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CMS awards 586 contracts in latest round of bidding

HME News - Thu, 04/28/2016 - 19:46
04/28/2016HME News Staff

WASHINGTON – CMS named the contract suppliers for the Round 2 re-compete of competitive bidding at 5:02 p.m. on Thursday.

CMS says it has executed 586 contracts, 91% of those offered, for seven product categories. The contract providers have 2,200 locations to serve Medicare beneficiaries in competitive bidding areas.

The agency also awarded nine contracts, 100% of those offered, for diabetes supplies as part of its national mail-order program.

CMS says 92% of contract suppliers are already established in the bid area, the product category, or both. It says small suppliers, those with gross revenues of $3.5 million or less, make up 62% of the contract suppliers.

“The bid evaluation process ensures that there will be a sufficient number of suppliers, including small suppliers, to meet the needs of the beneficiaries living in the CBAs,” the agency states in a fact sheet.

Previously, on March 15, CMS announced the single payment amounts for the Round 2 re-compete. The amounts represent average reductions of anywhere from a few percentage points to up to 25%, over and above the amounts for the original Round 2. The amounts for original Round 2 were, on average, 45% lower than the original fee schedule.

CMS says that, under the first two years under the Round 2 and the national mail-order programs—from July 1, 2013 to June 30, 2015—it has saved about $3.6 billion.

“Health monitoring data indicate that its implementation is going smoothly with few inquiries or complaints and has had no negative impact on beneficiary health outcomes,” the agency states in the fact sheet.

CMS goes live with the Round 2 re-compete and national mail-order programs on July 1.

AAHomecare books Congressional champions for conference

HME News - Thu, 04/28/2016 - 12:22
04/28/2016HME News Staff

WASHINGTON – AAHomecare has lined up Reps. Marsha Blackburn, R-Tenn.,andRenee Ellmers, R-N.C., to speak at the 2016 Washington Legislative Conference, slated for May 25-26 at the Washington Court Hotel. 

Rep. Ellmers introduced a bill this week that would halt CMS’s plans to make dramatic changes to coverage for prosthetic devices, while Rep. Marsha Blackburn, R-Tenn., introduced a bill last year that would require prior authorizations for certain high-cost DME, including oxygen. 

In addition, a general session on May 25 will feature a panel discussion about issues affecting rural providers. The panel, moderated by John Gallagher, vice president of government relations at VGM, and Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services, will address the challenges associated with serving patients in rural areas, and how to communicate these issues to patients and policymakers.

“Conference attendees should make a point to attend the rural panel session, whether or not your company is in a rural area,” said Karyn Estrella, executive director of the Home Medical Equipment and Services Association of New England, in an AAHomecare bulletin. “Getting first-hand accounts of the challenges these companies face will be important to convey during your Hill visits.”

As part of the conference, AAHomecare is coordinating Capitol Hill visits to lobby lawmakers on industry issues, include a bill to delay an upcoming second round of Medicare cuts in non-bid areas.

 

O&P stakeholders add bill to arsenal

HME News - Tue, 04/26/2016 - 09:29
04/26/2016HME News Staff

WASHINGTON – Rep. Renee Ellmers, R-N.C., has introduced a bill that would halt CMS’s plans to make dramatic changes to coverage for prosthetic devices.

H.R. 5045, the “Preserving Access to Modern Prosthetic Limbs Act of 2016,” would “impose a moratorium on the implementation of a proposed Medicare local coverage determination on lower limb prostheses,” according to a bulletin from the American Orthotics and Prosthetics Association.

The bill would restrict CMS from implementing the proposed LCD until at least June 30, 2017. It would also require the agency and its contractors to remove it from their websites. Private payers like United Healthcare and Cigna have made coverage changes since the proposed LCD was made public in July.

The bi-partisan bill has been co-sponsored by Reps. Marsha Blackburn, R-Tenn., and Jan Schakowsky, D-Ill.

The changes in the proposed LCD include requiring a face-to-face visit and a completed rehab program to receive a prosthetic device.

Lymphedema advocates push for broader coverage

HME News - Fri, 04/22/2016 - 14:04
Medicare currently pays for pump therapy, but not compression garments and other supplies04/22/2016Theresa Flaherty

WASHINGTON – Lymphedema advocates took to Capitol Hill last week to gain support for legislation that would address a gap in treatment coverage for the chronic and often debilitating condition.

With a presidential election looming in the fall, the Lymphedema Advocacy Group, which held its 2016 Lymphedema Lobby Days April 19-20, wants to take advantage of the time it has now, before lawmakers get too distracted.

“There’s momentum behind this,” said Judy Woodward, chairwoman of awareness for LAG. “We need to make sure that momentum builds and we keep the voices coming. The next two months are a critical window.”

In all, 71 participants from 21 states and the District of Columbia had 214 scheduled meetings with members of Congress. LAG is an all-volunteer organization made up of patients, caregivers, healthcare professional, and HME providers and manufacturers.

The Lymphedema Treatment Act would require Medicare to pay for compression garments, bandages and supplies to reduce lymphedema-related swelling and prevent its recurrence. Currently, Medicare pays for pneumatic compression pumps, as well as therapy provided by a PT/OT.

That’s a little short sighted, say advocates.

“Even if a patient is granted a pump, they have to use compression between pump sessions with that compression being the garments that you can actually wear 23 hours a day,” said Heather Ferguson, founder and executive director of LAG. “Otherwise, all that fluid re-accumulates.”

The legislation, introduced in the Senate in December 2015 and in the House of Representatives in March 2015, has 16 and 202 co-sponsors, respectively.

As is often the case, despite widespread support on the Hill, there is occasional pushback about cost, says Bruce Carroll, director, health policy & reimbursement strategy for BSN, which manufactures products for wound care and related vascular diseases.

