Feed aggregator

CMS delivers another blow with new pricing

HME News - Thu, 06/23/2016 - 20:11
July 1 pricing factors in Round 2 re-compete pricing, making cuts even steeper06/23/2016HME News Staff

WASHINGTON – CMS late this afternoon released new pricing for non-competitive bidding areas as of July 1, and in one fell swoop handed down cuts of anywhere from 10% for insulin pumps to 80% for TENS units compared to pricing in 2015.

Among 15 products highlighted in a CMS fact sheet, 11 show cuts of 50% or more, AAHomecare pointed out in a bulletin.

“It’s clear that these are cuts that will be devastating for providers and patients alike in these areas, and ultimately unsustainable for a healthcare infrastructure serving the needs of a growing senior population, as well as people with disabilities and chronic conditions who depend on HME,” the association stated.

CMS implemented a first round of cuts in non-bid areas, averaging about 25%, on Jan. 1.

The agency did, as stakeholders suspected it would, factor in new pricing for the Round 2 re-compete into the July 1 pricing, making the cuts even steeper.

The new pricing comes just as the industry was with one hand celebrating the Senate passing a bill that would delay this second round of cuts for one year and with the other hand decrying a sit-in in the House of Representatives over gun control that prevented a similar bill from passing there.

AAHomecare says there “may be a chance” to move forward after Congress returns from its July 4 recess, with a bill that would retroactively stop the July 1 pricing.

“We are also working with other parties in the Senate and in the administration to directly ask CMS to delay the cuts until legislation can be considered,” it stated.

Bid delay bill passes in Senate

HME News - Thu, 06/23/2016 - 09:09
06/23/2016HME News Staff

WASHINGTON – The Senate has passed a bill that would delay a second round of Medicare reimbursement cuts, according to the Council for Quality Respiratory Care.

Medicare plans to implement a second round of cuts in non-bid areas on July 1, following a first round of cuts that went into effect in those areas on Jan. 1. Together, they will reduce reimbursement, on average, 50%.

“We applaud the Senate for recognizing the urgency in passing this legislation before July 1, which will help to ensure that patient care is not jeopardized as a result of these Medicare cut,” said Dan Starck, chairman of the CQRC in a press release.

S. 2736, introduced by Sens. John Thune, R-S.D., and Heidi Keitkamp, D-N.D.,would delay the second round of cuts for one year, until July 1, 2017.

CQRC strongly urges the House of Representatives to follow the Senate’s lead and pass a companion bill, H.R. 5210. The bill has 116 co-sponsors.

Gov’t charges 301 with $900M in false billing

HME News - Thu, 06/23/2016 - 09:08
06/23/2016HME News Staff

WASHINGTON – A $900-million takedown by the Medicare Fraud Strike Force on June 22, the largest in history, included schemes involving durable medical equipment.

The nationwide sweep resulted in criminal and civil charges against 301 individuals, including 61 doctors, nurses and other licensed medical professionals, for alleged false billings.

“As this takedown should make clear, healthcare fraud is not an abstract violation or benign offense—it is a serious crime,” said U.S. Attorney General Loretta Lynch, who announced the takedown with Department of Health and Human Services Secretary Sylvia Burwell. “The Department of Justice is determined to continue working to ensure that the American people know that their healthcare system works for them—and them alone.”

The individuals have been charged with various healthcare fraud-related crimes, including conspiracy to commit healthcare fraud, violations of the anti-kickback statutes, money laundering and aggravated identity theft. The crimes involve various medical treatments and services, including home health care, psychotherapy, physical and occupational therapy, durable medical equipment and prescription drugs.

In the Southern District of California, five individuals, including a doctor and pharmacist, were charged in a scheme to pay bribes and kickbacks to doctors in exchange for prescribing durable medical equipment and compound pain creams that were not medically necessary. The indictment alleges that, in this case alone, about $27 million in false and fraudulent claims were submitted.

The cases are being prosecuted and investigated by U.S. attorneys offices nationwide.

Including these most recent actions, nearly 1,200 individuals have been charged in national takedown operations, which have involved more than $3.4 billion in fraudulent billings.

TwinMed snags Medicaid contract

HME News - Wed, 06/22/2016 - 11:11
06/22/2016HME News Staff

SANTA FE SPRINGS, Calif. – TwinMed has been awarded a $225 million contract to provide incontinence supplies to Medicaid beneficiaries in New York.

Under the five-year contract, TwinMed will establish minimum quality standards for adult and youth size diapers, and reduce costs, while maintaining the existing provider network, according to a press release.

“TwinMed is committed to providing better care at a lower cost to Medicaid beneficiaries throughout the State of New York and are pleased to partner with Governor Cuomo and the New York State Department of Health to deliver, maintain and exceed current standards as outlined by the Governor’s New York State Medicaid redesign,” said Kerry Weems, CEO.

TwinMed is a national distributor of medical supplies, primarily to skilled nursing facilities.

New York’s Medicaid program is one of the largest in the country with more than 5.3 million enrollees.

Brightree names new CEO

HME News - Tue, 06/21/2016 - 08:27
06/21/2016HME News Staff

ATLANTA – Brightree announced its acquisition by ResMed earlier this year and now it has a new CEO.

Matt Mellott will take the lead at the software company, replacing current president and CEO Dave Cormack, who will transition to a multi-year advisory role.

Mellott joins Brightree from MedBridge Healthcare, a sleep disorder diagnostic testing and respiratory therapy company. In his 12 years at MedBridge, most recently as president, he helped to grow the company to include 140 sleep disorder centers and 21 HME locations across 22 states.

