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Updated: 6 hours 33 min ago

Diabetes supplier dropped from lawsuit

Thu, 11/30/2017 - 14:29
11/30/2017HME News Staff

INDIANAPOLIS – J&B Medical Supply has been dismissed from a lawsuit alleging it had sold blood glucose test strips under the retail pharmacy benefit rather than the DME benefit.

All charges were dismissed without prejudice and without costs, according to a court filing.

The lawsuit, filed earlier this year by Roche Diagnostics and Roche Diabetes Care, claimed that they wrongfully paid millions of dollars in rebates in lost millions of dollars in legitimate sales to an alleged scheme by several pharmacies and medical supply companies.

J&B Medical at the time said it stopped purchasing test strips from Roche in 2009.

In addition to the Wixom, Mich.-based J&B Medical, the suit named several other Michigan companies: Binson’s Hospital Supplies and Northwood, both of Centerline; Olympus Global in East Lansing; and Delta Global in Flint; as well as Alpha XE in Cheyenne, Wyoming.

HHS details status of appeals backlog

Wed, 11/29/2017 - 14:33
11/29/2017HME News Staff

FALLS CHURCH, Va. – The Office of Medicare Hearings and Appeals receives more than a year’s worth of appeals work every 24 weeks at the third level of appeals, according to a recent PDF posted to the agency’s website.

As of the end of the fourth quarter of fiscal year 2016, the pending workload at the administrative law judge level exceeded 650,000 appeals, while annual adjudication capacity going forward was about 92,000 appeals, according to the “HHS Primer: The Medicare Appeals Process.”

At the first and second level of appeals, CMS is currently meeting its statutory timeframes to process appeals and is not experiencing a backlog, HHS says.

At the fourth level of appeals, the Medicare Appeals Council is currently receiving more than a year’s worth of appeals work every 10 weeks. As of the end of the fourth quarter of fiscal year 2016, the pending workload at the council exceeded 22,000 appeals, while annual adjudication capacity was about 2,600 appeals, HHS says.

Several companies are generating a significant portion of the appeals backlog, HHS says. Four DME companies and one state Medicaid agency filed 51% of appeals at the ALJ level in the first quarter of fiscal year 2015, it says. Three DME companies filed 35% of the appeals at the second level of appeals, or the QIC level, in 2015 compared to just 12% in 2012.

HHS says the current appeals structure encourages appellants to appeal every claim because there is no filing fee and because the minimum amount in controversy required for an ALJ hearing, $160, is substantially lower than the amount required for judicial review, $1,560.

HHS says it has a three-pronged approach to addressing the backlog and improving the system: invest new resources at all levels of appeal to increase adjudication capacity and implement new strategies to alleviate the current backlog; take administrative actions to reduce the number of pending appeals and encourage resolution of cases earlier in the process; and propose legislative reforms that provide additional funding and new authorities to address the appeals volume.

Without administrative action, HHS estimates the appeals backlog at OMHA will exceed 1.5 million by the end of fiscal year 2021.

CMS starts implementation process for Cures provision

Tue, 11/28/2017 - 12:47
11/28/2017HME News Staff

WASHINGTON – CMS wants state Medicaid programs to submit their DME fee schedules using a new spreadsheet to make sure they’re not paying too much for equipment, according to a notice in the Federal Register.

CMS says the spreadsheet will help the agency comply with a provision in the 21st Century Cures Act that requires it to cap Medicaid reimbursement for DME at Medicare reimbursement starting Jan. 1, 2018.

“We would require the minimal amount of information be collected from states to comply with this statute (at 8 hours per state per year),” the agency states in the notice. “More specifically, we would ask states to demonstrate compliance by filling in their DME fee schedules onto the new spreadsheet page with the relevant information—HCPCS code series A, K, and E only, that are relevant to this information collection of durable medical equipment.”

CMS is accepting comments on the new program through Jan. 29, 2018.

Industry stakeholders have been waiting for details on how CMS plans to comply with the provision in the Cures Act. The provision was included in the act as a “pay-for.”

All eyes on House bill for manual accessories

Wed, 11/22/2017 - 11:05
11/22/2017Liz Beaulieu

WASHINGTON – With the clock ticking on 2017, stakeholders have zeroed in on increasing the number of co-sponsors for a bill in the House of Representatives that would protect accessories for complex rehab manual wheelchairs.

At press time, H.R. 3730, which would exempt these accessories from competitive bidding pricing, had 49 co-sponsors.

“We’re staying in regular contact with our champions and what they’ve told us is, stay focused on building the level of support for the bill,” said Seth Johnson, senior vice president of government affairs for Pride Mobility Products. “It’d be great to get the number of co-sponsors to 75-80.”

A previous bill that would have exempted accessories for both complex rehab power and manual wheelchairs from bid pricing had more than 100 co-sponsors.

Stakeholders had also been working on getting a companion bill introduced in the Senate, but while they still have support there from Sens. Bob Casey, D-Pa., and Rob Portman, R-Ohio, they’re running out of time.

“When the House passes the bill and it comes over to the Senate, (Casey and Portman) will look to move it through the process,” Johnson said. “They’re supportive, but they’re also wrapped up in other healthcare-related issues.”

With all eyes now on the House bill, stakeholders are working to increase the number of co-sponsors, while their champions navigate possible legislative vehicles or stand-alone opportunities in a chaotic Congress.

“It’s a two-edged sword,” said Don Clayback, executive director of NCART. “On the one hand, this is an issue that is known in Congress and that they have been working on for three years; on the other hand, it’s a small issue amid many other bigger issues.”

But stakeholders and their champions have pulled off last-minute successes before, in December of 2015 and 2016, when they were able to delay CMS’s plans to apply bid pricing to accessories. CMS then dropped plans to apply the pricing for complex rehab power wheelchairs in June, but not for complex rehab manual wheelchairs.

“We’re just asking Congress to complete the circle,” Clayback said.

 

Stakeholders call on CMS to overhaul prosthetic policies

Wed, 11/22/2017 - 11:03
11/22/2017Theresa Flaherty

BOSTON – A growing gap between technology advancements and what Medicare and other payers will cover creates safety issues for amputees, says a new study.