“It’s a logical step that (lawmakers) understand that covering these garments would prevent things like hospitalizations or amputation,” he said. “They understand once you present it to them. The upfront cost is relatively low.”

If Medicare will pay for coverage, it’s a good bet that private insurers will follow suit, say advocates.

“I do think that HME providers are seeing a lot of patients that don’t have coverage for compression and so either they have to scrape together nickels and dimes to pay for the garments or they don’t use them and then they rely solely on the pump, which is effective but only for a short amount of time,” said Christa Miehe, president of Essentially Women, a member services organization owned by The VGM Group. “There are a lot of people who would be better served health-wise and there are people that don’t have $300, $400 or $500 to pay out of pocket.”

Private payers ‘exploit’ O&P changes

HME News - Fri, 04/22/2016 - 14:02
04/22/2016Theresa Flaherty

WASHINGTON – It’s no surprise to O&P stakeholders that private payers are picking up on a widely criticized proposed rule by Medicare to deny coverage for prosthetic devices that were previously covered.

“We predicted that the rule would, ultimately, be exploited by private health insurers,” said Michael Oros, president-elect of the American Orthotics and Prosthetics Association during a press call last week.

The four DME MACs in July released draft local coverage determinations for lower limb prosthetics that include a number of proposed changes, including requiring a face-to-face visit and requiring patients to complete a rehab program. UnitedHealthcare and Cigna have made coverage changes in the wake of the proposed rule, AOPA says.

Mark Martin, who lost his leg to an aneurysm in 2014, has experienced firsthand this cookie-cutter approach to providing prosthetic care.

“I experienced denials even on my initial preparatory prosthetic,” said the 40-year-old from Portland, Ore. “Then, when I advanced to the being ready for a definitive prosthetic, I was met with wave after wave of denials. Many, many months passed that I could have been advancing my recovery.”

After a public uproar, CMS said it would hold off on implementing the LCDs until further study, but the simple fact that the agency didn’t withdraw them made the proposed changes fair game for other payers, says AOPA.

Adding to stakeholder frustration: everything from the lack of transparency from the very start of the LCD process, to CMS’s refusal to name the individuals who comprise a workgroup it has formed to study the changes.

“There is no assurance that any stakeholders or patients would be involved in this,” said Tom Fise, executive director of AOPA.

CMS has also denied a Freedom of Information Act request filed by AOPA asking to view the several thousand public comments made on the proposed rule.

There are currently about 2 million amputees in America, and that number is growing by nearly 200,000 a year. Appropriate prosthetic devices enable most of them to return to their previous activity level and lifestyle, they say.

“Under United’s coverage, I would not be able to have the same device as I currently use to keep my lifestyle as active,” said Rob Rieckenberg, 37, of Minneapolis, who lost a leg after he was mugged and left on train tracks and was hit by a train. “It’s hard enough to recover from losing a limb, but to be told by your insurance company that it’s not a medical necessity is another devastating blow.”

Inogen sweeps majority of bid areas

HME News - Fri, 04/22/2016 - 13:58
04/22/2016Liz Beaulieu

GOLETA, Calif. – Inogen has accepted contracts for respiratory products in 93 of the 117 competitive bidding areas as part of the Round 2 re-compete, the company says.

Inogen achieved similar penetration in the original Round 2, says President and COO Scott Wilkinson.

“We have looked at it from a market access standpoint and we, ultimately, will have roughly 90% market access through the Medicare program in both scenarios, so our position is pretty much unchanged,” he said.

As a result of the new payment amounts for the Round 2 re-compete, Inogen has adjusted its anticipated total revenue headwind to 3.5% to 4%, from 2.5% to 3.5%. The company says the new amounts represent a 17.4% reduction, on average, for stationary oxygen concentrators, and an 11.3% reduction, on average, for POCs.

Inogen is holding firm, however, on its 2016 guidance of revenues of $187 million to $191 million; adjusted EBITDA of $37 million to $39 million; and net income of $12 million to $14 million.

“The company believes its current guidance is still achievable because of the declining Medicare rental revenue as a percent of total revenue, and the company’s guidance having already factored in an estimate of the reimbursement decline,” the company states in a recent Form 8-K.

Inogen says it has lowered Medicare’s contribution to its total revenues from 26.5% in 2014 to 21% in 2015.

“The company believes it is well diversified between its sources of revenue, business channels and geographies,” it states.

The Round 2 re-compete, like the Round 1 re-compete, combines oxygen, and sleep and aerosol therapy into one product category. The company plans to stick to its strategy of offering sleep and aerosol therapy, subcontracting this business in certain areas, Wilkinson says.

“While it has not been an area of strategic focus, Inogen has provided sleep and aerosol products as part of our offering for several years,” he said.

In areas where it has not been offered contracts, Inogen says it will, once again, grandfather existing patients—meaning it will continue to service these patients but will accept the lower payment amounts starting July 1, 2016, when the Round 2 re-compete amounts go into effect. It will also continue to accept new patients in these areas for cash pay and private insurance rentals.

Inogen noted that, because the reductions associated with POCs are less steep, it believes the new payment amounts will accelerate the adoption of non-delivery oxygen technology, including its Inogen One product line.

“The company believes this reimbursement premium will provide further incentive for home healthcare providers to adjust their business models to incorporate non-delivery technology,” the company states.

 

Joint conference rallies around access

HME News - Fri, 04/22/2016 - 13:57
04/22/2016Tracy Orzel

ARLINGTON, Va. – Programming a conference for three separate organizations sounds like a challenge, but that’s not the case for the upcoming RESNA/NCART 2016 Conference, organizers say.

“Collaboration is a buzzword—it’s easier said than done,” said Mike Brogioli, executive director of RESNA. “But I’ve found (combining these conferences) hasn’t been a challenge. It’s been more of an opportunity.”