“Leading a home medical equipment provider has helped shape my understanding of what post-acute care providers value in a software partner,” he said in a press release. “I’m looking forward to sharing those insights, accelerating Brightree’s already impressive pace of innovation and further enhancing its customers’ ability to deliver exception care, while building lasting businesses.”

Prior to MedBridge, Mellott served in a variety of executive finance leadership and CFO roles. He began his career with KPMG, one of the Big Four accounting firms.

Cormack joined Brightree in 2005 and led the company through a period of tremendous growth, taking what was then a fledgling software-as-a-service startup with 12 employees and fewer than 100 customers into a company with revenues exceeding $100 million annually.

“Brightree wouldn’t be the company it is today without the leadership of Dave Cormack,” said Raj Sodhi, president of healthcare informatics at ResMed, in a statement. “We’re pleased Dave has agreed to stay on in an advisory role to ensure a smooth transition.”

In addition to Mellott, Brightree named Bobby Ghoshal COO. He will oversee the company’s technology, product management initiatives, business operations and finance functions. Ghoshal was previously vice president of information technology in ResMed’s Americas group.

“Matt Mellott and Bobby Ghoshal…will continue moving Brightree forward, expanding on the company’s leadership in business management and clinical software applications for the post-acute care industry,” Sodhi said.

Brightree was acquired by ResMed in April 2016.

Industry pulls out all stops to push bill

HME News - Fri, 06/17/2016 - 13:51
Second phase of cuts hits non-bid areas on July 106/17/2016Theresa Flaherty

WASHINGTON – Friday afternoon was a nail-biter for the HME industry as a bill that would delay a second phase of Medicare reimbursement cuts moved through the “hotline” process in the Senate.

An unknown Republican Senate office on Friday put a hold on S. 2736, leading industry and state associations to blast urgent messages to members directing them to reach out to their senators.

“We need a wave of immediate support,” VGM said in a bulletin. “The clock is literally ticking for this bill to have a chance of being passed.”

At press time, there were still many unanswered questions, including whether the hotline process had also been initiated on the Democrat side of the Senate, and what the hard deadline for passing the bill is, first thought to be 5 p.m. Friday.

“We’ve also heard that the process can go into (the week of June 20),” said Cara Bachenheimer, senior vice president of government relations for Invacare.

If the bill passes the Senate, it will move to the House of Representatives for a vote under suspension.

Introduced March 17 by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.C., the bill seeks to delay the second phase of cuts in non-bid areas for 15 months—from July 1, 2016, until Oct. 1, 2017. However, a recent Congressional Budget Office score of the bill reduced the delay to 12 months.

That still buys the industry and its champions time to get a more permanent fix to the program, say stakeholders.

“This will get us into next year, where there will be a larger Medicare bill,” Jay Witter, senior vice president of public policy for AAHomecare, told attendees at the VGM Heartland Conference last week.“Once that second round cut happens, it will be extremely difficult to move forward.”

Although July 1 is less than two weeks away, CMS has yet to release the new payment rates, which may be even lower than what the industry has anticipated, say stakeholders.

“We all assumed the rate cut would double, however CMS has said it would (incorporate the reduced single payment amounts implemented Jan. 1 into the new SPAs),” said Bachenheimer. “It’s further manipulation by CMS of the bid prices.”

Heartland ushers in new era, providers in tow

HME News - Fri, 06/17/2016 - 13:49
‘After three days…(attendees) said they felt optimistic’06/17/2016Theresa Flaherty

WATERLOO, Iowa – Igniting ideas and cultivating connections was the ever-positive theme at last week’s Heartland Conference, now in its 15th year.

“The energy level was high, and there was great engagement and thought-provoking conversations from vendors and members,” said Clint Geffert, president of VGM & Associates. “During one of the final sessions, on the last day, we asked attendees to give one word about how they felt after three days of networking and education, and they said they felt optimistic, empowered, inspired, encouraged and comfortably refreshed—which is precisely what we strive for.”

The Heartland Conference, held June 13-16, drew nearly 1,000 attendees from across the country, according to VGM. It featured more than 100 educational sessions across 10 tracks, and 71 exhibitors.

New mindset

Attendees were urged to position themselves to take advantage of a shift in behavior that sees consumers, more than ever, going online to find information and products quickly.

That’s going to ratchet up quicker than you think, said Google’s Josh Weum, during a session titled, “Micro Moments—How Our Biggest Opportunities are Found in the Smallest Moments.”

“It’s going to be overnight, when the elderly get online, and we are very close to that integration,” Weum told attendees. “You want to be there when they get there—that’s when you have that impact. The Internet is happening yesterday.”

Overdue recognition

Women are often under-recognized in business, and the VGM Group is taking a step toward fixing that this year.

During a special session, “Women and Wine: Celebrating the Women of HME,” VGM announced “The HME Woman of the Year Award.”

“Women play such an important role in our industry and we want to recognize that by honoring a specific woman for the contributions she has made through leadership, patient care, best practices, advocacy or any other aspect of leadership,” said Mike Mallaro, CEO of the VGM Group.

New beginningsThis year’s Heartland Conference was the first without VGM founder Van Miller, but his presence was there—most notably in the form of his former dog, Daisy, who is now training with Retrieving Freedom to become a service dog for a veteran. Through raffle tickets and donations, attendees raised $2,114 for the organization, a nonprofit that trains service dogs and matches them with families.