The Rand Corporation, in a study released in October, says microprocessor-controlled knees (MPKs) prevent falls better than older artificial lower limbs. Twenty-six percent of patients with MPK limbs fall per year, compared to 82% of patients with non-MPK limbs.

“As a clinician, I have experienced with my patients that they are at a greater risk of falling when they do not have access to MPK technology,” said Dr. Michael Oros, CPO and president of the American Orthotic and Prosthetic Association during a press conference. “Stability and safety mean everything to amputees.”

MPK devices do cost more than non-MPK devices: $15,083 per year vs. $13,382 per year. But they are associated with a reduction of $3,676 per year in direct health costs and $909 in indirect costs such as lost wages, according to the study.

“Are the extra costs in line with other things that we fund?” said Dr. Soeren Mattke, managing partner, Health Care Practice, for the Rand Corporation. “Amputees have a much lower probability of falls with MPK and that translates to follow-on costs and quality of life implications.”

Despite advances in technology, Medicare total payments for prosthetics declined 15% between 2010 and 2014. Additionally, in 2015, the four DME MACs released draft local coverage determinations for lower limb prosthetics that would severely limit access to K3 and K4 devices.

CMS needs to overhaul its policies to better reflect technological advances. Even MPKs, which are considered “new” by prosthetic standards, have been around for nearly 20 years, says Oros.

“The current operating environment for coverage is outdated and needs to change,” he said.

In brief: MedPAC recommends CMS shift more products into bid program, AmerisourceBergen buys H.D. Smith

Wed, 11/22/2017 - 10:55
11/20/2017HME News Staff

WASHINGTON – The Medicare Payment Advisory Committee made payment policy recommendations for non-competitively bid DMEPOS during a meeting earlier this month, according to Epstein Becker & Green, a healthcare law firm. MedPAC plans to recommend that CMS shift more products away from the “excessive” fee schedule to bid rates. It also plans to call for “immediate reduced payment rates for certain non-CBP products while CMS works on incorporating them into the CBP,” the law firm reports in a post for The National Review. Alternatively, MedPAC plans to recommend a policy option that would have CMS consider capping balance billing at a percentage of the fee schedule rate and reduce the allowed amount by 5% for non-participating providers, the law firm reported.

AmerisourceBergen buys H.D. Smith

VALLEY FORGE, Pa., and SPRINGFIELD, Ill. – AmerisourceBergen will purchase H.D. Smith for $815 million in cash, the two companies have announced.

H.D. Smith is among the largest wholesalers in the country, providing a full line of brand name, generic and specialty drugs from 10 distribution centers across the U.S.

“The acquisition of H. D. Smith strengthens our core business and expands and enhances our strategic scale in U.S. pharmaceutical distribution,” said Steven Collis, chairman, president and CEO of AmerisourceBergen, a provider of pharmaceutical products that generates more than $150 billion in annual revenues.

H. D. Smith subsidiaries Triplefin, a pharmaceutical brand support provider, and Arete Pharmacy Network, a pharmacy services administrative organization, are not part of the acquisition.

AmerisourceBergen plans to fund the acquisition through the issuance of new long-term debt.

The acquisition is expected to be slightly accretive to AmerisourceBergen’s adjusted diluted earnings per share in fiscal year 2018, and be about $0.15 accretive to adjusted EPS in fiscal year 2021.

For fiscal year 2018, AmerisourceBergen now expects revenue growth to be in the range of 8% to 11%, adjusted operating income growth to be in the range of 4% to 7%, and operating growth income for its Pharmaceutical Distribution Services segment to be in the range of 4% to 7%.

The acquisition is subject to regulatory review and other closing conditions, and is expected to close in early calendar 2018.

Part B premiums, deductibles remain stable for 2018

WASHINGTON – The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same as 2017, CMS has announced.

Some beneficiaries who were protected from Part B premium increases in prior years will have increases in 2018, but they will be offset by the increases in their Social Security benefits next year, CMS says.

“Medicare’s top priority is to ensure that beneficiaries have choices for affordable, high-quality care that fit their needs,” said CMS Administrator Seema Verma. “Next year, no beneficiary protected by the hold-harmless provision will see a Part B premium increase that is greater than the increase in their Social Security benefits. We encourage Medicare beneficiaries to explore their options to make an informed choice between original Medicare and Medicare Advantage before Open Enrollment ends on Dec. 7.”

The average monthly premium for Medicare Advantage enrollees will drop to about $30 in 2018, about a 6% decrease compared to 2017, CMS estimates. More than 77% of Medicare Advantage enrollees remaining on their current plans will have the same or lower premiums for 2018, the agency says.

The annual deductible for all Medicare Part B beneficiaries will be $183 in 2018, the same as 2017.

Providers meet with Verma

MODESTO, Calif. – Representatives of Home Oxygen Company attended a Nov. 20 meeting with Rep. Jeff Dunham, R-Calif., and CMS Administrator Seema Verma to discuss the challenges of rural providers in California. “Administrator Verma was very attentive to our needs and knowledgeable of our challenges,” said Andrea Ewert, president and CEO of Home Oxygen Company. “Our representatives were able to articulate the challenges of running a business and serving Medicare beneficiaries in this financially compressed market.” Denham is a co-sponsor of H.R. 4229, which seeks to extend a retroactive delay of a second round of reimbursement cuts in non-bid areas from Jan. 1, 2017, to Jan. 1, 2019. The bill currently has 71 co-sponsors.

Aeroflow partners with Stratice to digitize orders

ASHEVILLE, N.C. – Aeroflow Breastpumps & Urology has partnered with Stratice Healthcare to use eOrdersPlus to digitize orders for medical equipment. eOrdersPlus, developed and operated by Stratice Healthcare, allows Aeroflow to capture documentation, physician signatures and other order-related information using a cloud-based solution. “We are always looking for additional avenues that ease the process for our partners and provide higher quality patient care," said Amanda Baethke, strategic partnerships manager at Aeroflow Healthcare. "Their system links to all the major EHR platforms in our area, and provides an easy way for physicians to prescribe to us directly.”eOrdersPlus eliminates multiple phone calls, duplicate faxes and time-consuming data entry, creating a better experience from start to finish, Aeroflow says.