The event, hosted by NCART, NRRTS and RESNA, and slated for July 10-14 at the Hyatt Regency Crystal City in Arlington, Va., will include interactive exhibits; more than 50 workshops; research platforms and poster sessions; Capitol Hill visits; pre-conference instructional courses; networking events; and student competitions.

This year’s theme:“Promoting Access to Assistive Technology.”

“Both conferences are focused on assistive technology—RESNA more broadly—but they have always included seating and mobility,” said Don Clayback, executive director of NCART. “On a very high level, there’s a common goal: Making sure people with disabilities have access to these type of products and equipment.”

Conference organizers say they’ve worked closely with each of the organizations to ensure that the sessions have broad-based appeal and balanced representation. However, Brogioli hopes attendees will use the conference as an opportunity to attend sessions outside of their specialty.

“You want to stretch yourself and learn,” he said.

While there will be more sessions and workshops for all attendees to choose from, the biggest difference—at least for traditional RESNA members—will be the addition of a Capitol Hill Day, an NCART/NRRTS conference staple. Attendees will have the option to advocate for 1.) access to and funding for assistive technology and/or 2.) specific complex rehab legislation that would prevent CMS from implementing competitive bidding prices to complex rehab wheelchair accessories, as well as a pair of bills that would create a separate benefit category for complex rehab.

“I think it will be a new and great experience for RESNA folks to literally take the message to Congress,” said Brogioli. “It’s democracy in action and it’s our duty as citizens to inform and educate our congressional offices who are there to serve us.”

In brief: Big names support bid delay, group surveys drivers on sleep

HME News - Fri, 04/22/2016 - 13:46
04/22/2016HME News Staff

WASHINGTON – Senate Finance Committee leaders have asked CMS to delay applying the next round of Medicare reimbursement cuts in rural areas.

In an April 18 letter to Health and Human Services Secretary Sylvia Burwell, Finance Committee Chairman Orrin Hatch, R-Utah, and Ranking Member Ron Wyden, D-Ore., express their concerns that six months isn’t long enough to detect and correct problems with the rollout of competitive bidding to non-bid areas.

“It is unlikely that CMS will be able to monitor, analyze, and make any necessary changes prior to July 1, 2016,” the letter states. “The ability of the real-time claims monitoring that CMS uses for items provided in competitive bidding areas to assess the short-term impact of the DMEPOS fee schedule rate reduction in non-competitive bidding areas is questionable.”

CMS started rolling out bid pricing to non-bid areas on Jan. 1. It plans to complete the transition on July 1.

The letter also calls for CMS to monitor changes in the percentage of HME providers accepting Medicare business since Jan. 1, and provide information on beneficiary complaints in those areas.

In March,Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.C., introduced S. 2736, a bill to delay the cuts until at Oct. 1, 2017. It currently has 19 co-sponsors.

Industry stakeholders are working to secure a Democratic co-sponsor for a companion bill in the House of Representatives.

Influential group backs bid bill

WASHINGTON – The National Federation of Independent Business has written a letter of support for S. 2736, a bill that would delay a second round of Medicare reimbursement cuts scheduled for July 1.

The NFIB cites the high proportion of HME providers that are small businesses and the high level of service those companies provide in its letter.

“The next round of the competitive bidding cuts threaten the viability of these small businesses,” the group stated.

AAHomecare says the NFIB represents 325,000 small and independent business owners nationwide and its endorsement carries significant weight on Capitol Hill.

AAHomecare gave a shout-out to Don Jones, president of Southern Medical Equipment Corp., and director of federal affairs for the Alabama Durable Medical Equipment Dealers Association, for securing the NFIB’s support.

The Senate bill would delay the upcoming cuts until Oct. 1, 2017. Stakeholders are working on a companion bill in the House of Representatives.

Groups surveys drivers on sleep apnea

ARLINGTON, Va. – The American Transportation Research Institute has launched an online survey seeking input from commercial drivers on a number of issues related to sleep apnea. ATRI is surveying drivers on their perspectives, personal experiences and knowledge of sleep apnea. It also seeks information on the sleep apnea assessments and treatments that drivers may have received, as well as the perceived effectiveness of those treatments. The survey results will be synthesized with other sleep apnea and driver fatigue research analyses, and then analyzed by several leading sleep apnea experts. The ATRI has made “Understanding the Impacts of Sleep Apnea on Commercial Drivers” one of its top research priorities this year. The survey was initially distributed at the Mid-America Trucking Show in late March, where more than 100 drivers participated.

Alliance continues Ariz. expansion

Prescott, Ariz. – Alliance Homecare has acquired Bradshaw Home Medical, also based in Prescott, Ariz. Valley Healthcare Group, parent to Alliance Homecare, now operates 10 DME locations in Arizona and Nebraska, and 10 accredited sleep centers. “This acquisition helps us to remain focused on providing the best patient care possible, while working to offset the cuts in Medicare in the rural areas,” said Ron Evans, owner of Valley Healthcare Group, in a release. “We now service patients from the southern border of Arizona to Prescott and Prescott Valley, and we are expanding to other areas in Arizona soon, covering 75% of the state’s population from the southern border up to northern Arizona.” The two companies will remain independently owned and operated. Evans, who launched Valley Respiratory Services in 2006 with his wife, has grown his business through acquisitions like Heartland Health Therapy in 2014, RTA Homecare in 2013 and Alliance in 2012.

InfuSystem buys infusion pump assets

MADISON HEIGHTS, Mich. – A subsidiary of InfuSystem Holdings, a national provider of infusion pumps and related services in the U.S. and Canada, has reached an agreement to acquire the infusion pump assets of Philadelphia-based InfusAID. Per the deal, InfuSystem will acquire about 400 infusion pumps from InfusAID, a privately held regional provider of ambulatory infusion pumps and service to medical facilities. “Similar to our acquisition of Ciscura in 2015, the pumps we acquire from InfusAID will come to us with 18 medical facility relationships that will help us gain additional market share as the marketplace continues to consolidate,” Erik Steen, CEO of InfuSystem, stated in a press release. “We also believe this transaction will offer clinicians and patients better access to more affordable in-network care via InfuSystem’s 340-plus insurance payer contracts.”

