowa – On the heels of its growth, VGM Homelink has rebranded and has a new logo, according to a press release. The managed care division of VGM, Homelink has doubled its size in three year. Homelink enables commercial insurance and workers’ compensation programs to access HME and related services through its nationwide network of more than 11,000 independent providers. “We are ready for a new look to grow with us, but I want to emphasize that we are the same Homelink that focuses on value, relationships and quality outcomes,” said Dave Kazynski, president.
YARMOUTH, Maine – Medicare has said it expects enrollment in Medicare Advantage plans to increase, a trend providers say they are seeing already.
“We are seeing a lot more this year then we have in the past,” said Dan Heckman, president and general manager of Heckman Healthcare in Decatur, Ill. “There was never a lot of penetration in this area by managed care. I think they are marketing it more aggressively.”
A recent release from CMS said that enrollment in MA plans in 2015 is expected to reach an all time high. From 2010, when the Affordable Care Act was implemented, and 2015, enrollment in the plans is projected to increase 42%.
One reason for the increase: Many of the plans offer better drug coverage, say providers.
“We have some particular patients—the more chronic patients—that have aged in to Medicare and they have been used to a Blue Cross-type policy,” said Laura Williard, senior director of regulatory affairs for High Point, S.C.-based Advanced Home Care. “They need something similar to what they are used to.”
Advanced has seen an increase in MA plans of about 2% among its oxygen and CPAP patients, she said.
The plans are often easier for HME providers to deal with, too, they say.
“They do pretty much everything that Medicare does,” said Ron Frantz, medical director for home health at Bell Apothecary in Easton, Pa. “Their rules and polices aren’t the same, but they pay the same as far as the equipment. We are able to do beds, oxygen and nebulizers—all the normal DME that we didn’t win a bid for.”
One big way in which MA plans are different from Medicare is audits.
“Technically, they aren’t immune from audits, but we are not seeing one audit from MA plans,” said Heckman. “I don’t know if they just haven’t thought of it.”
The annual open enrollment period for Medicare began Oct. 15. The mass enrollment period is always a challenge, says Williard. When beneficiaries change plans or switch from traditional Medicare, HME providers are often the last to know.
“We have an insurance change process during this time and we put extra resources to that,” she said. “We find that we know that a change is happening, but we don’t know who the new plan is. That can impact and delay getting authorizations.”
WASHINGTON – There is a short window of opportunity for the HME industry to push its legislation when lawmakers return after the elections—but there is opportunity, say stakeholders.
“(Hill) staff are prepping for a busy month between the elections and Christmas and I expect a frenzy on Capitol Hill,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “I think we will have some great opportunities so we really need to keep working toward that.”
Those opportunities include a possible “doc fix” bill, an omnibus spending bill and a Medicare package that is in the works, she said.
With all 435 seats in the House of Representatives, as well as 36 Senate seats, up for re-election on Nov. 4, it’s the perfect time to get in front of lawmakers on competitive bidding and audits, says Tom Ryan, president and CEO of AAHomecare.
His priority? H.R. 4920, which seeks to reform the competitive bidding. It currently has 49 cosponsors.
CMS has said it plans to open the bidding window for the Round 2 recompete in the winter of 2015.
“There’s a small window to get this bid fix in,” he said. “We had 180 on H.R. 1717. This is one provision of that bill and we should be able to crosswalk all of those people over.”
Building support during the election cycle could create momentum when lawmakers return the second week in November for a lame duck session, said Ryan.
“Very often that’s an opportunity to get that member who has been on the fence—particularly if they are not re-elected—to say, “I’ll give this to you,” he said.
WASHINGTON – Stakeholders are hard at work developing supplier standard recommendations that they want to have on hand once a bill to create a separate benefit for complex rehab is signed into law.
The bill stipulates that the secretary of the Department of Health and Human Services consult with a stakeholder workgroup to look at creating a standard over and above the assistive technology professional (ATP), says Don Clayback, executive director of NCART.
"What we're doing proactively is setting up a group to develop some recommendations that we'll present to CMS once the legislation is passed," he said.
NRRTS board members met in August to start the brainstorming process.