BioScrip makes buy, announces public offering

HME News - Fri, 06/17/2016 - 13:48
06/17/2016HME News Staff

DENVER – BioScrip, a provider of infusion and homecare management solutions, has entered into an agreement to buy the business of HS Infusion Holdings.

The Hammonton, N.J.-based Home Solutions provides home infusion and home nursing products and services to patients across the East Coast. Its principal shareholder is KRG Capital Partners, a Denver-based private equity firm.

“The combination of BioScrip and Home Solutions brings together two highly complementary core infusion services portfolios that will have greater scale and financial resources,” the companies said in a press release.

BioScrip will buy substantially all of the assets and assume certain liabilities of Home Solutions and its subsidiaries for $85 million—$80 million in cash and $5 million in shares of the company’s common stock.

BioScrip and Home Solutions generated revenues of $982 million and $109 million, respectively, in 2015. On a pro forma basis, the combined company is expected to generate revenues of more than $1 billion.

“The additional financial contribution from Home Solutions, including anticipated synergies, is expected to strengthen the company’s balance sheet and leverage profile, thereby improving BioScrip’s strategic flexibility and competitive positioning and realigning the company as a growth platform in the attractive post-acute care segment,” the release states.

Upon completion of the transaction, Daniel Greenleaf will become CEO of BioScrip and will join the company’s board of directors. Previously, he was president and CEO of Coram Specialty Infusion Services, a top perfoming healthcare company with about $1.2 billion in revenues, 5,000 employees and 85 locations. Under Greenleaf’s tenure, Apria Healthcare and its private equity owner, The Blackstone Group, sold Coram to CVS Caremark for $2.1 billion.

“(This) underscores the value created for Coram’s home infusion platform during Mr. Greenleaf’s tenure,” the release states.

Rick Smith, director and CEO of BioScrip, will become vice chairman of the board.

BioScrip will continue to be headquartered in Denver and will maintain branches throughout the United States. It will also maintain Home Solutions’ billing and operations center in Hammonton.

BioScrip announces public offering

DENVER – BioScrip has commenced an underwritten public offering for its common stock, with Jeffries LLC acting as sole book-running manager. The company expects to grant underwriters a 30-day option to purchase up to an additional 13% of the shares of common stock offered in the public offering. BioScrip plans to use the net proceeds from the offering to fund the cash portion of its $85 million purchase of Home Solutions and to repay a portion of its outstanding borrowings under its revolving credit facility. It also plans to use the proceeds for general corporate purposes.

Apple debuts wheelchair app

HME News - Fri, 06/17/2016 - 13:46
06/17/2016Liz Beaulieu

SAN FRANCISCO – Among the fanfare during the keynote address at the Apple Worldwide Developers Conference on June 13 was the announcement that an upcoming free software update for the watchOS will include an app specific for wheelchair users.

“The team has been working hard to enable features to allow more people to use the activity apps, and one group that we’ve been thinking a lot about is wheelchair users,” said Jay Blahnik, director of fitness and health technologies for Apple, during the WWDC keynote address.

Instead of “time to stand,” the app’s activity tracker will notify wheelchair users that it’s “time to roll.”

The app will also include two workouts and rings optimized for wheelchair pushes.

“We couldn’t be more excited,” said Blahnik, a fitness instructor, consultant and author.

To develop the app, Apple first had to do some research. Because wheelchair users use different techniques to push their wheelchairs over different terrain, for example, it had to figure out how to track each technique.

“We knew we couldn’t use the same algorithms,” Blahnik said.

Apple worked with the Challenged Athletes Foundation, a San Diego-based charity providing grants to athletes with physical disabilities; and the Lakeshore Foundation, a Birmingham, Ala.-based nonprofit that advocates physical fitness for people with disabilities. With their help, the company recruited about 300 wheelchair users for more than 3,000 hours of research.

“We knew to do this right, we’d not only have to do a lot of studies but we’d also have to enlist the help of experts,” Blahnik said.

Apple expects to offer the update, including the wheelchair app, later this year.

Wheelchair users: Long-time Apple fans

Wheelchair users, who have favored Apple products for years, couldn’t be happier about the company’s plans to offer a specific wheelchair app as part of an upcoming software update for its watchOS.

“I’m very appreciative of Apple’s sensitivity to our needs as a community of active users,” said Kristina Rhoades, a T-5 complete paraplegic and national sales manager for El Dorado Mobility in Salina, Kan.

Rhoades says she uses the existing activity tracker but knows it’s not customized for rolling vs. walking.

“I’m excited to see how this enhancement improves the user experience with more accurate analytics on what is happening with my body as I use the app,” she said. 

Clinicians and wheelchair users have long preferred Apple products because they offer “swipe not type” technology.

“This is a key functionality for people who have limited hand dexterity or other mobility issues,” said Lisa Wells, director of Wheel:Life, an online community for wheelchair users.

For a company like Apple to more specifically and publicly acknowledge wheelchairs users is huge, Rhoades and Wells say.

“The trend toward more apps in smaller devices caters naturally to people who rely on a range of mobility equipment or hands-free devices,” Wells said. “This type of technology makes the world more accessible for people with disabilities.”