Docs criticize Medicare’s diabetes policies

LEAWOOD, Kan. – The American Academy of Family Physicians sent a three-page letter to HHS Secretary Sylvia Burwell on April 13, expressing its concerns that the prescribing process for diabetes testing supplies has become “overly burdensome.” Also in the letter: That the competitive bidding program has resulted in patients receiving unbranded or inaccurate supplies. The AAFP argues that it should be acceptable for physicians to write prescriptions for “diabetic supplies” to encompass syringes, needles, test strips, lancets, glucose testing machine, etc., along with frequency. Current policy requires everything from a documented diagnosis to a patient’s testing log. The AAFP also calls on CMS and the FDA to better communicate about the quality and safety of monitoring systems sold under the bid program.

Diabetes manufacturer snags contract

MINNEAPOLIS – Arkray USA has contracted with the 340B Prime Vendor program to provide diabetes care products, including its GlucoCard Shine and GlucoCard Expression meters, to patients in qualifying healthcare facilities. "Arkray's accurate, reliable and easy-to-use diabetes management products help patients of 340B hospitals and clinics live healthier lifestyles and lower healthcare costs," said Arkray USA President Jonathan Chapman.

Drive|DeVilbiss debuts SmartLink app

CHARLOTTESVILLE, Va. – Drive|DeVilbiss Healthcare and WillowTree, a UX design and app development company, have announced the launch of their new SmartLink App for their IntelliPAP 2 CPAP device. The app interfaces with the device wirelessly over Bluetooth, pulling data daily to keep track of patient progress. The app also allows patients to play an interactive role in their therapy: It provides feedback on their therapy; reports for daily, weekly, monthly and yearly usage; notifications for high leak and low usage; reminders for replacing supplies, such as mask and tubing; help videos for setting up and maintaining the unit. “With effortless feedback, clinically relevant notifications and alerts, and tailored, actionable insights into one’s sleep therapy, the SmartLink app will enrich the mundane relationship an individual with sleep apnea traditionally has with their equipment,” said Ed Link, chief marketing officer for Drive|DeVilbiss, in a release. 

People news: Jay Broadbent, Kay Johnson

Kay Johnson, owner of Midwest Medical Services in Watertown, S.D., has been named the 2016 MAMES Above and Beyond Award winner. The award is given to MAMES members who go “above and beyond” in the fight to protect access to quality care. Johnson, who currently serves on several MAMES committees, invited Sen. John Thune, R-S.D., to participate in a meet-and-greet with all MAMES members from South Dakota at Midwest Medical to discuss the impact of the competitive bidding pricing roll out. She alsorecently volunteered to testify in front of the US Small Business Administration on federal regulations impacting her small business...The Small Business Administration has named provider Jay Broadbent Utah Small Business Person of the Year. Broadbent founded Alpine Home Medical in 1997, with a single employee operating out of a delivery van. Today, it is the largest independent HME provider in Utah with nearly 200 employees. Broadbent, CEO, also heads up the B in Motion Foundation with his wife Kristie to provide wheelchairs and other mobility equipment to users who can’t afford it. Broadbent and the winners from the other 49 states and U.S. territories will be honored in Washington, D.C, in May.

Short takes: Medtrade, URise Products, Valumatrix

Medtradeshow organizers are accepting submissions for conference session ideas until May 9. Ideas should address one of these tracks: audits, business operations, competitive bidding, continuing education and training, executive leadership, keeping it legal, retail/caretail, sales and marketing, sleep/oxygen or strategic planning. This year’s event takes place Oct. 31-Nov. 3 at the Georgia World Congress Center in Atlanta…The Doctors TV show on April 25 will air its inaugural “Funder Games,” featuring five healthcare startups with audience members voting on the new best product. The winner: URise Products and its just launched StandUp Walker. The walker is a stand-assist device combined with a modern take on a mobility walker…Valumatrix has signed an agreement to offer publishing services, including its “The Fifth Element Employee Newsletter,” through the Innovatix and Essensa Group Purchasing Portfolio. Innovatix is the nation’s leading non-acute care supply chain solutions company and GPO, serving 32,000 member pharmacies, senior living facilities and independent medical oncologists.

Stock movers: Ray Huggenberger, Mick Farrell

Inogen CEO Ray Huggenberger sold more than half of his shares in the company in a transaction April 15. He sold 29,635 shares at an average price of $48.59 for a total value of $1.44 million. He now owns 25,210 shares…ResMed CEO Mick Farrell sold 5,975 shares at an average price of $59.34 in a transaction on April 15 valued at $354,556. He now owns 154,723 shares.

Senate Finance leaders urge delay of bid pricing

HME News - Wed, 04/20/2016 - 09:53
04/20/2016HME News Staff

WASHINGTON – Senate Finance Committee leaders have asked CMS to delay applying the next round of Medicare reimbursement cuts in rural areas.

In an April 18 letter to Health and Human Services Secretary Sylvia Burwell, Finance Committee Chairman Orrin Hatch, R-Utah, and Ranking Member Ron Wyden, D-Ore., express their concerns that six months isn’t long enough to detect and correct problems with the rollout of competitive bidding to non-bid areas.

“It is unlikely that CMS will be able to monitor, analyze, and make any necessary changes prior to July 1, 2016,” the letter states. “The ability of the real-time claims monitoring that CMS uses for items provided in competitive bidding areas to assess the short-term impact of the DMEPOS fee schedule rate reduction in non-competitive bidding areas is questionable.”

CMS started rolling out bid pricing to non-bid areas on Jan. 1. It plans to complete the transition on July 1.