Once the workgroup completes the standards, it will share a draft and solicit comments, says Executive Director Weesie Walker.
"It's still a work in progress, but we are getting much closer," she said. “We're trying to look at it from a standpoint of raising the bar, because that's part of the separate benefit category, and to look at creating a pathway for the new people coming into the field.”
To support its standards, the workgroup plans to conduct research on, for example, why only certain individuals should be qualified to provide complex rehab.
"We have to be mindful that there needs to be consumer protection,” Walker said. “That's really what it's all about—preserving healthcare dollars with people getting appropriate equipment and knowing they're working with someone who is a professional supplier."
The bill combined with standards could be a “defining moment” for the complex rehab industry, Walker says.
"As the industry has rapidly progressed over the past two decades, with all the products that are available and the technology, it's really exciting," she said.
EXPORT, Pa. – When Circadiance wanted to test the idea of creating an all-cloth CPAP mask for infants and children, it didn’t seek out the opinions of a focus group or lean on some deep-pocketed investors.
Instead, it went straight to the crowd.
On Sept. 30, it launched an online fundraising campaign on Indiegogo, surpassing its goal of $50,000 on its first morning. At press time, it had raised more than $80,000.
“We are the No. 1 trending crowdfunding campaign on Indiegogo,” said David Groll, CEO of Circadiance.“We hope that our position within the crowd funding community translates into much broader appeal and attracts a lot of other people to help us reach a much higher funding level.”
A pediatric mask is something Groll says is sorely needed in a market focused almost exclusively on adult patients.
The problem: There aren’t as many pediatric patients who could benefit from the mask, so the economics don’t encourage manufacturers to develop and market a smaller product. Finding capital is a challenge.
That’s where crowdfunding comes in.
“Everybody has a lot of empathy for sick babies,” Groll said. “That was one reason I felt the pediatric application was one that might get support in this way.”
This summer, the company created a short video explaining some of the mask-related problems babies can face, including pressure ulcers. Some providers, desperate to help their tiniest patients, have resorted to retooling adult-sized masks to fit smaller faces.
Circadiance emailed the video to more than 10,000 people, including clinicians and customers who buy and use its products. The company also posted it on Twitter and Facebook, where its SleepWeaver mask has more than 30,000 likes.
Groll said the response was enough to convince Circadiance to push ahead with the next phase of its campaign—collecting actual pledges from supporters.
“For us, the benefits are really tangible,” he said. “People pledged a lot of money. It’s not enough for us to reach our goal, but it’s a strong indication of interest.”
Editor’s note: This is the second in a series of stories about how the HME industry is forging a new identity. Click here to read the previous story.
ANCHORAGE, Alaska – Geneva Woods is navigating some rugged terrain in its quest for success. And that’s not a reference to the pharmacy provider’s service territory, which includes vast swaths of wilderness in Alaska, Montana and Wyoming.
Based in Anchorage, the company combines pharmacy, infusion, mobility and respiratory categories, serving patients in remote, heavily wooded areas. Managing that range of services and geography requires special category expertise, logistics prowess and operational efficiency.
For President Dan Afrasiabi, it all came down to looking at the business in a new way.
“My background is in different businesses, from technology and software to data analytics,” he said. “I questioned every basic assumption that was the basis of this business. There is a great reluctance in this industry to try new things. But if you’re still doing things the way people did in the 80s, you’re not doing it the right way.”
By working with Atlanta-based Brightree to improve its IT capabilities, Geneva Woods has a panoramic cyber-view of operations, from intake to billing. The process is called WIP: work in progress.
“There are too many legacy systems in this business that prevent you from having a company-wide view of a patient’s status,” Afrasiabi said. “Brightree connected all our processes by developing WIP states. We can look at every claim and know which WIP state is in for sales, collections, responses, audits, write-offs and stop holds. That has resulted in significantly improved metrics around revenues across every category.”
GO for it
Workplace professionalism is another priority at Geneva Woods, Afrasiabi said. The company keeps all services in-house, including long-distance deliveries to residents of the backcountry.