ResMed study results published in CHEST

SAN DIEGO – Patient engagement apps significantly improve adherence to CPAP therapy, according to a ResMed study now published in CHEST. Patients whose nightly use was remotely and self-monitored via ResMed’s Airview and myAir platforms were more than 87% adherent on therapy, compared to 70% of those only remotely monitored, according to the study. “CHEST’s publication is a significant call for clinicians to recommend self-monitoring tools for PAP patients,” said Carlos Nunez, M.D., ResMed’s chief medical officer. “I also believe these tools could help patients on therapies beyond sleep as well, since half of all patients don’t take their medications as prescribed.” ResMed has billed the study, first presented at the CHEST 2016 conference in Los Angeles, as the world’s largest to look at sleep apnea and self-monitoring, with 128,000 patients participating.

Toyota challenge to benefit people with lower-limb paralysis

LOS ANGELES – The Toyota Mobility Foundation, in partnership with Nesta’s Challenge Prize Centre, has launched a $4 million global challenge to change the lives of people with lower-limb paralysis, culminating with the unveiling of winners in Tokyo in 2020. The challenge seeks teams around the world to create game-changing technology that will help radically improve the mobility and independence of paralyzed people. Technology could include anything from exoskeletons, to artificial intelligence and machine learning, to cloud computing. A panel of expert judges will pick five finalists who will each receive $500,000 to take their concepts from an intelligent insight to a prototype. The winner will receive $1 million to help get their product to market. Among the ambassadors supporting the challenge is Rory Cooper, director of the Human Engineering Research Laboratories at the University of Pittsburgh.

NSM names new CIO

NASHVILLE, Tenn. – National Seating & Mobility has named Mark Marschke its new CIO. The national complex rehab provider recruited Marschke from a unit of Warren Buffett’s Berkshire Hathaway. He will oversee NSM’s technology strategies and solutions. Most recently, Marschke was CIO of Atlanta-based Larson-Juhl, which designs and makes picture frames. During his time at Larson-Juhl, he was a member of the Berkshire-Hathaway CIO Council.

PHM seeks to finalize restructuring

LAFAYETTE, La. – Patient Home Monitoring on Dec. 15 will ask security holders to vote on splitting the company in two. PHM will become a DME company specializing in delivering and servicing oxygen therapy, sleep apnea treatment and mobility equipment; and Viemed will become a respiratory company specializing in non-invasive vents for patients with COPD, CHF and neuromuscular conditions. PHM announced plans to split into two different companies last year. PHM’s board of directors has unanimously approved the arrangement and recommends that security holders also vote in favor of it. Shares of PHM will continue to be listed for trading on the Toronto Stock Exchange under PHM, and shares of Viemed will be listed under VMD.

BraunAbility names new leader

WINAMAC, Ind. – The board of directors of BraunAbility, a manufacturer of wheelchair accessible vehicles and lifts, has selected Staci Kroon as the company’s new president and CEO effective Nov. 27. She will also serve as the board’s director. The announcement follows the retirement of Nick Gutwein, who has led BraunAbility since 2008. Kroon comes to BraunAbility from Eaton Corp., a $20 billion global technology leader in power management solutions, where she was most recently executive vice president of Eaton Business Systems. Previously, she was president of Eaton’s automotive business in North America. Gutwein, who has elected to pursue his work in the ministry full time, will remain a member of BraunAbility’s board of directors.

RESNA updates position paper on pediatrics

ARLINGTON, Va. – RESNA has published an updated position paper on the application of power mobility devices for pediatric users. The goal of the paper is to share typical clinical applications, as well as provide evidence from literature, supporting the application of power mobility for young children and to assist practitioners in decision-making and justification. The paper, approved by RESNA’s board of directors on Nov. 2, has now been updated with more current and additional scientific literature. The paper, which was worked on by a working group of three or more experts and underwent a 30-day public comment period, is valid for five years.

AmerisourceBergen buys H.D. Smith

Wed, 11/22/2017 - 09:40
11/22/2017HME News Staff

VALLEY FORGE, Pa., and SPRINGFIELD, Ill. – AmerisourceBergen will purchase H.D. Smith for $815 million in cash, the two companies have announced.

H.D. Smith is among the largest wholesalers in the country, providing a full line of brand name, generic and specialty drugs from 10 distribution centers across the U.S.

“The acquisition of H. D. Smith strengthens our core business and expands and enhances our strategic scale in U.S. pharmaceutical distribution,” said Steven Collis, chairman, president and CEO of AmerisourceBergen, a provider of pharmaceutical products that generates more than $150 billion in annual revenues.

H. D. Smith subsidiaries Triplefin, a pharmaceutical brand support provider, and Arete Pharmacy Network, a pharmacy services administrative organization, are not part of the acquisition.

AmerisourceBergen plans to fund the acquisition through the issuance of new long-term debt.

The acquisition is expected to be slightly accretive to AmerisourceBergen’s adjusted diluted earnings per share in fiscal year 2018, and be about $0.15 accretive to adjusted EPS in fiscal year 2021.

For fiscal year 2018, AmerisourceBergen now expects revenue growth to be in the range of 8% to 11%, adjusted operating income growth to be in the range of 4% to 7%, and operating growth income for its Pharmaceutical Distribution Services segment to be in the range of 4% to 7%.

The acquisition is subject to regulatory review and other closing conditions, and is expected to close in early calendar 2018.

Buy the book: Therapists publish guide

Tue, 11/21/2017 - 10:25
11/21/2017Liz Beaulieu

YARMOUTH, Maine – There’s a new Bible on seating and mobility.

Therapists and ATPs Michelle Lange and Jean Minkel published a clinical resource guide on seating and mobility in November through SLACK Books, part of the Healio Network, that spans a whopping 440 pages.

“There are a number of assistive technology books on the market, but some of them haven’t been updated in awhile and many of them dedicate only one chapter to seating and mobility,” said Lange, OTR/L ABDA ATP/SMS, who practices privately in the Denver area. “There hasn’t been a text that has gone into this much depth—and there really is so much to address.”