The letter also calls for CMS to monitor changes in the percentage of HME providers accepting Medicare business since Jan. 1, and provide information on beneficiary complaints in those areas.

In March, Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.C., introduced S. 2736, a bill to delay the cuts until at Oct. 1, 2017. It currently has 19 co-sponsors.

Industry stakeholders are working to secure a Democratic co-sponsor for a companion bill in the House of Representatives.

Influential group backs bid bill

HME News - Tue, 04/19/2016 - 09:59
04/19/2016HME News Staff

WASHINGTON – The National Federation of Independent Business has written a letter of support for S. 2736, a bill that would delay a second round of Medicare reimbursement cuts scheduled for July 1.

The NFIB cites the high proportion of HME providers that are small businesses and the high level of service those companies provide in its letter.

“The next round of the competitive bidding cuts threaten the viability of these small businesses,” the group stated.

AAHomecare says the NFIB represents 325,000 small and independent business owners nationwide and its endorsement carries significant weight on Capitol Hill.

AAHomecare gave a shout-out to Don Jones, president of Southern Medical Equipment Corp., and director of federal affairs for the Alabama Durable Medical Equipment Dealers Association, for securing the NFIB’s support.

The Senate bill would delay the upcoming cuts until Oct. 1, 2017. Stakeholders are working on a companion bill in the House of Representatives.

Bid bill has sticking point in the House

HME News - Fri, 04/15/2016 - 13:04
04/15/2016Theresa Flaherty

WASHINGTON – One month after the introduction of a Senate bill to delay competitive bidding cuts, industry stakeholders are still working to get a Democratic co-sponsor for a House companion bill.

The sticking point: The bill’s “pay-for,” which would speed up plans to limit federal Medicaid reimbursement for DME to the Medicare payment rates from Jan. 1, 2019, to Oct. 1, 2018.

“There’s a concern that, from a policy standpoint, we don’t want a pay-for that affects the senior or disability population,” Tom Ryan, president and CEO of AAHomecare. “We are trying to get some of that population to respond that the reality is that to move up the Medicaid pay-for three months on just those competitive bid items, that is not going to be as devastating as another 25% cut across rural America and the non-bid areas.”

The first round of cuts in non-bid areas went into effect Jan. 1. The second round of cuts are scheduled for July 1. The Senate bill, S. 2736, would delay the second round of cuts until Oct. 1, 2017.

Stakeholders say the good news is that lawmakers in the House are receptive to the meat of the bill. They believe the companion bill will drop in the next few weeks.

“There are always hurdles and this is just another hurdle we have to work through,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “The cuts, just on the face of it, are so dramatic.”

The Senate bill, introduced March 17 by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.C., currently has 19 co-sponsors, including Sen. Rob Portman, R-Ohio, who signed on April 13. To boost support, AAHomecare last week hired an additional lobbyist, Jenn Higgins, a partner with Chamber Hill Strategies.

“She knows our issues extremely well and she’s passionate about our issues,” Ryan said.

Adding fuel to the fire that bid program is unsustainable: the recently released single payment amounts for the Round 2 re-compete, which saw an average reduction of 7.1%, over and above the original Round 2, according to an analysis by AAHomecare. CMS is in the process of offering 12,181 contracts to 637 bidders, but word on the street is that many providers are turning down the business.

“We are seeing a lot of folks backing away,” said John Gallagher, vice president of government relations for The VGM Group. “They are saying they can’t do it.”

NewsPoll: Are bid contracts ‘worth it’?

HME News - Fri, 04/15/2016 - 13:01
04/15/2016Tracy Orzel

YARMOUTH, Maine – Respondents to a recent HME NewsPoll are split over whether accepting a competitive bidding contract from Medicare is a good idea.

Fifty-four percent of respondents said that, in general, they did not accept the majority of the contracts they were offered, while 32% said they accepted a contract the first time around, but not the second.

One reason: “(It’s) not worth it,” said Jill Duda, business operations manager at Philadelphia-based Flagship Medical, of the decrease in reimbursement rates and the increase in paperwork.

Another respondent, who only accepted one of six contracts (for enteral) during Round 2, said the threat of damaging their reputation of providing quality products and service far outweighed the threat of losing business.

Others say business is doing just fine without contracts—in some cases, better.

David Beshoar, president of MedServ Equipment based inPalatine, Ill., was awarded contracts for Round 2, but did not accept any due to low reimbursement, nor did he submit bids for the Round 2 re-compete.

“In spite of not being able to bill Medicare for the last two-and-a-half years, our revenue and profits continue to increase,” he said.

Meanwhile, some providers felt they had to accept the contracts to survive.

“I hate to say (it), but we have no choice, even if it means these patients are going to get less care than ever,” wrote another.

One health system-owned HME company said it accepted Round 2 re-compete contracts so it can provide better care. It failed to receive contracts for Round 2, resulting in late discharges, longer lengths of stay and an increased chance of readmissions.

“The Round 2 re-compete allowed us to bid aggressively to be able to support the continuum of care throughout our community and ensure timely, fluid and safe discharges from all campuses,” the respondent said. “While the margins are thin, the outcomes will counter the risk associated with fragmented providers.”

Thin as they are, those who accepted contracts say they’re committed to making it work.

“We will look into getting price concessions from vendors; scale down our workforce; deliver less; and seek operational efficiencies,” said another respondent. “We will also look to continue focusing our business on non-Medicare patients and non-competitive bid items.”

Regulatory review: Suspensions, overpayments and exemptions

HME News - Fri, 04/15/2016 - 12:59
04/15/2016Liz Beaulieu

WASHINGTON – From a regulatory perspective, the first several months of 2016 have brought pain, and a little bit of relief, to HME providers.

Among the pain points, says Wayne van Halem, is the new level of aggressiveness in the actions taken by the ZPICs. The contractors are handing out payment suspensions where, previously, they may have handed out overpayment demands, he says.