“We don’t outsource anything,” he said. “And we have high standards. The word ‘drivers’ is banned from our vocabulary—we have GO techs.”
GO (Geneva One) techs drive trucks equipped for every contingency, including automated ordering devices that store orders internally when wireless networks aren’t available and send them out as soon as a signal is detected.
Make it part of your DNA
By bundling services together under one umbrella and fully utilizing information technology, the Geneva Woods model creates unprecedented operational efficiencies, Afrasiabi says.
“It was difficult and complicated at first, but once we made it part of our
DNA, it created an advantage,” he said.
ALEXANDRIA, La. – Oncologix Tech has acquired Esteemcare and Affordable Medical Equipment Solutions, it announced Oct. 2. The companies, with offices in Columbia and Charleston, S.C., provide respiratory and sleep therapy and hold 45 competitive bidding contracts for CPAP, according to a release. "With $2.5 million in annual revenues and with over 45 additional MSA markets awarded for sales and distribution, the company is uniquely positioned for rapid growth and expansion,” said Wayne Erwin, chairman and CEO of Oncologix. Oncologix is a diversified medical holding company that manufactures Class II medical devices, and provides sales and distribution of home medical products.
Invacare amends credit agreement
ELYRIA, Ohio – Invacare has amended its credit agreement to gain additional flexibility calculating it financial covenants through the duration of the credit agreement. The amendment provides an add back to the company’s EBITDA for warranty accruals up to $10 million and subtracts cash payments when paid in future periods, the company said in a release. “We appreciate the ongoing support of our current lenders,” said Rob Gudbranson, interim president and CEO. “Over the past years, we have proactively managed our business to generate cash, including the divestitures of non-core businesses, and have paid down total debt outstanding by approximately $212.7 million since 2010 to $58.5 million as of June 30, 2014.” IN other financial news, Invacare also announced a quarterly dividend of .0125 per share, payable Oct. 10.
ASP: Perforomist sees healthy jump
BALTIMORE – Third-quarter payments for respiratory drugs is up nearly across the board. Brand name drug Perforomist (J7606) saw the biggest jump, up nearly 90 cents, to $7.46 per dose according to the latest average sales price (ASP) figures. Brovana (J7605) increased to $6.96, up 57 cents from the previous quarter; and budesonide (J7626) increased nearly 48 cents to $5.38 cents per dose. Albuterol (J7613) and ipratropium (J7644) stayed relatively flat, at 14 cents per dose and just under 12 cents per dose, respectively.
Provider makes award triple play
NEW BERLIN, Wis. – Home Care Medical has received the HME Provider of the Year award from the Wisconsin Association of Medical Equipment Services (WAMES). This is the third year in a row the provider has been honored with the award. Also receiving awards: Jim Spellman, director of operations and WAMES president, received the Industry Excellence award for his efforts on the WAMES Legislative Committee; and Donna Smith, director of respiratory care, received the Distinguished Service award for her efforts on the WAMES Respiratory Committee. “This year, Home Care Medical proudly celebrated our 40 year milestone and this award, along with Jim and Donna’s contributions, represent our continued commitment and dedication to excellence,” said John Teevan, Home Care Medical president, in a release.
Dr. Hughes to exit
HINGHAM, Mass. – Dr. Paul Hughes is stepping down from his role as the medical director for Jurisdiction A, according to a bulletin from the Home Medical Equipment Services Association, citing a message from NHIA. Dr. Fred Mamuya will serve as interim director. Mamuya has been with NHIC, the Jurisdiction A DME MAC, for the past two years as ALJ Appeals Medical Director. Dr. Hughes’ last day is Oct. 10
Breathe adds text messaging
KANSAS CITY, Kan. – Breathe has released its latest software enhancement to its text messaging feature, the company announced today. With the new feature, DME sales team members can receive text messages when their office receives prescriptions, if a patient qualifies for oxygen or not, and when the patient is set up on oxygen. “It's our mission to provide and oximetry software solution that continues to evolve based on our clients’ needs, text messaging was a simple software enhancement that has had such a big impact for our clients,” said Amber Yeager, owner of Breathe. Breathe is a nationally recognized independent diagnostic testing facility.
