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Updated: 5 hours 22 min ago

Round 2021 update: Not so fast CBIC?

Thu, 09/24/2020 - 08:12
09/24/2020HME News Staff

WASHINGTON – The CBIC recently sent a message indicating that Round 2021 “contract offers and disqualification information would soon be provided” in Connexion, but they did it without clearing it with CMS, according to AAHomecare. 

“Furthermore, our counsel was told that CMS has not yet made a decision on moving forward on Round 2021,” the association stated in a bulletin. 

Industry stakeholders took the CBIC’s message as a sign that maybe CMS’s next round of competitive bidding was moving forward as planned, with single payment amounts announced this summer, contract suppliers this fall and implementation on Jan. 1. 

AAHomecare and other stakeholders are awaiting details on the scope and timing for Round 2021. They have been advocating for a delay in the next round of the bid program for at least one year or through the length of the current public health emergency. 

The industry's efforts were recently boosted by a letter to CMS signed by more than 100 members of the House of Representatives requesting a delay. 

CGS adds ostomy supplies, diabetic shoes to reviews

Wed, 09/23/2020 - 08:28
09/23/2020HME News Staff

NASHVILLE, Tenn. – CGS has announced two more widespread post-pay, service-specific reviews for ostomy supplies and therapeutic shoes/inserts. 

For ostomy supplies, the codes affected are A4431, A4434, A5081, A5122. CGS says data analysis showed Jurisdiction C’s allowed dollars for these codes were significantly above expected amounts. Additionally, these codes were consistently ranked in the top 20 for CERT errors. 

For therapeutic shoes/inserts, the codes affected are A5500 and A5512 through A5514. CGS says data analysis showed Jurisdiction B’s allowed dollars for these codes were significantly above expected amounts. Additionally, this policy group ranked No. 8 in total CERT errors. 

OIG: Medicare pays too much for non-invasive vents

Tue, 09/22/2020 - 13:52
Agency recommends CMS include E0466 in bid program ‘as soon as possible’09/22/2020HME News Staff

WASHINGTON – Medicare pays more for non-invasive ventilators than certain other payers, according to a new report from the Office of Inspector General.

The OIG estimates that Medicare and beneficiaries could have saved $86.6 million if Medicare-allowed charges were comparable with payment rates of select non-Medicare payers for HCPCS code E0466.

Medicare paid $424.4 million for non-invasive vents in 2018, a 52% increase compared to 2016, the OIG found.

The agency believes Medicare pays more for non-invasive vents than select non-Medicare payers because CMS does not routinely evaluate the pricing trends or payment rates of those payers. Instead, CMS uses statutorily mandated fee schedule payments and applies an economic update factor to them.

The OIG recommends that CMS review Medicare-allowed charges for non-invasive vents and add E0466 to the competitive bidding program as soon as possible.

In response, CMS confirmed that it has been evaluating non-invasive vents for potential inclusion in the bid program and noted that it had included the product category in Round 2021 but removed it in April due to the COVID-19 pandemic.

The agency said it will consider whether to include non-invasive vents in future rounds of the program.

Vertess closes four deals during pandemic

Tue, 09/22/2020 - 13:49
09/22/2020HME News Staff

FORTH WORTH, Texas – Vertess has closed on four DME transactions in the second and third quarters, despite the challenges brought on by the COVID-19 pandemic.

“Even in the face of adversity that is 2020, I am thrilled to have helped deserving owners successfully exit their businesses, while also helping bridge the gap for these health care providers to extend their established platforms,” said Bradley Smith, managing director.

The transactions are:

  • Med Inc., a Virginia-based respiratory provider, has been acquired by Rotech, a Florida-based national provider.
  • The assets of Metro-Med, Inc., a California-based respiratory provider, has also been acquired by Rotech.
  • Health Technology Resources, an Illinois-based provider, has been acquired by Protech Home Medical Corp., a Kentucky based publicly traded health care services company.
  • Alliance Medical Supply, a Texas-based pediatric respiratory and nutritional provider, has been acquired by Pediatric Home Respiratory Service, a Minnesota-based home care provider.