“Some of the reasons for suspensions are ridiculous,” said van Halem, president of The van Halem Group. “Because CMS is reorganizing their contracts, I have a sneaking suspicion the ZPICs are trying to show CMS that they meet all of the contract requirements.”

An example of a reason for suspension, van Halem says: allegedly leading a physician on an order by using a form titled “Power Mobility Device Order,” even though the form came from the DME MAC.

Another pain point is a new rule that went into effect in March that requires providers to disclose overpayments within 60 days, something that has been an expectation in the past but is now in writing.

“It depends on your volume of claims, but this is a pretty common occurrence,” van Halem says.

Additionally, there’s a new batch of SMRC audits, this time focusing on oxygen equipment, nebulizers and CPAP devices.

The SMRC audits, which involve submitting additional documentation, are straightforward but time consuming, especially for larger providers, says Stephanie Morgan Greene, a healthcare attorney who’s executive vice president of business development for ACU-Serve.

“Our larger clients that have multiple locations are getting SMRC audits for each location for each of the product categories,” she said. “One client has received its 10th audit at 40 claims a piece. It’s a lot of work.”

On the other side of the spectrum: The RACs have started rewarding providers with low error rates by exempting them from certain audits. Three hundred and thirty PTANs have received exemption letters in one or more categories in Jurisdiction C, says Andrea Stark.

“We’ve also seen letters in Jurisdiction D,” said Stark, a reimbursement consultant with MiraVista. “We’re definitely seeing that in action.”

Tool provides first look at severity of audits

HME News - Fri, 04/15/2016 - 12:57
04/15/2016HME News Staff

WASHINGTON – Twelve percent of HME claims for new patients, on average, were subject to MAC prepayment audits in the fourth quarter of 2015, according to data collected through AAHomecare’s HME Audit Key.

Drilling down by product category, 22% of hospital beds, support surfaces and manual wheelchair claims were subject to audits, followed by 16% of orthotics and prosthetics, and 14% of respiratory equipment.

“These results are a first step in a comprehensive effort to collect data that demonstrates the burdensome nature of audits, in terms of volumes and overturn rates,” AAHomecare stated in its weekly bulletin.

Nationwide, 78% of providers appealed denials, with O&P leading the way with a 98% appeal rate, followed by ostomy, urological and wound care supplies at 87%.

Upon review, 60% of claims for hospital beds, support surfaces and manual wheelchairs were paid. For O&P and respiratory equipment, 15% and 74%, respectively were paid.

AAHomecare will begin accepting data for the first quarter of 2016 on April 16.

“The HME industry needs reliable and representative data to better demonstrate the burdensome nature of audits,” the association stated. “We must build our capabilities to accurately detail how the industry is being impacted to finally secure much-needed reform to the audit process.”

AAHomecare went live with the HME Audit Key earlier this year. Prior to its launch, the association raised $250,000 to develop the tool.

In brief: OIG sticks to script, Aeroflow accepts chunk of contracts

HME News - Fri, 04/15/2016 - 12:55
04/15/2016HME News Staff

WASHINGTON – The Office of Inspector General has reiterated its recommendation that CMS match Medicaid reimbursement rates for HME to Medicare rates.

The recommendation, published this week in the OIG’s April 2016 “Compendium of Unimplemented Recommendations,” suggests that CMS seek legislative authority to limit Medicaid reimbursement rates for DMEPOS to Medicare rates and further reduce those rates through competitive bidding or manufacturer rebates.

Lowered reimbursement rates could result in approximately $30.1 million in potential savings for states and the federal government, according to the OIG.

CMS concurred with the OIG’s recommendation. The agency says it has sought legislative authority to make the changes but additional congressional action is needed.

CMS also pointed out that the president’s proposed budget for fiscal year 2016 includes a similar proposal for lowering Medicaid reimbursement rates.

Additionally, “States have the flexibility to administer their Medicaid programs in accordance with a CMS-approved state plan,” the agency says. “CMS communicates frequently…to inform them of all available options, including manufacturer rebates and competitive bidding procedures.”

The OIG believes that, if enacted, the expected savings would be $4.27 billion over a 10-year period.

Aeroflow lands 645 bid contracts, seeks subcontractors

ASHVILLE, N.C. – Aeroflow Healthcare has received 645 contract offers for 108 competitive bidding areas as part of the Round 2 re-compete, the provider has announced. Aeroflow, which already works with more than 100 subcontractors in 39 states as part of previous rounds of the program, plans to add more subcontractors for the Round 2 re-compete. “Aeroflow supports its partners through continued use of technology, increased marketing support, and leverage of its infrastructure that allows partners to continue growing market share,” the company stated in a press release. Aeroflow has a dedicated team that works solely with subcontractors. For the Round 2 re-compete, it received contract offers for enteral, general HME, nebulizers, negative pressure wound therapy pumps, respiratory equipment, standard mobility and transcutaneous electrical nerve stimulation.

Wheel:Life partners with BLVD.com

ATLANTA – Wheel:Life and BLVD.com have joined forces to help more disabled consumers locate and acquire adaptive vehicles for personal use. Wheel:Life readers will have access to a series of informational articles on accessible vehicles and direct links to locate them on BLVD.com, a website that connects individuals with accessible vehicle dealers. They will also have the ability to list their adapted vehicle on the “for sale by owner” section of the website. “One of the most urgent needs within our audience is finding reliable, accessible transportation,” said Lisa Wells, director of Wheel: Life, in a release. “Not everyone has the financial resources to buy a brand new, customized vehicle straight off the lot.”