Computers Unlimited founder honored
BILLINGS, Mont. – Computers Unlimited founder Mike Schaer has been inducted into the Montana Business Hall of Fame. Criteria for acceptance include outstanding business performance, high standard of ethics and a willingness to take risks. Schaer, a self-taught computer programmer, launched Computers Unlimited in 1978. Today the company employs nearly 200 people, according to local news reports. His son David took the reins in 2009. Schaer remains on the board as chairman.
ResMed, Brightree plan enhancements
SAN DIEGO – ResMed has expanded its relationship with Brightree, with both companies agreeing to enhance the integration of ResMed’s U-Sleep compliance solution within the Brightree solution and add new features from ResMed’s AirView patient management system. The first of these enhancements is salted to introduced in November. Brightree and ResMed began working together in 2013 to automate the onboarding of patients that use ResMed S9 PAP devices into U-Sleep.
$24 million Medicare fraud alleged
HOUSTON– Angel Mirabal, of Miami, was arrested Sept. 26 on charges of scheming to defraud Medicare. From April 2013 to July 2013, Mirabal allegedly conspired to bill Medicare $24 million in fraudulent claims for reimbursement through Quick Solutions Medical Supplies. According to the indictment said Mirabal and his co-conspirators used fraudulent shell companies to launder and disburse the proceeds from the health care fraud scheme.
YARMOUTH, Maine – San Diego-based ResMed will report its first quarter 2014 financial results Oct. 23, at 4:30 pm EST. The company will host a webcast to discuss operating results and future outlook. Also on Oct. 23, Elyria, Ohio-based Invacare will host a call to discuss third quarter 2014 results. That call is scheduled for 8:30 am EST.
DEERFIELD, Ill. – News that Walgreens is mulling the sale of a controlling stake in its home infusion business came as no surprise to analysts.
“I think Walgreens recognizes that this is a core asset and would probably be valued quite substantially by a third party,” said Justin Ishbia, founder and managing partner of Shore Capital Partners. “There will be a lot of interest from a lot of people.”
The news of the potential sale follows CVS Caremark’s acquisition of Coram from Apria Healthcare for $2.1 billion earlier this year.
Walgreens is said to have hired Bank of America to explore a sale of just more than 50% in Walgreens Infusion Services in a deal that could be worth around $1.5 billion, according to a Reuters article.
“It’s possible they just think it could be more valuable in somebody else’s hands with them keeping a piece while also monetizing projects,” said Ishbia.
Walgreens entered the home infusion space when it acquired OptionCare for $850 million in 2007. It grew into the largest provider of home infusion when it traded its long-term care pharmacy business for OmniCare’s home infusion business in 2010.
As part of its growth strategy, Walgreens has been acquiring smaller infusion providers, something that appeared to have slowed down in recent years, say analysts.
“It’s possible that slowed because they’ve been thinking about this strategy,” said Reg Blackburn, a managing director with The Braff Group. “It’s also possible because of the lack of large acquisition targets in the market.”
One area Walgreens could possibly be considering focusing on: its specialty pharmacy business.
“The specialty pharmacy market is growing really rapidly,” said Blackburn. “Chronic disease specialty pharmacy—a lot of which is mail order—is just not the same high-touch model as the acute portion of home infusion.”
WASHINGTON – The stars could align for the latest iteration of a bill to require Medicare to cover home infusion therapy, say industry stakeholders.
Similar bills have been introduced over the past several years, but stakeholders have a few things working in their favor this year. The first: a new study by Avalere, a non-partisan healthcare policy firm, that found Medicare could save $80 million over a 10-year period if it covers home infusion therapy. The National Home Infusion Association (NHIA) commissioned the study at the behest of lawmakers.
“It’s never been a question of convincing congressional staff members that this is valuable,” said Russ Bodoff, executive director of NHIA. “I think everyone accepts that home infusion is a valuable service. The question always was, ‘Is it a savings or is it a cost?’ Now there’s data.”