Lange and Minkel are familiar names to those practicing seating and mobility. Denver-based Lange helps NRRTS select topics and speakers for its more than 30 webinars each year, as well as edits the clinical articles that appear in the group’s Directions magazine. She also consults and does education work for Stealth Products and Seating Dynamics, two manufacturers in the market.

While Lange and Minkel authored three of the book’s 25 chapters—which address everything from the assessment process to postural support to clinical decision-making—most were authored by other clinicians “who are also passionate about what they do,” some from as far away as Iceland, Lange said.

“Jean and I started the guide by sitting down at a conference and coming up with a table of contents, and the toughest part was identifying an author for each topic,” she said.

But it’s that variety of authors and their specialties in different populations—whether it’s pediatrics, bariatrics or geriatrics—that are the guide’s best selling points, Lange said.

“I work mostly with kids and I’m not that familiar with bariatrics, but when I was editing the chapter by Stephanie Tanguay (of Motion Concepts), I took notes,” she said. “She gave me a different way of looking at optimizing driving. I thought, ‘I’m going to use that idea, it’s great.’”

Lange envisions a myriad of uses for “Seating and Wheeled Mobility: A Clinical Resource Guide”—for therapists who are just beginning to specialize in seating and mobility, for those who are working with a new population of people with disabilities, and for those looking for better ways to document and support the need for equipment to payers.

“I think this will be one of those books that people keep on their shelves and keep turning back to,” she said.

Aeroflow looks to grow through strategic buys

Tue, 11/21/2017 - 10:22
11/21/2017Theresa Flaherty

ASHEVILLE, N.C. – What began as a way to expand nationally through subcontracting relationships in the competitive bidding program has turned into a full-blown acquisition strategy for Aeroflow Healthcare.

This year alone, the company has closed nine deals, says Andrew Amoth, strategic partnerships coordinator.

Amoth spoke with HME News recently about Aeroflow’s growth strategy and why the provider uses multiple lenses to view potential acquisitions.

Shifting landscape

When the competitive bidding program launched, Aeroflow won contracts across the country, requiring the provider to develop subcontracting relationships with local companies. That didn’t last beyond the first round of the program, says Amoth.

“With contract changes, we found there were a lot of scenarios where a DME had the bid before and then they didn’t have it in the next round,” he said. “It brought about a lot of opportunity for asset purchases in the CPAP resupply space.”

Aeroflow then applied that model to other products that didn’t require opening bricks-and-mortar locations, said Amoth.

“We still have our traditional DME footprint in the Southeast, but we are moving toward a pick, pack and ship model where appropriate,” he said. “We can grow from that footprint and service anywhere in the country with these types of acquisitions.”

Three lenses

Aeroflow uses three lenses when it values a potential acquisition: assets, revenue percentage and EBITA. That allows the provider to take a broader look at the seller’s potential value, says Amoth.

“A lot of buyers will just look at the bottom line, or they will just look at the EBITA and do a multiple of that,” he said. “So if a provider is struggling on the bottom line, but we still see some value on the top line, we don’t discount that. We really want the seller to feel we are valuing their business as they would.”

Volume game

To succeed in today’s environment of compressed margins, companies have to build scale, says Amoth.

“As far as remaining profitable and looking at specific product lines, it is a volume game and trying to be strategic with relationships and with other providers,” he said. “It definitely takes a lot of agility to stay ahead in this market.”

Part B premiums, deductibles remain stable for 2018

Tue, 11/21/2017 - 09:36
11/21/2017HME News Staff

WASHINGTON – The standard monthly premium for Medicare Part B enrollees will be $134 for 2018, the same as 2017, CMS has announced.

Some beneficiaries who were protected from Part B premium increases in prior years will have increases in 2018, but they will be offset by the increases in their Social Security benefits next year, CMS says.

“Medicare’s top priority is to ensure that beneficiaries have choices for affordable, high-quality care that fit their needs,” said CMS Administrator Seema Verma. “Next year, no beneficiary protected by the hold-harmless provision will see a Part B premium increase that is greater than the increase in their Social Security benefits. We encourage Medicare beneficiaries to explore their options to make an informed choice between original Medicare and Medicare Advantage before Open Enrollment ends on Dec. 7.”

The average monthly premium for Medicare Advantage enrollees will drop to about $30 in 2018, about a 6% decrease compared to 2017, CMS estimates. More than 77% of Medicare Advantage enrollees remaining on their current plans will have the same or lower premiums for 2018, the agency says.

The annual deductible for all Medicare Part B beneficiaries will be $183 in 2018, the same as 2017.

Bid bill update: Co-sponsors pile on

Fri, 11/17/2017 - 13:48
11/17/2017Theresa Flaherty

WASHINGTON – Industry stakeholders have kicked efforts to gather co-sponsors for H.R. 4229 into high gear and have no plans of slowing down, they say.

Rep. Cathy McMorris Rodgers, R-Wash., introduced the legislation Nov. 2, with 53 original co-sponsors. At press time, there were 75 total co-sponsors.

“Right now, this is a good grassroots opportunity to show that there is an urgent need and a feeling in Congress that we have to fix this problem long term,” said Tom Ryan, president and CEO of AAHomecare. “Some of the more aggressive states are piling co-sponsors on.”

The bill would extend a retroactive delay of a second round of reimbursement cuts in non-bid areas from Jan. 1, 2017, to Jan. 1, 2019. It would also address a so-called “double dip” cut to oxygen therapy.

Stakeholders in the Midwest, in particular, are throwing up big numbers. In Iowa, they have 100% of representatives signed on to H.R. 4229; in Missouri, it’s 75%.

“Some of the real tough cookies we’ve had to deal with in the past are finally supporting us,” said Rose Schafhauser, executive director of the Midwest Association for Medical Equipment Services, whose territory includes largely rural states that have been devastated by the roll out of bidding-derived pricing. “They are finally getting it—it is impacting the patients and nobody wants that.”

Still, a big question remains: How much will the bill cost and how will it be paid for? That’s for congressional leadership to determine, say stakeholders.