Court orders PharMerica to pay $48.5M tab

LOUISVILLE, Ky. – A circuit court judge has told PharMerica Corp., a national provider with 17 specialty home infusion pharmacies, to honor outstanding invoices from AmerisourceBergen Drug Corp. for about $48.5 million. PharMerica has withheld payment and applied the invoice amounts against rebates and other amounts that it believes AmerisourceBergen owes the provider, which are in excess of $48.5 million. But the Jefferson County Kentucky Circuit Court ruled on April 1 that PharMerica must pay the invoices even if AmerisourceBergen failed to pay the provider for rebates and other amounts owed. PharMerica plans to appeal. It says it is in the process of obtaining a bond that will prevent it from having to pay AmerisourceBergen while an appeal is pending. In addition to the specialty home infusion pharmacies, PharMerica operates 94 institutional pharmacies, and five specialty oncology pharmacies in five states. AmerisourceBergen is the provider’s former wholesale supplier of pharmaceutical products.

ResMed files new claim against 3B Medical

SAN DIEGO – ResMed has filed new legal action with the United States International Trade Commission seeking to stop what it claims is patent infringement by Chinese manufacturer BMC Medical and its U.S. distributor 3B Medical. ResMed claims that two of the manufacturer’s flow generators, the RESmart and Luna, infringe on two claims of ResMed’s patent.In response, 3B issued a press release stating that ResMed’s filing of another patent case is an attempt to “stifle legitimate and fair competition.” 3B also pointed out that, most recently, the United States Patent and Trademark Office issued a series of judgments declaring certain patent claims by ResMed as invalid.

Universal Software, IMCO partner up

DAVISON, Mich., and TAMPA, Fla. – Universal Software Solutions has partnered with IMCO Home Care to offer Healthcare Data Management System—its fully integrated practice management solution—to HME providers. “This new relationship we have with IMCO Home Care is a winning combination for everyone,” said Christopher Dobiesz, president of Universal Software. “The logical and commonsense approach within HDMS creates an environment that is fast to learn, easy to use, and provides built-in intelligence that all directly create noticeable efficiencies.” IMCO is a member services group for independent medical wholesalers serving the acute care, long term care, primary care and home care markets.

HOMES names award winners

NEW BEDFORD, Mass. – The Home Medical Equipment and Services Association of New England has announced its 2016 award recipients. They are: Outstanding Volunteer Award, Jason Morin of Home Care Specialists and Thomas French of Apria Healthcare; Christopher J. Denmark Commitment to Excellence Award, Tamme Dustin of Herron & Smith; and April Mason Homecare Advocacy Award, Rep. Bill Keating, D-Mass. The awards will be presented at the HOMES/NYMEP annual meeting in May.

SpinLife offers scholarship opportunity

COLUMBUS, Ohio – SpinLife, a direct-to-consumer DME retailer, is now accepting applications for its 2016 SpinLife Innovation in Motion Scholarship program. The annual competition is open to manual and power wheelchair users enrolled at an accredited four-year college or university. Applicants must submit an essay or poem, painting, or another medium to expresses what "life in motion"—this year’s theme—means to them. SpinLife will award a $1,000 scholarship to the winner and $500 gift cards to SpinLife.com to two runners-up.

Responsive Respiratory expands offering

ST. LOUIS – Responsive Respiratory has added M6 and E cylinder sizes to their selection of home filling cylinders. The expanded line integrates with the manufacturer’s home filling system, allowing providers a choice in obtaining cylinders and accessories to fill patient needs. “We know providers are feeling the pain of reduced reimbursements and are looking at every avenue available to reduce costs and streamline their business, while continuing to service the needs of their patients,” said Tom Bannon, president, in a release. “The expansion into M6 and E home filling cylinders was driven by customer need—the need to adapt existing equipment to meet the changing service and ambulatory requirements of their patients.”

 

 

Tool provides first look at severity of audits

HME News - Thu, 04/14/2016 - 09:35
04/14/2016HME News Staff

WASHINGTON – Twelve percent of HME claims for new patients, on average, were subject to MAC prepayment audits in the fourth quarter of 2015, according to data collected through AAHomecare’s HME Audit Key.

Drilling down by product category, 22% of hospital beds, support surfaces and manual wheelchair claims were subject to audits, followed by 16% of orthotics and prosthetics, and 14% of respiratory equipment.

“These results are a first step in a comprehensive effort to collect data that demonstrates the burdensome nature of audits, in terms of volumes and overturn rates,” AAHomecare stated in its weekly bulletin.

Nationwide, 78% of providers appealed denials, with O&P leading the way with a 98% appeal rate, followed by ostomy, urological and wound care supplies at 87%.

Upon review, 60% of claims for hospital beds, support surfaces and manual wheelchairs were paid. For O&P and respiratory equipment, 15% and 74%, respectively were paid.

AAHomecare will begin accepting data for the first quarter of 2016 on April 16.

“The HME industry needs reliable and representative data to better demonstrate the burdensome nature of audits,” the association stated. “We must build our capabilities to accurately detail how the industry is being impacted to finally secure much-needed reform to the audit process.”

AAHomecare went live with the HME Audit Key earlier this year. Prior to its launch, the association raised $250,000 to develop the tool.

OIG sticks to script on Medicaid pricing

HME News - Wed, 04/13/2016 - 12:40
04/13/2016HME News Staff

WASHINGTON – The Office of Inspector General has reiterated its recommendation that CMS match Medicaid reimbursement rates for HME to Medicare rates.

The recommendation, published this week in the OIG’s April 2016 “Compendium of Unimplemented Recommendations,” suggests that CMS seek legislative authority to limit Medicaid reimbursement rates for DMEPOS to Medicare rates and further reduce those rates through competitive bidding or manufacturer rebates.

Lowered reimbursement rates could result in approximately $30.1 million in potential savings for states and the federal government, according to the OIG.

CMS concurred with the OIG’s recommendation. The agency says it has sought legislative authority to make the changes but additional congressional action is needed.

CMS also pointed out that the president’s proposed budget for fiscal year 2016 includes a similar proposal for lowering Medicaid reimbursement rates.