In brief: ResMed, Respironics both boast improved adherence

HME News - Fri, 06/17/2016 - 13:40
06/17/2016HME News Staff

SAN DIEGO – Remote monitoring and automated coaching from ResMed significantly improve the use of CPAP therapy for patients with obstructive sleep apnea, according to an independent study presented last week at the SLEEP conference in Denver. As part of this largest-ever, randomized, controlled study on OSA in the United States, more than 500 patients on CPAP therapy received support, including remote monitoring and automated coaching from ResMed’s U-Sleep platform. Those who received support from U-Sleep achieved Medicare-defined adherence 21% more than the average study participant over a 90-day period, the study found. “Anything that significantly increases CPAP use in the first 90 days is a big deal,” said Dr. Dennis Hwang, a sleep specialist at Kaiser Permanente’s Fontana Medical Center and the study’s principal investigator. “That initial period is crucial for patients to embrace CPAP to treat their sleep apnea, which is linked to heart failure, atrial fibrillation, Type 2 diabetes and other serious conditions. Tools like U-Sleep hold a lot of promise for patients on CPAP and the clinicians who treat them.” The U-Sleep patient management platform provides individualized feedback via text, email or phone based on CPAP use.

Philips Respironics improves adherence with new service

MURRYSVILLE, Pa. – Philips Respironics has launched Patient Adherence Management Service, a connected management solution using cloud-based data to support treatment adherence for sleep and respiratory patients. PAMS marries the company’s EncoreAnywhere software, DreamStation PAP therapy devices, its portfolio of masks and DreamMapper patient engagement application with a new Patient Outreach Protocol to boost adherence rates up to 24% within the first 90 days, the company says. “With this new connected management service, our goal is to help patients fully engage with and adapt to their therapy, ultimately helping them live healthier lives,” said Dr. Mark Aloia, vice president and global lead, behavior change for Philips, a speaker at this week’s SLEEP conference in Denver. The Patient Outreach Protocol includes personalized calls, emails and texts to deliver education, motivational reminders and support from sleep coaches and respiratory therapists.

Mediware release amps up retail capabilities

LENEXA, Kan. – The next release of Mediware’s CareTend will enable HME and home infusion providers to grow their retail operations. The release’s point-of-sale capabilities give providers the tools they need to quickly process transactions using their own hardware. The POS system is scalable for single and multi-site operations, so providers can see all transactions, inventory items and sales, regardless of location. Transactions are processed using barcode scanning and multiple forms of payment are accepted.

Universal Software steps up partnership with Vantiv

DAVISON, Mich. – Universal Software Solutions has enhanced its partnership with Vantiv Integrated Payments. Universal Software has made a fully integrated EMV (Europay, MasterCard and Visa) U.S.-based processing solution with a Vantiv processing platform available for its Healthcare Management Data System (HDMS). Customers will benefit from chip card payment solutions and services, and advanced security products and reporting tools. “We’re thrilled to work with USS to help make the healthcare payments ecosystem more secure and keep cardholder data safe,” said Matt Downs, head of business and channel development integrated payments at Vantiv. The enhancement will be available in the third quarter of 2016. Universal Software and Vantiv have been partners since last summer.

Early registration opens for Medtrade

ATLANTA – Early registration for Medtrade opens Monday. “We are preparing a show that is designed to help providers deal with changing times,” said Kevin Gaffney, group show director. “Early registration is the first step toward making your plans to find the solutions you need.” Early registration gets attendees $75 off the trade show floor and $200 off the conference program. Medtrade, the HME industry’s biggest trade show, is set for Oct. 31-Nov. 3 at the Georgia World Congress Center in Atlanta. To register, go to www.medtrade.com.

Lab Tactical redesigns newsletter

ATLANTA – Lab Tactical has redesigned its “Lab Notes” email newsletter for HME providers. Now called “The Renaissance Provider,” the free newsletter will focus on sharing news about profitable, patient-centered solutions for HME businesses. The first edition includes tips on “How do I transition to an outcomes-driven clinical model?” Among the answers: replace the word outcome with value, and treat compliance criteria like a yield sign in your billing process.

Short takes

Pittsburgh-based Circadiance has launched the SleepWeaver Advance pediatric soft cloth CPAP mask. The company recently received FDA clearance to market the mask in the United States, after launching the product in Europe several months ago. The mask is making its debut at the SLEEP conference this week in Denver…Sioux City, Iowa-based Mercy Home Medical Equipment has appointed Micah Bonderson as manager. Bonderson was previously a branch manager for Avera Home Medical Equipment in LeMars, Iowa. He also has experience as a respiratory therapist…An Aquatec OceanDual shower chair from Oakdale, Pa.-based Clarke Health Care Products was selected and used by Dr. Stephen Hawking during this recent trip to New York to promote a new project. The chair, which features tilt-in-space and recline positioning and matches a chair Hawking uses at home, was transported to various hotels during his stay. National Seating and Mobility in Garden City, N.Y., arranged the purchase and delivery of the chair…The use of absorbent briefs with curly fiber significantly lower/acidify skin pH, reducing the risk for incontinence-associated skin damage, according to a study announced by Hartmann, a Rock Hill, S.C.-based manufacturer of incontinence, wound care and compression therapy products. The study was led by Donna Bliss, a renowned incontinence researcher and professor at the University of Minnesota School of Nursing.

Calling all women leaders

HME News - Thu, 06/16/2016 - 13:20
06/16/2016HME News Staff

WATERLOO, Iowa – The VGM Group introduced the “HME Woman of the Year Award” at a special session at its annual Heartland Conference this week.

“Women play such an important role in our industry and we want to recognize that by honoring a specific woman for the contributions she has made through leadership, patient care, best practices, advocacy or any other aspect of leadership,” said Mike Mallaro, CEO of the VGM Group.

The new award is open to all women who work in the HME industry, VGM says.

The announcement was made during a new session at the Heartland Conference called “Women and Wine.” The session included presentations on how to manage stress, and how to develop a community of peers to share ideas and celebrate accomplishments.