“That’s not our challenge right now,” said Cara Bachenheimer, senior vice president of government relations for Invacare.

Additionally, stakeholders haven’t given up on an interim final rule that presumably would provide relief in non-bid areas and that has been sitting at the Office of Management and Budget since Aug. 24.

“Our goal is to have some sort of relief, whether it’s through the IFR or the legislation,” said Bachenheimer. “The IFR is preferable because it’s faster and easier.”

Going forward, stakeholders are eyeing a potential Senate companion bill to H.R. 4229, with Sen. John Thune, R-S.D., as a possible lead sponsor. Thune has sponsored bid-related legislation in the past.

Stakeholders are also working with Dobson DaVanzo & Associates on a second study that will compare a recent access survey to claims data to determine if there’s some cost-shifting going on.

“I hope that’s a good complement to the access survey,” said Ryan. “We’ve had some good meetings on the Hill with the access survey and have made it even more Hill-friendly with specific anecdotes by state.”

 

In brief: Inconsistencies in bid program, Trump’s new HHS nominee

Fri, 11/17/2017 - 13:47
11/16/2017Theresa Flaherty

BALTIMORE – CMS did not always follow its own procedures and federal requirements for awarding competitive bidding contracts consistently, according to a new report from the Office of Inspector General.

CMS did not follow the bid process consistently for 23 of 215 winning suppliers, the OIG found.

Breaking it down, the agency awarded contracts to 10 suppliers that did not meet financial statement requirements and 13 suppliers that did not have the required license in at least one competition, according to the OIG.

The inconsistencies affected 99 of the 240 sampled single payment amounts, the OIG found.

Additionally, CMS did not monitor suppliers in accordance with established procedures and federal requirements for another 31 suppliers. These suppliers did not maintain the applicable license required by their contract for the last six months of 2013, according to the OIG.

With these errors, CMS paid suppliers $182,000 less than they should have, or less than .03% of the $553.7 million paid under Round 2 during the last six months of 2013, the OIG estimates.

The report recommends that CMS follow established program procedures and federal requirements consistently; ensure that suppliers have the required licensure; and monitor supplier licensure requirements by implementing a system to identify potential unlicensed suppliers.

Trump to nominate ‘star’ to lead HHS

WASHINGTON – President Donald Trump will nominate former pharmaceutical executive and industry lobbyist Alex Azar to the top post at the Department of Health and Human Services, according to news reports.

Trump tweeted on Monday: “He will be a star for better healthcare and lower drug prices.”

The nomination follows the resignation of Trump’s first HHS secretary, Tom Price. Price left HHS in September amid an investigation into his use of charter flights instead of cheaper commercial flights.

Currently, Azar is the chairman and founder of Seraphim Strategies, which provides strategic consulting and counsel on biopharmaceutical and health insurance industries. Previously, he was president of Lilly USA, an affiliate of Eli Lilly, from January 2012 to January 2017.

Azar has worked at HHS before: From 2005-07, he was a deputy secretary in the department, and from 2001-05, he was general counsel.

Azar’s nomination must be approved by the Senate.

CareCentrix looks into offshore activity

HARTFORD, Conn. – CareCentrix has clarified the intent of its offshore policy, in response to a query from AAHomecare. The company recently updated its manual to state that providers may not “(1) perform or engage with business agents to perform any functions, activities or services under its agreement with CareCentrix from a location outside the United States; or (2) send or transmit to, or access, members’ protected healthcare information or other personal information from outside the United States.” CareCentrix said the purpose of the change is to determine: Do its providers actually have PHI offshore; and if they do, what are the specific details on what is being sent offshore, and what security measures are in place to ensure regulatory privacy and security? After CareCentrix receives information from providers, it will make a determination as to whether or not steps need to be taken to ensure that regulatory guidelines are met. AAHomecare says it has been assured that contracts will not be terminated if providers indicate they are using offshore services.

F&P wins patent case in UK

AUCKLAND, New Zealand – The English Patents Court has sided with Fisher & Paykel Healthcare, saying a ResMed patent for masks is invalid in the U.K. “While today’s ruling is just one more step on the journey, it reinforces our confidence in our position, and we are satisfied with progress so far,” said Lewis Gradon, managing director and CEO, in a press release. In 2016, F&P sought a declaration from the High Court of Justice, Chancery Division, Patents Court in the U.K. that three of ResMed’s European patents were invalid in the U.K. and should be revoked. ResMed counterclaimed for infringement, but just before the trial was set to start, the company revoked two patents, leaving only one before the court. ResMed responded to the ruling, saying it was pleased by the court’s “unambiguous statement regarding our assertion that Fisher & Paykel’s Simplus and Eson masks infringe ResMed’s patent” and pointing out the court’s statement that, “Had it been valid it would have been infringed.” ResMed says it is considering an appeal.

Quantum Rehab hosts design forums

EXETER, Pa. – Quantum Rehab recently hosted its 2017 Design Forums for Rehab Professionals. The two-day events brought together clinicians from rehab facilities across the country to share their experience with ways to improve existing technology, and new ideas for products and services. “We seek constant input from consumers, providers and clinicians to ensure Quantum delivers innovative, market-driven mobility technology,” said Jay Brislin, vice president of Quantum Rehab, in a release.

AOPA, O&P News ‘perfect fit’

WASHINGTON – The American Orthotic & Prosthetic Association has agreed to buy O&P News Magazine from SLACK Inc., it announced today. “(It’s) the perfect fit of O&P News with AOPA’s objective to expand communications with the O&P community to ensure that the latest in research and technology developments and information is served up in as many forums as possible,” said Michael Oros, AOPA president. “O&P News has the potential to play an important role in that endeavor.” AOPA already publishes the O&P Almanac. The association plans to explore opportunities to diversify content toward the practitioner and referral community with O&P News.

FAHCS hosts successful conference

FORT LAUDERDALE – The Florida Alliance of Home Care Services welcomed Madeline Delp, Ms. Wheelchair USA, to its Fall Conference, held Nov. 8 and 9. As the conference keynote speaker, Delp shared her experiences and illustrated why it’s important for the HME industry to assist patients as best as they can, said FAHCS in a release. The association’s current agenda includes working with AAHomecare and The VGM Group on payer issues, and reaching out to third-party administrators in an effort to build relationships for constructive dialogue.