Outlook for 2020: ‘Focus on service and trust’

Fri, 09/18/2020 - 11:49
09/18/2020Tracy Orzel

YARMOUTH, Maine – The COVID-19 pandemic has hit home that providers need to go from being HMEs to HMAs—home medical advisors, said Invacare’s Matthew Monaghan during last week’s HME News Business Summit. 

“It’s less of a focus on E for equipment and more on service and trust,” said Monaghan, chairman, president, CEO of Invacare. “For the next 18 months, it’s really about going beyond equipment and being that trusted care advisor.” 

Monaghan, a panelist for the session “Outlook for 2020 and beyond,” was joined by Scott Wilkinson, CEO of Inogen, and Jim Hollingshead, president, sleep and respiratory care, at ResMed. 

As more residential and long-term care facilities close or face restrictions due to COVID-19, at-risk patients will have to be cared for in the home—a reality that didn’t exist six months ago—and providers can use their expertise to put the minds of family members and professional care providers  at ease, Monaghan said. 

“That will be a neat opportunity for providers to show they’re different— (making) people feel comfortable that they can provide loved ones the care that they need in this environment, which is going to linger for awhile,” he said. 

Adapt and adopt 

The pandemic has made providing health care more difficult, but it’s also driving convenience, Monaghan said. Invacare is developing products that are easier to set up and designing order forms that allow for more nuance, so products are ready out of the package. 

“Amazon is helping us find what the ultimate tools of convenience are and providers can get those same kinds of benefits that allow them to get more done,” he said. 

Inogen is also making it easier for providers by offering to drop ship on their behalf.  

“We’ve all got to work together to drive cost out of the system,” said Wilkinson. “Why should we ship a product to a home care company, and then they have to pay to ship or deliver it, when we can cut that out and all share in the savings?” 

But the best way providers can get ahead is by embracing technology, which has already been fast tracked by the pandemic by at least two or three years, says Wilkinson. 

“Telemedicine and connected devices are here to stay,” he said. “That’s a great way to reduce service costs, minimize unplanned events and eliminate unnecessary product swaps.” 

With reimbursement and volumes, in some cases, temporarily down, Hollingshead acknowledges that it’s hard for providers to make that kind of investment, but it’s the best way to streamline care and manage operating expenses.  

“To me it’s simple: Adopt the tools,” he said. 

Stakeholders size up Biden vs. Trump

Fri, 09/18/2020 - 11:48
09/18/2020Theresa Flaherty

WASHINGTON - How will the November elections impact the HME industry? 

There are a number of dynamics at play in the presidential election between Joe Biden and Donald Trump and in the various races in the House of Representatives and Senate, says John Leppard, a health care analyst with Washington Analysis. 

“At the top of the line: a Biden win-Democratic sweep is probably a net slightly positive in the near- to medium-term as it augurs greater stability,” he said. “He’s less likely to lift the public health emergency and the duration of that extends to the duration of the CARES Act reimbursement rates for non-bid areas.” 

A recent round-up of national polls has Biden leading Trump by a margin of anywhere from seven to 10 percentage points, according to the New York Times. 

If Trump were to win re-election, however, the relationships that the industry has built over the past four years with politically appointed staff will benefit, says John Gallagher, vice president of government relations for VGM. Additionally, the GOP is historically more business-friendly and steps taken by the current administration to, among other things, deregulate are also positive for the HME industry, he says. 

“The continuation of the administration posts is a positive,” he said. 

Stakeholders don’t expect much impact from congressional races, despite all 435 seats in the Democratic-controlled House and 35 of the 100 seats in the Republican-controlled Senate being up for grabs. 

“I don’t see the House flipping and, to be honest, I don’t see the Senate flipping,” said Gallagher. “In the Senate, the democrats might pick up a seat or two, but it’s kind of a wash.” 

One thing seems certain: No matter who’s in charge, competitive bidding is not going away, say stakeholders. 

“Biden or Trump—they’re not going to want to unravel that card,” said Gallagher. “We still have to be going after that on the legislative side.” 

Highmark Health taps into stay-at-home preferences

Fri, 09/18/2020 - 11:47
09/18/2020Theresa Flaherty

PITTSBURGH – Highmark Health recently expanded its Home Recovery Care program to two more hospitals in its network, boosted by the ongoing public health emergency that has increased the value of home care. 