Reps. Eliot Engel, D-N.Y., and Pat Tiberi, R-Ohio, introduced The Medicare Home Infusion Site of Care Act on Sept. 10. The bill would require Medicare to pay for home infusion services and related supplies under Medicare Part B. The drugs are already covered under Part D.
The second thing working in the industry’s favor: a growing recognition of the potential of the post-acute care market to not only reduce costs but also increase the quality of care.
“Patient care is getting more and more important and what the appropriate site of care is seems to be something that’s right up Congress’ alley right now,” said Ken Van Pool, vice president of legislative affairs for NHIA.
With the current legislative session rapidly winding down, stakeholders are focusing on building a coalition of support around the bill to get it attached to a larger vehicle.
“It doesn’t look like there’s going to be a lame duck doc fix or Medicare bill, but if there is, we want to be prepared for that,” Van Pool said. “Longer term, there are several vehicles that will move. We are looking at any and all avenues.”
HINGHAM, Mass. – Industry stakeholders worry what a recently announced widespread prepayment review for non-invasive ventilators in Jurisdiction A may mean for coverage and reimbursement going forward.
The NHIC, the DME MAC for that jurisdiction, says it has initiated the review due to a spike in billing for E0464, a product that costs Medicare about $1,500 a month on a rental basis.
“We knew it was only a matter of time,” said Wayne van Halem, president of the van Halem Group. “The volume for this code has increased dramatically.”
Why the spike? The popularity of non-invasive vents (they’ve had “amazing results,” van Halem says); an increase in the use of non-invasive vents over Bi-Level devices; and the lack of specific coverage criteria.
While the National Coverage Determination (NCD) outlines general criteria for the provision of vents, there are no Local Coverage Determinations (LCDs) with specific criteria, stakeholders say.
“It has given providers a false sense of security—there’s no coverage criteria, so it can’t be audited,” van Halem said. “That’s just not the case.”
What could happen next: The other jurisdictions could follow suit, and depending on what they all find, a new policy with more specific coverage criteria and a modified payment methodology could be implemented.
“Providers will want to be very proactive that their documentation not only supports the clinical need but also that Bi-Level was tried and ruled out,” van Halem said.
When it comes to providing non-invasive vents vs. Bi-Level devices, the DME MACs began laying out their case in a bulletin in April. After stating the conditions for which vents are covered, they stated: “Each of these disease categories are comprised of conditions that can vary from severe and life-threatening to less serious forms. These disease groups may appear to overlap conditions described in the Respiratory Assist Devices LCD, but they are not overlapping. Choice of an appropriate device i.e., a ventilator vs. a bi-level PAP device is made based upon the severity of the condition.”
Brian Simonds, a provider in Jurisdiction A, isn’t opposed to more specific coverage criteria for non-invasive vents—in Massachusetts, where he’s located, the Medicaid program requires prior authorizations—but he says any attempt to, say, cap reimbursement is unacceptable.
“We’re taking a huge risk in getting these patients home,” said Simonds, director of Baystate Home Infusion & Respiratory Services. “There’s a tremendous amount of education for the patient and the family. Then there are the preventative maintenance requirements. It’s not just like regular equipment. You have to be very vigilant.”
WASHINGTON – AAHomecare has named Cara Bachenheimer of Invacare and Joel Mills of Advanced Homecare as its 2014 Homecare Champions. The award recognizes AAHomecare members who have made exceptional contributions to the homecare community throughout their careers. AAHomecare officials lauded Bachenheimer, senior vice president of government relations for Invacare, as a “consensus builder who sees the big picture.” AAHomecare officials praised Mills, CEO of Advanced Homecare and one of the association’s original members, for his long-time commitment to the industry. AAHomecare will present awards to Bacheheimer and Mills during the Stand Up for Homecare reception at Medtrade on Oct. 21.