Mallaro says the award is meant not only to highlight existing leaders but also to inspire a new group of leaders.

“As the landscape of health care shifts, our industry requires an ‘all-hands-on-deck’ mentality and growing pool of leaders,” he said.

VGM will announce the “woman of the year” at Medtrade this fall.

BioScrip makes buy, announces public offering

HME News - Tue, 06/14/2016 - 10:14
06/14/2016HME News Staff

DENVER – BioScrip, a provider of infusion and homecare management solutions, has entered into an agreement to buy the business of HS Infusion Holdings.

The Hammonton, N.J.-based Home Solutions provides home infusion and home nursing products and services to patients across the East Coast. Its principal shareholder is KRG Capital Partners, a Denver-based private equity firm.

“The combination of BioScrip and Home Solutions brings together two highly complementary core infusion services portfolios that will have greater scale and financial resources,” the companies said in a press release.

BioScrip will buy substantially all of the assets and assume certain liabilities of Home Solutions and its subsidiaries for $85 million—$80 million in cash and $5 million in shares of the company’s common stock.

BioScrip and Home Solutions generated revenues of $982 million and $109 million, respectively, in 2015. On a pro forma basis, the combined company is expected to generate revenues of more than $1 billion.

“The additional financial contribution from Home Solutions, including anticipated synergies, is expected to strengthen the company’s balance sheet and leverage profile, thereby improving BioScrip’s strategic flexibility and competitive positioning and realigning the company as a growth platform in the attractive post-acute care segment,” the release states.

Upon completion of the transaction, Daniel Greenleaf will become CEO of BioScrip and will join the company’s board of directors. Previously, he was president and CEO of Coram Specialty Infusion Services, a top perfoming healthcare company with about $1.2 billion in revenues, 5,000 employees and 85 locations. Under Greenleaf’s tenure, Apria Healthcare and its private equity owner, The Blackstone Group, sold Coram to CVS Caremark for $2.1 billion.

“(This) underscores the value created for Coram’s home infusion platform during Mr. Greenleaf’s tenure,” the release states.

Rick Smith, director and CEO of BioScrip, will become vice chairman of the board.

BioScrip will continue to be headquartered in Denver and will maintain branches throughout the United States. It will also maintain Home Solutions’ billing and operations center in Hammonton.

BioScrip announces public offering

DENVER – BioScrip has commenced an underwritten public offering for its common stock, with Jeffries LLC acting as sole book-running manager. The company expects to grant underwriters a 30-day option to purchase up to an additional 13% of the shares of common stock offered in the public offering. BioScrip plans to use the net proceeds from the offering to fund the cash portion of its $85 million purchase of Home Solutions and to repay a portion of its outstanding borrowings under its revolving credit facility. It also plans to use the proceeds for general corporate purposes.

Lincare offloads specialty pharmacy biz

HME News - Fri, 06/10/2016 - 13:19
06/10/2016Theresa Flaherty

CLEARWATER, Fla., and CHARLOTTE, N.C. – National HME provider Lincare will get $75 million for its specialty pharmacy business.

Lincare will sell Acro Pharmaceutical Services, which operates in all 50 states, and Community Pharmacy Services, which serves a 340B drug program in the Philadelphia area, to Premier, a Charlotte, N.C.-based national healthcare company with an alliance of 3,600 hospitals and 120,000 other healthcare providers.

“Lincare got a fantastic price for that business, which really was not in their core business,” said Jonathan Sadock, managing partner and CEO of Paragon Ventures.

Lincare, which is owned by industrial gas giant Linde, has said its specialty pharmacy business generated approximately $206 million in revenues in 2015.

Lincare’s specialty pharmacy business allows Premier to expand its already large presence in the oncology market, and enter the multiple sclerosis and pulmonary fibrosis markets.

“It was intriguing to us because they had a number of limited distribution products that were complementary to our list and we saw that as an opportunity to expand in those markets,” said Greg Isaac, CEO of Premier Specialty Pharmacy.

Between 15% and 20% of all specialty medications are limited distribution products, a system designed to ensure patients get the right medications from the right pharmacy with the right expertise, said Isaac.

Premier believes it is in the right place, at the right time.  Patients are living longer with chronic conditions, and pharmaceutical companies are focusing more on the development of oral tablets, rather than infusible or injectable medications, said Isaac.

“It’s easier for patients to take pills and they are more familiar with them,” said Isaac. “Many patients are afraid to inject themselves with these complex medications.”

Premier, which also comprises a group purchasing organization and several national collaboratives focused on healthcare improvement, accountable care organizations, and population health management, has a market objective of lowering healthcare costs, but providing better patient outcomes, said Isaac.

“So, with the specialty pharmacy, how do we get patients started faster on these complex therapies, how do we keep them on these therapies through the course of therapy, and how do we help with their financial burden because many of these prescriptions come with a very high copay,” he said.

Coming soon: New overtime rule

HME News - Fri, 06/10/2016 - 13:17
Will you raise salaries, pay more overtime or reduce hours?06/10/2016Theresa Flaherty

Editor’s note: The new overtime rule is also the subject of our current HME Newspoll. Add your two cents here.

YARMOUTH, Maine – A new overtime rule, slated to take effect Dec. 1, has employers across the country taking a hard look at employee job descriptions and pay rates, says consultant Richard Davis.

“The good news is, you have plenty of time,” says Davis, president of HirePower HR. “But you can’t wait.”