ISS releases program, opens registration

VANCOUVER, British Columbia – The program and registration for the 34th International Seating Symposium, March 6-9 at the Westin Bayshore here, is now available online. The event’s program addresses current and future developments in seating, positioning and mobility, with topic areas that include service delivery, product development, research and outcomes. It features pre-symposium, plenary, instructional, paper and poster sessions. Sponsors of the event include Inspired by Drive, Invacare, Ki Mobility, Permobil, Comfort Company, Quantum Rehab, Sunrise Medical and Stealth Products. ISS is considered one of the premier meetings in the world for clinicians, researchers, manufacturers and others who work to improve seating and mobility for people with disabilities. The event is hosted by Sunny Hill Health Centre for Children and the University of British Columbia.

Mediware, Empire Home Infusion go deeper

LENEXA, Kan. – Mediware Information Systems has announced that Empire Home Infusion Services in Ballston Spa, N.Y., has expanded its partnership with the company to include on-site consulting and training. The provider, part of the St. Peter’s Health Partners System, says the consulting and training has improved its relationships with referral sources. “We can now stand by our commitment to always respond to incoming referrals within thirty minutes,” said Michelle Mazzacco, vice president of the community services division at St. Peter’s Health Partners. “In addition, we have streamlined insurance verification and how we manage Part D claims so that our business minimizes the risk of unpaid claims and, in turn, reduces our overall bad debt.” Empire Home Infusion has relied on Mediware Reimbursement Services to manage its billing and collection needs since 2004.

Philips launches COPD campaign featuring marathoner

AMSTERDAM – Royal Philips has launched a “global movement” to raise awareness for COPD ahead of World COPD Day on Nov. 15. Philips is collaborating with marathoner Russell Winwood, who has COPD, to create motivational content designed to help educate, engage and empower COPD patients and their caregivers. The company is working with Winwood to share his personal journey with other COPD patients to inspire them to live their lives to the fullest. Six months after his diagnosis, he completed his first full Ironman and continues to participate in triathlons around the world, showing that a COPD diagnosis does not need to stop patients from enjoying their favorite activities. Philips has also committed to donating $1 to The COPD Foundation for every campaign video share throughout November, which is COPD Awareness Month. COPD is the fourth leading cause of death worldwide and is expected to be the third leading cause by 2020.

Wearables can help predict hypertension, sleep apnea

SAN FRANCISCO – Off-the-shelf wearables and a multi-task deep learning algorithm are “surprisingly good” predictors of hypertension and sleep apnea, researchers at the University of California at San Francisco have found. “Whether such (devices) can provide durable and portable predictions for these conditions in other study samples is worth pursuing,” they wrote. Wearables and deep learning algorithms use PPG sensors and accelerometers to determine heart rate variability and activity patterns, which have been associated with incident hypertension, diabetes and sleep apnea. The results were not statistically significant for diabetes.

ResMed announces board change

SAN DIEGO – ResMed has named Karen Drexler to its board of directors, the company has announced. Drexler is CEO and board member of Bay area biotech company Sandstone Diagnostics, and has extensive healthcare management experience. "I'm thrilled to welcome Karen Drexler to ResMed's Board," said ResMed Founder and Board Chairman Peter Farrell. "Her deep expertise in advising and managing medical device, digital health and diagnostic companies, and particularly her experience in technology and out-of-hospital care models, will serve ResMed well as we continue to deepen our leadership in connected care and digital health." Drexler replaces Dr. Chris Roberts, who has retired after serving more than 25 years on the board.

Pediatrics: Thrive Skilled Pediatric Care, Kids Mobility Network

Wakefield, Mass.-based Thrive Skilled Pediatric Care has acquired Richmond-Va.-based The Pediatric Connection, which has three locations in Virginia, according to a local news article. The Pediatric Connection offers respiratory equipment and nutritional services…Denver-based Kids Mobility Network has provided more than $5 million in durable medical equipment to children with disabilities. The nonprofit has provided wheelchairs, walkers and other DME since 2006.
 

Remote patient monitoring lags for oxygen therapy, poll shows

Fri, 11/17/2017 - 13:46
Barriers include lack of requirement, cost, respondents say11/17/2017Liz Beaulieu

YARMOUTH, Maine – Remote patient monitoring appears to be permeating the sleep therapy market, but not so much for the oxygen therapy market, according to the most recent HME Newspoll.

Eighty percent of poll respondents report they use the technology in their sleep business, but only 15% say they do in their oxygen business.

“Really, we only use remote monitoring for CPAP compliance,” wrote Josh Turner, billing manager and compliance officer for McAbee Medical in Decatur, Ala. “With reimbursement the way it is and compliance for oxygen usage not being required, we have to look for the best value in oxygen equipment.”

CMS has required compliance as a condition for reimbursement for CPAP therapy since 2008.

With margins razor-thin, remote patient monitoring allows providers to prove CPAP patients are compliant with their therapy in the most efficient and cost-effective way possible, respondents say.

“It is a really valuable tool and saves staff time and (results in) fewer patient interactions in the office,” wrote Kim Wonsick, the compliance officer at J&B Medical in Niceville, Fla. “Typically, if a patient has to come in to bring an SD card, it will turn into a 15- or 20-minute discussion that needs to be directed to their sleep doctor.”

For oxygen patients, in addition to the lack of a compliance requirement, cost seems to be a big barrier to providers adopting remote patient monitoring, according to the poll.

“I wish we could afford to use it on oxygen,” said Katy Collins, the lead RT at Archbold Home Care in Thomasville, Ga.

For these reasons, the ramp up in using remote patient monitoring for oxygen patients will likely be a protracted one. In fact, only 15% of respondents who don’t currently use remote patient monitoring plan to in the next year, according to the poll.

“Remote patient monitoring for oxygen is great but will be a slow implementation, as we would not replace our existing equipment just to add the technology, and then only if the price is competitive,” Wonsick added.