Philips Respironics to develop vent for gov’t
MURRYSVILLE, Pa. – Philips Respironics has snagged a three-year, $13.8 million contract to develop a next-generation portable ventilator for the U.S. Department of Health and Human Services (HHS). The ventilator will help fill the need for portable, low-cost, user-friendly and flexible ventilators in a pandemic or other public health emergencies, according to a Sept. 17 press release from HHS. “An affordable portable ventilator will help us meet the needs of critically ill patients during a public health emergency, whether due to a naturally occurring pandemic or an act of bioterrorism,” stated Robin Robinson, director of the Biomedical Advanced Research Institute and Development Authority, which will over see the project. Per the contract, Philips Respironics must develop a ventilator that will meet the needs of everyone from infants to the elderly. It must also be low cost: Currently, ventilators with all the required features cost anywhere from $6,000 to $30,000 per unit. The contract includes an option for HHS to purchase 10,000 completely kitted, initial production ventilators from Philips Respironics for $32.8 million.
CAMPS co-locates at Medtrade Spring
LAS VEGAS – The California Association of Medical Product Suppliers (CAMPS) will co-locate its annual meeting with Medtrade Spring in 2015. The events will take place March 30-April 1 at the Mandalay Bay Convention Center in Las Vegas. “This co-location agreement saves CAMPS members time and money by allowing them to go to one trade show instead of two,” stated Kevin Gaffney, group show director, Medtrade, in a press release. CAMPS and Medtrade had a similar agreement a decade ago. CAMPS expects to provide California-specific topics and speakers to the event. The association will also hold a membership update meeting and a small reception for California attendees.
#Pharmacists ready to tweet
ALEXANDRIA, Va. – Pharmacists from around the world will take part in a tweet-a-thon Oct. 2. The second annual event will allow pharmacists to highlight the positive impact pharmacist have on patients, communities and the healthcare system, according to a release from the National Community Pharmacists Association (NCPA). Last year m ore than 7,100 tweets with the hashtag #Pharmacist were sent. “From preventing potentially adverse reactions, to teaching newly diagnosed diabetic patients how to use their glucose monitor, to administering 40 flu shots in three hours—last year’s stories were diverse and inspiring,” according to the release.
AbleNet secures reimbursement for 100-plus products
ST. PAUL, Minn. – AbleNet has secured Medicare reimbursement for more than 100 assistive technology products, including speech generating devices (SGDs), accessories and mounting solutions, the company announced Sept. 24. The funding “opens opportunities for people with communication disabilities to participate in daily activities and lead more fulfilling and productive lives,” AbleNet stated in a press release. To see the products that have been approved for funding, visit http://www.dmepdac.com/dmecsapp/do/search, and under “Search DMEPOS Product Classification List: Manufacture/Distributor” enter “AbleNet.”
Are diabetes rates slowing?
YARMOUTH, Maine – The incidence and prevalence of diabetes appears to have plateaued between 2008 and 2012, according to an article published Sept. 24 in the Journal of the American Medical Association. However, there appear to be continued increases in diabetes among subgroups, including non-Hispanic black and Hispanic subpopulations, and those with a high school education or less, the article states. The basis for the article: an analysis of data from the National Health Interview Survey for 664,969 adults ages 20 to 79 years old from 1980 to 2012 to measure the annual percentage change in rates of the prevalence and incidence of diagnosed diabetes (Type 1 and Type 2 combined).
180 Medical ups scholarship program
OKLAHOMA CITY – 180 Medical will give nine young adults $1,000 to help overcome their medical hardships and pursue their goals of higher education. “Our scholarship committee could not pick just five, so we are awarding nine individuals this year,” stated Kieranne Nelms, marketing manager, in a press release. The 180 Medical College Scholarship is for students with spinal cord injuries, spina bifida, transverse myelitis and/or a neurogenic bladder who plan to attend a two-year, four-year or graduate school program full time in the fall. In addition to eligibility documentation, winners submitted brief essays about the importance of college to their goals, lessons learned from a failure or qualities that set them apart. The founder and CEO of 180 Medical, Todd Brown, created the scholarship program. Brown was left paralyzed from the chest down by a motocross accident in 1994.
DeVilbiss revamps website
SOMERSET, Pa. – DeVilbiss Healthcare’s www.intellipap.com now has a refreshed look and improved usability. In addition to a softer appearance that the company believes makes it more welcoming, the website allows users to view pictures and instructions more readily. The website also has a simplified format: Users see only the input fields for items necessary to obtain compliance information. They can enter patient, device, provider and physician information as needed.