The new rule requires employers to pay overtime (time and a half) for more than 40 hours of work per week for all employees earning up to $913 per week or $47,476 per year. That’s a big jump from the previous threshold of $455 per week or $23,660 per year.

“If someone makes less than that, they can never be exempt,” said Davis. “The employer will have to follow the wage and labor laws and pay overtime.”

Davis offered a few initial steps that employers should take to ensure they are compliant when Dec. 1 rolls around.

Review job classifications

The first thing an employer should do is review the job descriptions of each employee to make sure that they are classified correctly as either exempt or nonexempt, says Davis.

“Delivery drivers, customer service reps, patient care coordinators and respiratory therapists are examples of HME employees that would more than likely be considered nonexempt,” he said. “I can tell you from experience that there are companies out there that are paying people as if they were exempt, and that would not pass the test with the Department of Labor. Do not try to play the game; just do it candidly and honestly.”

Assess pay

Review your list of exempt employees and determine whether they meet the minimum pay threshold, says Davis. If they don’t, the employer needs to decide whether to raise pay or evaluate how many hours of overtime the employee works to see if it would be less expensive to reclassify them and pay the overtime.

On the flip side, employers may make the decision to cut hours, Davis says.

“If I have people that are going to go from exempt to nonexempt, I would evaluate their position to determine whether it remains full time or whether it makes sense to make it a part-time position so there’s not going to be any overtime issue down the road,” he said. “That’s the hard part—it may seem punitive to some employees.”

Bill stirs up turf war over adaptive equipment

HME News - Fri, 06/10/2016 - 13:16
06/10/2016Liz Beaulieu

WASHINGTON – A bill in the House of Representatives with a commendable goal—creating standards for the provision of automobile adaptive equipment for veterans—has divided the manufacturers and providers in that market.

Most recently, the Independent Auto Lift Dealers of America, an informal group of manufacturers and providers led by Harmar, sent a letter to the Committee of Veterans Affairs in the Senate, where a similar bill is being considered, suggesting changes to the bill. Chief among them: better differentiation between simple and complex modifications to ensure that exterior lifts that don’t affect the operation of or alter the structure of the vehicle may continue to be installed at home.

“We have, at current count, 223 dealers that believe their business model would be marginalized,” said Drew McCartney, CEO of Harmar. “We want to preserve the ability of veterans to get an install at a place of their choosing.”

At the crux of the Independent Auto Lift Dealers of America’s concern: Until recently, the National Mobility Equipment Dealers Association, which has spearheaded the bills and whose members primarily provide more complex vehicle modifications, required onsite installations as part of its Quality Assurance Program certification (It added a remote service and installation policy about two years ago).

NMEDA CEO Dave Hubbard says the most recent version of the bill acknowledges what has become known as “driveway installs.” It includes an amendment that states: “…the allowance, where technically appropriate, for veterans to receive modifications at their residence or location of choice.”

“We’ve had people say that this will make driveway installs go away, but that’s not the case,” he said. “It’s mentioned in the bill as a positive, where appropriate.”

Another change suggested by the Independent Auto Lift Dealers of America: language that would prevent NMEDA and its QAP from becoming the de-facto certification for the VA’s automobile adaptive equipment program, a strategy the association has used successfully in some states, McCartney says.

“There are other certifying entities without a dog in the fight, like ANSI and RESNA,” he said.

NMEDA disagrees with the Independent Auto Lift Dealers of America’s interpretation of the bill, saying it leaves the details of the development of a comprehensive policy regarding quality standards up to the secretary of Veterans Affairs.

“The legislation was put together in generalist terms and calls for bringing together all stakeholders,” Hubbard said. “We just want the VA to do something.

Hubbard added: “To deliver a bottle of oxygen, you have to be JCAHO certified but to install a $30,000 high-tech drive-by-wire system that allows quads to drive, you don’t have to be. That’s really what started this.”

The Independent Auto Lift Dealers of America argues that driveway installs are not only convenient but also safe. Harmar, which is actually a manufacturer member of NMEDA, requires dealers to complete a one-week certification course and has a database of 50,000 successful installs for vets, McCartney says.

“This bill is a solution in search of a problem,” he said.

As the bill works its way through the House, with aggressive lobbying from both groups, veterans must be kept as the No. 1 priority, says Jerry Keiderling, president of Accessible Home Improvement of America, part of The VGM Group, which shared news of the letter from the Independent Auto Lift Dealers of America with its members.

“God knows, no one wants to do anything against the vets,” he said. “We’re for certifying standards, but two different modalities are mixed together in this bill. It’s not really a battle, but more, let’s be logical about this.”

In brief: Bill gains momentum, deadline for sleep rule extended

HME News - Fri, 06/10/2016 - 13:11
06/10/2016HME News Staff

WASHINGTON – A bill in the House of Representatives that would delay a second round of Medicare reimbursement cuts slated for July 1 has gained 18 additional co-sponsors in the wake of the AAHomecare Washington Legislative Conference, May 25-26. The total for H.R. 5210 now stands at 97. Additionally, the bill’s sponsor, Rep. Tom Price, R-Ga., testified June 8 at a House Ways & Means Health Subcommittee hearing on “Legislation to Improve and Sustain the Medicare Program.”“Patients' lives are literally at risk,” he told the committee of the bid program’s impact. A Senate companion bill, S. 2736, has 29 co-sponsors.