But respondents who are leveraging connected technology from the likes of O2 Concepts, Invacare and CAIRE to remotely monitor their oxygen patients are saying it pays off.

“It has reduced service calls, assisted with reimbursement from HMO administrators and reduced shrinkage due to theft or moving after death,” wrote one respondent. “Currently, one-fifth of our patients are monitored.”

AAH council spells it out

Fri, 11/17/2017 - 13:44
New white paper highlights importance of both complex rehab, standard mobility11/17/2017Liz Beaulieu

WASHINGTON – AAHomecare’s Complex Rehab and Mobility Council this month published a short white paper that outlines the differences between complex rehab and standard mobility products in grids and photos.

While industry stakeholders have published other materials highlighting the specialized nature of complex rehab, this three-page paper also highlights the benefits of standard mobility, says Chairwoman Nancy Froslie.

“We wanted to show the importance of both,” said Froslie, an ATP and the rehab manager at Sanford HealthCare Accessories in Jamestown, N.D. “We didn’t want it to come off that one was more important than the other. Different patients have different needs.”

The main element of the paper is a grid that outlines the patient population, length of need, configuration, positioning capacity and pressure management, and prescribing and fitting process for four categories of products: standard manual wheelchairs, CRT manual wheelchairs, standard power wheelchairs and CRT power wheelchairs.

The council envisions providers using the paper to, among other things, explain why accessories for complex rehab manual wheelchairs should be exempt from competitive bidding. The paper includes a grid with photos of both basic and complex accessories.

“Being able to see the differences between the two in a picture—to me, that’s really important,” Froslie said. “It’s representative of how the products are used.”

The council also envisions providers using the paper to advocate for a separate benefit for complex rehab, and for fair coverage and reimbursement with non-Medicare payers.

“We wanted something that, even though we’re targeting Medicare, was broad enough to be a tool for other payers,” said Ashley Plauche, manager of government affairs for AAHomecare. “It could even be used in a clinical setting or with patients to help them better understand what their options are.”

InfuSystem sees progress

Fri, 11/17/2017 - 13:41
11/17/2017Theresa Flaherty

MADISON HEIGHTS, Mich. – InfuSystem has shifted its focus from expanding its fleet of infusion pumps to improving collections, and it’s starting to pay off, says Gregg Lehman, executive chairman of the board.

The infusion provider reported net revenues of $17.6 million for the third quarter of 2017, a 2.1% increase compared to the same period in 2016.

“We are making solid progress on our collection efforts,” said Lehman on a recent earnings call. “For the foreseeable future, our task is to focus on our existing business and managing it as well as possible.”

InfuSystem reported a net loss of $0.1 million for the quarter this year compared to a net income of $0.1 million for the same quarter last year. Breaking down revenues, rentals increased 4.7% to $15.3 million and sales decreased 12.4% to $2.3 million. The provider reduced debt by $2.9 million in the quarter.

Going forward, InfuSystem is reviewing existing customers and lines of business, and plans to pursue new opportunities in its infusion products and pain management businesses, says Lehman.

“I am pleased we continue to win new business and grow our market share in a responsible way,” he said.

The third quarter was the first full quarter under an executive management reorganization in May that created a temporary “Office of the President” led by Lehman, and consisting of two directors and three senior management team members.

“We are happy with how the office is working as demonstrated by improvements in our financial results,” said Lehman. “Our initial plan was to operate under this structure through the end of the year, but no decision has been made.”

Inconsistencies in bid program

Fri, 11/17/2017 - 13:20
11/17/2017HME News Staff

BALTIMORE – CMS did not always follow its own procedures and federal requirements for awarding competitive bidding contracts consistently, according to a new report from the Office of Inspector General.

CMS did not follow the bid process consistently for 23 of 215 winning suppliers, the OIG found.

Breaking it down, the agency awarded contracts to 10 suppliers that did not meet financial statement requirements and 13 suppliers that did not have the required license in at least one competition, according to the OIG.

The inconsistencies affected 99 of the 240 sampled single payment amounts, the OIG found.

Additionally, CMS did not monitor suppliers in accordance with established procedures and federal requirements for another 31 suppliers. These suppliers did not maintain the applicable license required by their contract for the last six months of 2013, according to the OIG.

With these errors, CMS paid suppliers $182,000 less than they should have, or less than .03% of the $553.7 million paid under Round 2 during the last six months of 2013, the OIG estimates.

The report recommends that CMS follow established program procedures and federal requirements consistently; ensure that suppliers have the required licensure; and monitor supplier licensure requirements by implementing a system to identify potential unlicensed suppliers.

 

Trump to nominate ‘star’ to lead HHS

Tue, 11/14/2017 - 10:01
11/14/2017HME News Staff

WASHINGTON – President Donald Trump will nominate former pharmaceutical executive and industry lobbyist Alex Azar to the top post at the Department of Health and Human Services, according to news reports.

Trump tweeted on Monday: “He will be a star for better healthcare and lower drug prices.”

The nomination follows the resignation of Trump’s first HHS secretary, Tom Price. Price left HHS in September amid an investigation into his use of charter flights instead of cheaper commercial flights.

Currently, Azar is the chairman and founder of Seraphim Strategies, which provides strategic consulting and counsel on biopharmaceutical and health insurance industries. Previously, he was president of Lilly USA, an affiliate of Eli Lilly, from January 2012 to January 2017.

Azar has worked at HHS before: From 2005-07, he was a deputy secretary in the department, and from 2001-05, he was general counsel.

Azar’s nomination must be approved by the Senate.

Mail-order market for diabetes on precipice of disaster

Fri, 11/10/2017 - 13:37
As Arriva prepares to close, stakeholders expect increased pressure on an already shaky infrastructure11/10/2017Theresa Flaherty

CORAL SPRINGS, Fla. – With Arriva Medical, the largest mail-order supplier of diabetes testing supplies, closing its doors at the end of the year, industry stakeholders predict chaos.

Arriva serviced 450,000 Medicare beneficiaries in 2016, according to the latest information in the HME Databank.