Inogen execs sell shares
NEW YORK – Inogen CEO Raymond Huggenberger sold 25,722 shares on Sept. 22 for an average price of $20.25 in a transaction valued at $520,870. He now owns 6,808 shares valued at $137,862. Inogen Director Timothy Petersen sold 46,865 shares on Sept. 22 in a transaction worth nearly $1 million. The shares sold at an average price of $21.05 for a total of $986,508. Peterson previously sold 39,135 shares on Sept. 17 in a transaction worth $850,012.
Short takes: Apria, ActiveCare, Essentially Women, Inogen
Apria Healthcare has secured a $100 million credit facility from Wells Fargo Capital Finance. “Wells Fargo Capital Finance provided us with a creative and flexible financing package that helps leverage our existing asset base for future growth,” stated Debra Morris, CFO of Apria, in a release. “Our sector of the healthcare industry continues to experience significant change. It is important for us to have a lender that understands these dynamics.” Wells Fargo’s healthcare finance portfolio has now surpassed $1 billion in commitments…Essentially Women will host its annual “Focus on the Future” event March 8-9 at the Rosen Plaza Hotel in Orlando. This year’s theme: “Heat Up Your Business: Facing Challenges – Expanding Opportunities.”
People news: Jones, Holm
ActiveCare, a provider of diabetes management and wellness services, has appointed Michael Jones president and interim CEO effective Oct. 1. Jones will replace David Derrick, who is stepping down for personal reasons. Previously, Jones founded or ran several fast-growing technology companies, including Interactive Care and RemedyMD, according to a press release… Ottobock has named Aaron Holm manager of consumer marketing and engagement. The goal of the newly created position: strengthen the company’s connection to consumers and impact product development processes and patient outcomes. Holm is a consumer himself—he lost both of his legs when he was crushed between two cars on the side of a freeway while helping a friend change a tire, and he has been using Ottobock’s microprocessor-controlled knees since 2007.
SOMERSET, Pa. – DeVilbiss Healthcare has ramped up the workforce at its manufacturing facility here by 20% to meet increased demand for its products, the company announced Sept. 25.
DeVilbiss has also increased its manufacturing hours from 12 to 16 hours a day with two eight-hour shifts.
“This is certainly the biggest increase in workforce that DeVilbiss has made in the past 10 years,” said Ed Murphy, president and CEO.
DeVilbiss has hired 33 assemblers and a manufacturing supervisor, three manufacturing engineers and a technician, and three quality engineers and two technicians. The hourly workforce now stands at about 110.
Behind the increase in demand for DeVilbiss products: A movement in the HME industry toward more expensive, but higher quality products, Murphy says.
“Where dealers are squeezed so hard on reimbursement, they’re looking more at the total costs of the products they buy,” he said. “The cost of product failure is astronomical. Even if a product is under free warranty repair, it will cost the provider $75 to $100 to pick up the equipment, bring it back to the warehouse, ship it to the manufacturer. It costs a lot, and it’s a pain.”
Since 2013, DeVilbiss has been manufacturing all of its products in the United States, a move that has allowed the company to not only keep closer tabs on quality but also increase its overall efforts in this area, Murphy says.
“In China, if you have someone put a meter on a product, read it and put the information into a computer, you introduce five potential sources of error,” he said. “In the U.S., we can have an automatic testing station that eliminates the labor component of the test and the sources of error, and increases reliability.”
So how much of an issue is reliability for, says, concentrators, anyway?
“Concentrators are complicated,” Murphy said. “A few years back, all of the manufacturers went too far trying to cut cost out of the product in reaction to what the market was looking for. At a certain point, you can’t reduce the cost anymore. You need to make sure you’re maintaining the quality and safety factors that allow the product to withstand a little more abuse.”
Murphy says DeVilbiss’ concentrators are a good example of the increase in demand the company has seen.
“When we moved our concentrators back from China, we originally set up two product lines,” he said. “We quickly had to add a third line and now that third line is almost all fully utilized, as well.”
In another recent move to drive demand for its products further, DeVilbiss has added an inside sales force to focus on smaller customers.