HRC originally launched at Allegheny Health Network in late 2019 as part of a joint venture between the payer and Contessa; it provides inpatient care in the home through telemedicine, providers and Contessa’s technology for coordinating care. 

“HRC gives us the opportunity to give individuals a choice of whether to receive treatment during a hospital stay or, if they prefer, to go home,” said Dr. Monique Reese, senior vice president, home and community care, Highmark Health. “There are plenty of surveys out there (that show) the preference is to stay in the home when that makes sense and is safe.” 

Eligible patients are those with health conditions that are considered low-acuity, like COPD, heart failure and cellulitis, and meet a set of criteria. An integrated team that includes HME, nursing and home care providers and a hospitalist work together to transition the patient safely home, says Reese.  Along with access to providers and equipment, the patient can also receive daily video check-ins. 

Although HRC was started before anyone even thought about a national health crisis, the COVID-19 pandemic has sped up the acceptance of stay-at-home programs, says Reese. Early in the pandemic, for example, CMS relaxed rules around telehealth visits. 

“We have seen that progress with the pandemic,” she said. “We’ve also positioned ourselves to enable providers and home health organizations to offer remote monitoring and virtual visits, and we will continue to see that as an option for providers, payers, and patients and families.” 

Annual event ‘bigger’ than Medical Service Company

Fri, 09/18/2020 - 11:46
09/18/2020Theresa Flaherty

CLEVELAND – Medical Service Company has taken its annual education forum for RTs and sleep technicians completely online this year and has tapped a well-known industry leader to keynote the event. 

The 20th Annual Jean S. Marx Memorial Education Forum, scheduled for Nov. 18, features 10 sessions across two tracks, sleep and respiratory, and provides the opportunity to earn up to seven CEUs.   

“Considering the circumstances of the pandemic, we thought it would be best to switch (to a completely virtual event),” said Julie Banyasz, brand marketing manager. “We’re looking forward to welcoming hundreds of health professionals from across the country.” 

Medical Service Company actually added a virtual component to last year’s event, which drew about total 200 attendees—10% of whom attended online.  

ResMed CEO Mick Farrell will keynote the event, a speaker they believe will be a big draw, says Banyasz. 

“Mick is going to talk about the growth of health care delivery in and out of the hospital and his thoughts on digital health technology,” she said. “We are hopeful that by bringing him in, we will attract people.” 

This year, with the COVID-19 pandemic curtailing both travel and in-person events, Medical Service Company also decided to give the event a boost by partnering with other DME providers across the country who want to offer it as a benefit to their own referral sources. The company is providing them with promotional marketing materials and custom promotional codes that providers can share with their referral sources to attend free of charge. 

"This gives them the ability to be a resource to their referral partners,” says Justin Owens, director of business development. 

Partnering collectively with other providers will also raise the bar on sleep and respiratory therapy, Owens says. 

“We felt this is bigger than Medical Service Company and we’ve seen the value of education over the past 20 years,” he said. “Now, we’ve got the technology to allow us to expand so anyone can benefit from the lineup of experts we have and, ultimately, lead to further enhancement and innovation and make the sleep and respiratory industry better.” 

HME News readers can sign up using the code HMENEWS to receive a $50 discount, making the event free to attend. 

In brief: Audits pile up, M&A heats up, Masimo sues Apple

Fri, 09/18/2020 - 11:45
09/18/2020HME News Staff

WASHINGTON - CGS, the DME MAC for jurisdictions B and C, will be conducting complex post-pay reviews for surgical dressings and knee orthoses, according to AAHomecare. 

CGS will be reviewing A6196 and A6212, and L1833 and L1851. The DME MAC is conducting the reviews due to data analysis that showed “significantly above expected amounts.” 

Surgical dressings and knee orthoses also ranked No. 5 and No. 9, respectively, in total CERT improper payment rates. The reviews will include only claim dates prior to the public health emergency. 

Urological supplies 

CGS will also be conducting complex post-pay medical reviews on urological supplies, according to the van Halem Group. 