“This is a disaster,” said Tom Milam, an industry consultant. “I think CMS has to find a way to react to this, but there’s no other firm out there that has the infrastructure or capacity to service but a small fraction of these beneficiaries.”

Earlier this year, Arriva Medical lost an appeal seeking to reinstate its Medicare billing privileges. CMS revoked those privileges in 2016, alleging the provider submitted 211 claims for deceased patients between April 15, 2016, and April 25, 2016.

Also closing, according to an article in the Sun Sentinel, is Boca Raton-based American Medical Supplies, which serviced 33,000 beneficiaries in 2016, according to the HME Databank. Both companies are owned by Alere, which was recently acquired by Abbott Laboratories.

That leaves just nine mail-order companies to serve all Medicare beneficiaries, say stakeholders.

“There were a lot of concerns in that sector to begin with,” said Tom Ryan, president and CEO of AAHomecare. “The infrastructure of the traditional DMEPOS suppliers is crumbling before us and all these closures put a strain on the infrastructure. It all comes back to access, access, access.”

Fueling those access problems: low reimbursement rates, which have been reduced 71% to a low of $8.32 for a box of test strips since the mail-order program first kicked off in 2011.

“I have spoken to some of the skeletons of providers who have been excluded from the program and they have said at the current reimbursement there’s no way they’d do it,” said Milam.

While CMS has long touted the program’s savings, others, including the American Association of Diabetes Educators, the American Association of Clinical Endocrinologists and the Diabetes Access to Care Coalition, say the low reimbursement rates have meant beneficiaries can’t access their preferred brands and must use inferior brands—all of which can lead to poor health outcomes and an increase in death and hospitalizations.

“All the patient groups have asked for the program to be suspended,” said Nancy Johnson, a former U.S. Congresswoman and retired policy analyst with deep knowledge of the competitive bidding program. “The bidding process was clearly deficient: when you reduce payments by 71%, it’s probably overkill.”

Invacare emphasizes small picture

Fri, 11/10/2017 - 13:34
Net sales for North America/HME increased 2.3% on a sequential basis11/10/2017Liz Beaulieu

ELYRIA, Ohio – Company officials at Invacare are looking for good news where they can find it. For the third quarter of 2017, it’s the sequential growth in net sales for North America/Home Medical Equipment.

Invacare reported net sales of $79.5 million for the business unit for the third quarter vs. $77.7 million for the second quarter, a 2.3% increase.

“We were thinking we would have a flat third and fourth quarter—a couple of quarters to reflect a flat bottom to rebound—and we had a little bit better third quarter than we expected,” Matt Monaghan, chairman, president and CEO, told investors during a conference call on Nov. 8 to discuss the company’s latest financial results.

Year-over-year, however, net sales for North America/HME were $79.5 million for the third quarter of 2017 vs. $99.3 million for the same quarter in 2016, a 19.9% decrease.

Monaghan cautioned investors not to look at the sequential growth in net sales for North America/HME, the business unit most impacted by a consent decree that limited manufacturing at the Taylor Street facility from late 2012 to mid-2017, as the beginning of a “V-shaped recovery.”

“What I want people not to say is, all of a sudden we are on this rapid trajectory,” he said. “There are going to be a couple of quarters, with the inertia that we have to move through, but I have a lot of confidence in the North America commercial team.”

Asked whether the sequential growth in net sales for North America/HME means Invacare is gaining back market share post-consent decree, particularly in the complex rehab market, driven by its recently launched TDX SP2 Power Wheelchair with LiNX, Monaghan said not quite.

“The backlog we have, the commercial interest in the product—I think the fourth quarter should be decent and I think an inflection point for North America HME,” he said.

Overall, Invacare reported net sales of $250.9 million for the third quarter of 2017, compared to $268.1 million for the same period last year. It recorded a net loss of $18.6 million vs. $5 million.

Inogen’s streak continues

Fri, 11/10/2017 - 13:32
Company also addresses connected technology trend11/10/2017Liz Beaulieu

GOLETA, Calif. – Despite headwinds from a new CRM system, Inogen’s direct-to-consumer channel still recorded an impressive 43.5% increase in sales for the third quarter of 2017.

“There has been a learning curve and in spite of that, productivity in Q3 improved versus 2016,” CFO Ali Bauerlein, told investors during a conference call on Nov. 7 to discuss the company’s latest financial results. “So we’re really proud of our sales team’s ability to hire and train personnel.”

Inogen reported total revenues of $69 million for the third quarter, up 26.8% from the same period last year. Sales revenue was $63.1 million, up 33.8%; and rental revenue was $5.9 million, down 18.7%.It reported net income of $7.3 million, up 39.9%.

With company officials calling 2017 “an investment year,” Inogen may be just getting started.

“While we’re starting to see contributions, we expect the people we hire in the second half of this year to contribute more materially in 2018,” Bauerlein said.

That’s a big reason why, for 2018, Inogen expects revenues to be in the $295 million to $205 million range. By comparison, for 2017, the company expects revenues of $239 million to $243 million.

Asked whether Inogen’s product pipeline includes a POC with connected technology, company officials downplayed the trend—for now. CEO Scott Wilkinson noted that, unlike for CPAP devices, there are no compliance requirements for oxygen concentrators, minimizing the importance of the technology.

“If we go back to what’s really important, it’s the right reliability and the right price—that’s what we’ve focused on,” he said. “It’s patient preference, as well, and they don’t have the burning need for connectivity right now. These wireless launches that we’re seeing—we think it’s a solution that’s ahead of its time.”

Still, Wilkinson believes there’s a “long-term place for connectivity in oxygen.”

“That’s why our engineers are working on it,” he said. “That’s also why we’ve built a product that’s connectivity ready. We’re not ignoring (the trend); it’s just not the most important thing right now.”

Inogen’s business-to-business channel also recorded an impressive increase, 41.7%, adding more grist to the mill that an increasing number of traditional HME providers are converting their fleets to POCs.

“Based on CMS data, the share of POCs in Medicare oxygen therapy was 8% in 2015 and 9.1% in 2016, and that doesn’t include patient cash sales,” Wilkinson said. “POCs are still the fastest growing modality and they still have significant growth opportunity before they reach full market saturation.”