“We wanted them to hear from us on a more regular basis.”
WASHINGTON – AAHomecare has named Cara Bachenheimer of Invacare and Joel Mills of Advanced Homecare as its 2014 Homecare Champions.
The award recognizes AAHomecare members who have made exceptional contributions to the homecare community throughout their careers.
AAHomecare officials lauded Bachenheimer, senior vice president of government relations for Invacare, as a “consensus builder who sees the big picture.”
“Bachenheimer is a regulatory, legislative and government relations expert who has been on the front lines of defending the HME industry for almost 20 years,” stated Tom Ryan, president and CEO of the association, in a press release. “Her strategic advice and counsel have helped guide the industry through some of its biggest challenges.”
AAHomecare officials praised Mills, CEO of Advanced Homecare and one of the association’s original members, for his long-time commitment to the industry.
“From starting in home care at 16 and learning the business from the ground up to revamping and becoming CEO of Advanced Homecare, Mills is well known for his passion for the industry, patient and employees,” Ryan stated.
AAHomecare will present awards to Bacheheimer and Mills during the Stand Up for Homecare reception at Medtrade on Oct. 21.
MURRYSVILLE, Pa. – Philips Respironics has snagged a three-year, $13.8 million contract to develop a next-generation portable ventilator for the U.S. Department of Health and Human Services (HHS).
The ventilator will help fill the need for portable, low-cost, user-friendly and flexible ventilators in a pandemic or other public health emergencies, according to a Sept. 17 press release from HHS.
“An affordable portable ventilator will help us meet the needs of critically ill patients during a public health emergency, whether due to a naturally occurring pandemic or an act of bioterrorism,” stated Robin Robinson, director of the Biomedical Advanced Research Institute and Development Authority, which will over see the project.
Per the contract, Philips Respironics must develop a ventilator that will meet the needs of everyone from infants to the elderly. It must also be low cost: Currently, ventilators with all the required features cost anywhere from $6,000 to $30,000 per unit.
The contract includes an option for HHS to purchase 10,000 completely kitted, initial production ventilators from Philips Respironics for $32.8 million.
WASHINGTON – Recent clarifications from CMS and its contractors have loosened the noose that is the face-to-face requirement, industry stakeholders say.
Stakeholders have learned that 1.) CMS and its contractors won’t audit providers for compliance with the face-to-face requirement until they start enforcing it (the written order prior to delivery requirement, however, is fair game); and 2.) CMS won’t require providers to obtain a new face-to-face evaluation when a state requires a new order on a periodic basis.
“They have been slow to come, but every clarification is a bit more breathing room,” said Andrea Stark, a reimbursement consultant with MiraVista.
CMS implemented both the face-to-face and written order prior to delivery (WOPD) requirements July 1, 2013. The agency started enforcing the WOPD requirement on Jan. 1; it planned to start enforcing the face-to-face requirement some time this year, but it has since pushed back its plans indefinitely.
There is a minor glitch in CMS’s plan to prohibit the DME MACs, RACs, ZPICs and PSCs from auditing providers for compliance with the face-to-face requirement: It doesn’t apply to the CERT. But stakeholders don’t see that as a “giant risk.”
“The CERT audits a small number of claims on a post-payment basis,” Stark said. “I don’t envision them doing a mass audit to catch providers.”
The clarification that CMS and its contractors will require providers to obtain new face-to-face evaluations only for orders for Medicare payment came from one of the four DME MACs, but stakeholders expect the others to follow suit.
“A lot of states have annual prescription requirements for oxygen,” said Kim Brummett, senior director of regulatory affairs for AAHomecare. “If you had to get a new face-to-face for every patient, every year, that would be crazy.”
Of course, there are still numerous gray areas that stakeholders would like to see CMS clarify. Among them: Do providers really need to obtain a new face-to-face evaluation when a beneficiary changes providers (due to personal preference, an acquisition, or competitive bidding), or when a beneficiary switches insurance plans?
“We’re not trying to be unreasonable,” Brummett said. “We continue to try to work with CMS to find a solution. Every little thing counts.”