FMCSA extends comment deadline on sleep rule

WASHINGTON – The Federal Motor Carrier Safety Administration and the Federal Railroad Administration have extended the public comment period on the potential impact of requiring sleep-apnea tests for commercial drivers and rail workers. The comment period has been extended from June 8 to July 8, 2016. The two groups announced in March that they were seeking input on the proposal and have hosted comment sessions in Washington, D.C., Chicago and Los Angeles.

OIG issues mid-year update

WASHINGTON – Power mobility devices and orthotic braces are among the product categories under review by the Office of Inspector General, according to a Mid-Year Update for 2016 released by the Office of Inspector General on June 7. The OIG will perform several reviews to determine whether claims were medically necessary and compliant for orthotic braces, nebulizers and related drugs, and power mobility devices. The OIG will also conduct a review to determine the effectiveness of system edits to prevent inappropriate payments for diabetes test strips and lancets to multiple suppliers. The OIG will also conduct a review to determine whether potential savings can be achieved if certain power mobility devices are rented over 13 months rather than acquired as a lump-sum purchase (The Affordable Care Act eliminated the lump-sum purchase option on Jan. 1, 2011, but only for standard power wheelchairs). Additionally, the OIG will describe billing trends for vents, respiratory assist devices and CPAP machines from 2011 to 2014, and examine factors associated with the increase in billing for vents. Also on the OIG’s docket:It willperform a mandatory review of CMS’s competitive bidding process.

Metamason draws $3M in funding

LOS ANGELES – Metamason, the company behind a 3-D scanned and printed customized CPAP mask, has closed on a $3 million Series Seed financing round. The investment was led by 3P Equity Partners, a manufacturing-focused private equity firm in San Jose, Calif., and Tsing Capital, a leading “cleantech” venture capital firm in China. “We are thrilled to reach this important milestone for the company,” said CEO Leslie Oliver Karpas. “Our investors are confident that Metamason will be a disruptive, positive force in the $4 billion global sleep apnea market.” Metamason plans to use the investment to complete regulatory clearance with the U.S. Food and Drug Administration and to run initial clinical trials for its patent-pending flagship product, Respere. Also on the horizon: a crowdfunding campaign later in 2016 and marketing activities in early 2017. Metamason expects to make Respere publicly available in the second quarter of 2017.

Senior Medicare Patrol projects see mixed results

WASHINGTON – Senior Medicare Patrol projects report $2.5 million in expected recoveries for Medicare in 2015, compared to $660,829 in 2014, a 282% increase, according to a June 3 report from the Office of Inspector General. These projects did not report any expected recoveries for Medicaid in 2015, compared to $504 in 2014. The Senior Medicare Patrol projects also reported $35,059 in savings to Medicare beneficiaries and others in 2015, compared to $80,228 in 2014, a 56% decrease. These projects also reported $21,533 in cost avoidance for Medicare, Medicaid, beneficiaries and others in 2015, compared to $200,598 in 2014, an 89% decrease. While the Senior Medicare Patrol seemed to be less successful in certain areas, the OIG believes the projects may not be receiving full credit for savings attributable to their work. “It is not always possible to track referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, waste and abuse from the projects,” the report states. “In addition, the projects are unable to track the potentially substantial savings derived from a sentinel effect, whereby Medicare beneficiaries’ scrutiny of their bills reduce fraud and errors.”

VirtuOx launches DocViaWeb

WASHINGTON – VirtuOx, a national sleep and respiratory testing provider, has launched a sister company, DocViaWeb, to provide HIPAA-compliant and cost-effective telemonitoring solutions for healthcare organizations and professionals to diagnose and treat at home. DocViaWeb specializes in two healthcare verticals: sleep disorders and home health care. The sleep disorders program provides the ability to test for sleep apnea in real time, using advanced diagnostic sleep medicine tools, and to schedule online consultations with board-certified sleep specialists. It also provides the ability to coordinate APAP or oral appliances through DME providers. The home health care program provides outsourced transitional care management and chronic care management using VirtuOx’s proprietary software, CareCentered.

Contour: 25 years, 20 million sold

CHARLOTTE, N.C. – Contour Products is marking two milestones: 25 years in business and 20 million units sold. The company is ramping up outreach to doctors and respiratory therapists to further promote its CPAP pillow line, including a “Contour Referral Program” offering helpful information, samples and promotional opportunities. “The importance of respiratory therapists and other medical professionals can’t be overstated,” said Scott Davis, president.

Convaid supports SMA events

TORRANCE, Calif. ­– The Pediatric Group of Etac NA will attend the Cure SMA National Conference, June 16-19 in Anaheim, Calif., as a platinum exhibitor and will donate a Convaid Trekker to kick off the event. The Pediatric Group—Convaid and R82—will also participate at Cure SMA Walk-n-Rolls throughout the United States over the course of this year. “We are steadfast advocates for families living with special needs,” said Nanneke Dinklo, marketing director for Etac NA. “We embrace opportunities to help families enjoy their freedom and live full, active lives.”

Invacare has more work to do, FDA says

HME News - Thu, 06/09/2016 - 08:40
06/09/2016HME News Staff

ELYRIA, Ohio – Invacare has hit a bump in the road in its goal of lifting a consent decree with the Food and Drug Administration that has handicapped the company since late 2012.

Invacare previously reported in February of this year that an independent auditor had issued a certification report for the third and final phase of the decree. The company planned to submit its own report and seek approval for both reports from the FDA.

On June 7, however, Invacare received a letter from the FDA outlining additional steps that the company must take before moving forward, including completing the remediation of certain design history files referenced in the FDA’s 2015 inspection report and in the decree.