Additionally, “States have the flexibility to administer their Medicaid programs in accordance with a CMS-approved state plan,” the agency says. “CMS communicates frequently…to inform them of all available options, including manufacturer rebates and competitive bidding procedures.”

The OIG believes that, if enacted, the expected savings would be $4.27 billion over a 10-year period.

Diabetes group calls on Congress to #SuspendBidding

HME News - Fri, 04/08/2016 - 12:58
04/08/2016Theresa Flaherty

TAMPA, Fla. – With drastically reduced payment amounts for diabetes test strips looming, advocates have taken to social media to call for a suspension of Medicare’s competitive bidding program.

“I think that social media has become what used to be the town square,” said Bennet Dunlap, co-founder of the Diabetes Patient Advocacy Coalition. “So, hopefully, social media can do some social good.”

DPAC last week launched a campaign calling for the immediate suspension of competitive bidding for diabetes testing supplies. The patient advocacy group has created the Suspend Bidding Action Center (www.diabetespac.org/suspendbidding) for site visitors to learn more about the issue, and help them to email their lawmakers and tweet members of Congress using the hashtag #SuspendBidding.

CMS on *March 15 announced single payment amounts for the Round 2 re-compete of competitive bidding, as well as the national mail-order program for diabetes supplies. The new payment amount for test strips is *$8.32 per box compared to $10.41 per box for the original Round 2.

“I hope people will feel concerned enough to say, ‘I don’t have all the details, but hey, Congress, let’s get some experts in there and look into this in the meantime,’” said Dunlap.

Although CMS says there has been no disruption in access to diabetes supplies as a result of payment reductions, a *study by the National Minority Quality Forum, first presented in June and recently published in the prestigious medical journal Diabetes Care, found not only decreased access, but also increased hospitalizations and deaths in test markets.

“My fear is that as we drive the price down, we drive quality out of the market,” said Dunlap. “Price conscious buyers will buy the cheapest strips and insulin is a very dangerous drug.”

DPAC joins a number of organizations calling for a suspension of the program, including the American Association of Clinical Endocrinologists (AACE), the American Association of Diabetes Educators (AADE) and the National Diabetes Volunteer Leadership Council (NDVLC).

*DPAC is a non-profit advocacy group for diabetes patients that launched in 2015.

http://hmenews.com/article/week-brings-volley-bid-related-items

http://hmenews.com/article/study-slams-bid-program-calls-suspension

http://hmenews.com/blog/pricing-test-strips-takes-dive-where-reaction

http://hmenews.com/article/diabetes-search-safety-quality-and-access-col...

Home infusion market refuses to stand still

HME News - Fri, 04/08/2016 - 12:57
04/08/2016Theresa Flaherty

YARMOUTH, Maine – When it comes to mergers and acquisitions in the home infusion space, analysts report seeing a “blurring of the lines” among its different segments.

“Just like our HME channels are blurring lines between providers and insurers, the same thing is happening with home infusion,” said Jonathan Sadock, managing partner with Paragon Ventures. “It’s becoming where it is not unusual to find an infusion provider and a specialty pharmacy all rolled together.”

Other channels that are showing interest in home infusion include long-term care pharmacy, retail pharmacy and hospitals.

Hospitals have been interested for some time, say analysts.

“There’s consolidation in the hospital space and as they become larger and larger they are under pressure to keep patients out of the hospital,” said Reg Blackburn, a managing director with The Braff Group. “One way to do that is to control home health, a component of which is home infusion. It’s just continued interest on their part.”

As has been the story for the past few years, despite high demand, inventory remains low, say analysts. They also say the mega-mergers of the recent past—including CVS Caremark’s 2013 acquisition of Coram for $2.1 billion and Madison Dearborn Partners’ 2015 acquisition of 51% of Walgreens Infusion Services (since rebranded as Option Care)—are a thing of the past. Instead, buyers are setting their sights on the lower end of the market.

“Buyers prefer companies with at least $10 million in revenues or larger, but there aren’t that many companies that are much bigger than $10 million or $20 million,” said Justin Ishbia, founder and managing partner of Shore Capital Partners, a private equity firm that used to own a home infusion company. “But, it’s also been my experience that once a business is more than $5 million in revenues, that’s an area where people start paying attention.”

And where are the big players in all this? After taking time to digest their respective acquisitions, both CVS Caremark and Option Care will likely be on the hunt for acquisitions.

“CVS is definitely on the acquisition trail from what we are hearing,” said Bruce Burns, president of Affinity Ventures. “Option Care has been silent, but sooner rather later, they’ll start buying. Madison Dearborn didn’t buy it to stand still.”

New ATP test offers chance to set new bar

HME News - Fri, 04/08/2016 - 12:56
04/08/2016Tracy Orzel

ARLINGTON, Va. – Starting in July, those taking RESNA’s ATP exam will have one less subject to study for and the opportunity to help determine the passing score.

While the updated exam will remain the same length and scope, it will no longer include U.S.-centric funding questions to better reflect the growing internationalization of assistive technology. 

“The new exam should not be any more difficult—nor easier—than any previous rendition of the test,” said Julie Piriano, director of rehab industry affairs at Pride Mobility and a RESNA board member.

RESNA periodically conducts an analysis to ensure the test reflects current assistive technology practice.

The foundation of the test will remain the same because, while technology has advanced since the last time the exam was updated in 2009, the concepts used to identify and meet the needs of individuals with disabilities have not, Piriano says.

“The test doesn’t test for technological advances, but rather the concepts with which they are applied,” she said.

To get as many people as possible to take the new test, RESNA is offering a $100 discount off the regular $500 exam feefor those who sit for the test between July 1, 2016, and Oct. 31, 2016. After that window of testing has closed, RESNA consultants will evaluate the performance data and set the passing cut off score.

“It’s a good time to test the water,” said Piriano. “The test costs you a little bit less and you’re part of the group that is setting the passing score.”

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