“Before the company can design any new Taylor Street wheelchair devices, the specified DHFs must be completed, then recertified by the company’s third-party expert, whose updated report must be accepted by the FDA,” Invacare stated in a Form 8-K filed with the Securities and Exchange Commission on June 8. “The FDA also has clarified that its acceptance of the expert’s updated report on these DHFs is a prerequisite to proceeding further with the third certification process.”

Design history files describe the methods used to design and test a product, as well as the processes that ensure those methods are properly followed.

Invacare said the FDA’s feedback is “aligned with work already underway.”

The company also said it does not expect the FDA’s letter to “materially impact” its upcoming second quarter financial results.

OIG issues mid-year update

HME News - Wed, 06/08/2016 - 11:43
06/08/2016HME News Staff

WASHINGTON – Power mobility devices and orthotic braces are among the product categories under review by the Office of Inspector General, according to a new report.

The OIG released its Mid-Year Update for 2016 on June 7.

Necessary and compliant

The OIG will perform several reviews to determine whether claims were medically necessary and compliant with Medicare requirements. Affected product categories include orthotic braces, nebulizers and related drugs, and power mobility devices.

System edits

The OIG will conduct a review to determine the effectiveness of system edits to prevent inappropriate payments for diabetes test strips and lancets to multiple suppliers. Prior OIG work found that inappropriate payments were made to multiple suppliers for test strips and lancets dispensed to the same beneficiary with overlapping service dates.

Power mobility devices

The OIG will conduct a review to determine whether potential savings can be achieved if certain power mobility devices are rented over 13 months rather than acquired as a lump-sum purchase. The Affordable Care Act eliminated the lump-sum purchase option on Jan. 1, 2011, but only for standard power wheelchairs.

Ventilators

The OIG will describe billing trends for vents, respiratory assist devices and CPAP machines from 2011 to 2014, and examine factors associated with the increase in billing for vents. The OIG will also examine the impact of the competitive bidding program on billing trends for vents.

Competitive bidding

The OIG will also perform a mandatory review of CMS’s competitive bidding process.

NMEDA responds to opponents

HME News - Tue, 06/07/2016 - 09:07
06/07/2016HME News Staff

TAMPA, Fla. – A bill that seeks to standardize how lifts are provided to veterans has been “misinterpreted” by its opponents, according to the National Mobility Equipment Dealers Association.

One of the main concerns with the bill outlined in a recent letter to lawmakers: that H.R. 3471 “needs a more robust conflict-of-interest provision related to the use of a third-party certification organization for the new safety standards.”

“Nowhere in the bill is an organization specified as the certifying body,” stated NMEDA in an email response to HME News. “Rather, the secretary of the U.S. Department of Veterans Affairs is to establish minimum standards.”

The bill seeks minimum standards for providing adaptive services and equipment, including a standard that those providing these services be certified by a certification organization or a manufacturer.

NMEDA, which has a certification program called the Quality Assurance Program, says the bill is necessary because there are currently no standards or safety provisions that must be met by providers of adaptive services and equipment provided to veterans.

“For far too long, the VA has allowed unqualified vendors to perform potentially unsafe and unreliable vehicle modifications and equipment installations,” the group stated. “(This bill) will put an end to the dangerous and costly practice. It will set in motion the actions necessary to formulate standards.”

GAO emphasizes smallness of accessories market

HME News - Fri, 06/03/2016 - 12:19
‘The report is really the best we could have hoped for,’ Bachenheimer says06/03/2016Liz Beaulieu

WASHINGTON – Mobility stakeholders say they now have backup from the Government Accountability Office.

Stakeholders were pleased last week when the GAO released a highly anticipated report that found Medicare utilization and spending for accessories for complex power wheelchairs are relatively low—about 312,000 and $159 million, respectively, in 2014.

“In the scheme of DME spending and healthcare spending overall, that’s a small number,” said Don Clayback, executive director of NCART. “Part of our message all along has been that this is a small group of specialized equipment used by people with high-level disabilities.”

The GAO was required to look at utilization and spending for accessories for complex power wheelchairs as part of a bill passed in December that delayed the application of competitive bidding pricing to these accessories for one year, until Jan. 1, 2017. Due to CMS’s inability to change its claims process system fast enough, however, the agency has applied bid pricing, anyway, until July 1.

The GAO was also required to look at the impact of this new pricing. It found that among the 10 accessories with the highest estimated expenditures, eight had pricing adjusted by competitive bidding. This resulted in reductions ranging from 4% (expandable controller, E2377) to 17% (mounting hardware for joystick, control interface, or positioning accessory, E1028).

“Overall, we’re looking at reductions as high as 34%” when Medicare implements a second round of reimbursement cuts in non-bid areas on July 1, Clayback said.

The GAO did make a point to say that, while spending for accessories for complex power wheelchairs is relatively small, it does account for 51% of total spending for accessories. That’s because it’s the accessories that make complex power wheelchairs complex.

“The accessories are what make it customized and highly individualized to address the unique medical needs of beneficiaries in need of this technology to remain active and independent in their homes and communities,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products.

With the report in hand, stakeholders are now working with their champions in Congress on a more permanent fix to prevent the reductions. There are limited opportunities in this election year, but last year’s delay and the GAO report give them a “jump start.”

“The GAO report is really the best we could have hoped for—it provides an objective detailed data analysis of CRT accessories versus standard ones,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “Our congressional champions have been waiting for this, and it solidifies what we’ve been saying: that CRT accessories are different and need to be permanently excluded from bid pricing. We can now move to the next step of working with Congress to address this issue legislatively.”

Syndicate content