A4351, A4352, A4353, A4355 and A4316 have been selected based on data analysis that revealed the allowed dollars for these codes have been “significantly above expected amounts.” Further analysis revealed they have also received multiple CERT errors. 

Reviews will include only claim dates prior to the PHE. 

CGMs and supplies 

CMS has approved the RAC, Performant, to begin reviewing continuous glucose monitors for medical necessity requirements and CGM supplies for excessive units effective Sept. 8, according to the van Halem Group. 

Performant will be reviewing K0554 and K0553. 

PE firm buys Paragon Healthcare 

AUSTIN, Texas – An affiliate of Peak Rock Capital, a middle-market private equity firm, has completed its acquisition of Paragon Healthcare, a provider of ambulatory and home infusion services and specialty pharmacy services. 

The Dallas-based Paragon Healthcare has pharmacy and infusion operations in nine states: Alabama, Georgia, Tennessee, Louisiana, Texas, Oklahoma, Colorado, Oregon and Washington. 

“The Paragon team has an impressive track record of rapidly growing its infusion services to patients across multiple, low-cost settings of care,” said Spencer Moore, managing director of Peak Rock. “We are excited to partner with Paragon management and employees in supporting the company’s continued strong growth in high quality patient care through organic initiatives and strategic acquisitions.” 

Peak Capital acquired Paragon Healthcare, founded in 2002, in partnership with the company’s management team. 

Rick Allen, co-founder and CEO of Paragon Healthcare, says the acquisition will allow the company to “facilitate continued growth in access to lower cost care.” 

Masimo sues Apple 

IRVINE, Calif. - Masimo has filed a legal complaint in the U.S. District Court for the Central District of California claiming Apple infringes on 10 of its patents with its Apple Watch, according to news reports. The complaint charges Apple with stealing trade secrets by hiring key personnel from Masimo, including Michael O’Reilly, its former chief medical officer and executive vice president for medical affairs. Masimo claims the Apple Watch, including the Series 4 and 5 models, uses technology covered by its patents related to heart rate monitoring and other capabilities. Masimo has developed non-invasive physiological monitoring techniques to track pulse rate, arterial oxygen saturation and other parameters using transmitted light. Apple announced this week that its Apple Watch can now track blood oxygen. 

Numotion holds mid-year event 

BRENTWOOD, Tenn. - Numotion recently held its first “Mid-Year National Leadership Conference” for all employees. The goal of the conference was to reflect on the past six months and the various dynamics that have impacted the company’s customers, team and communities. The conference, which was streamed to all employees, featured opening comments from CEO Mike Swinford and updates from other members of the management team. It also included an awards presentation, a TED Talk from social psychologist Alison Ledgerwood, and a community service event. As part of the community service event, more than 750 employees raised $7,500 and completed 234 projects. The idea for the conference came from employee feedback indicating the desire to meet more than once a year. 

WellSky Foundation donates to Meals on Wheels 

OVERLAND PARK, Kan. - The WellSky Foundation has donated $50,000 to Meals on Wheels America, an organization supporting more than 5,000 community based programs across the U.S. dedicated to addressing senior isolation and hunger. Through the donation, Meals on Wheels will collaborate with the WellSky Foundation to conduct a pilot research project designed to assist health care organizations supporting older adults, particularly those transitioning from acute care settings and those facing multiple chronic health conditions. The project will explore how partnerships between health care organizations and local Meals on Wheels programs can improve senior health outcomes. It will expand upon earlier efforts by Meals on Wheels America to develop and scale a tech-based process for reporting and addressing changes in the physical or mental condition of people who receive home-delivered meals. “This latest collaboration reflects the WellSky Foundation’s ongoing commitment to helping seniors safely remain in their homes, regardless of their individual circumstances,” said Ellie Hollander, president and CEO of Meals on Wheels America. 

MIT adds ResMed to internship program 

CAMBRIDGE, Mass. – The MIT Leaders for Global Operations program announced Sept. 9 that ResMed has become the newest member of its industry partnership. The program collaborates with the MIT Sloan School of Management and the MIT School of Engineering to deliver an interdisciplinary engineering-MBA dual degree program featuring internships at partner companies. “The future of health care is digital and we need leaders with both engineering expertise and business acumen to help guide this industry and provide life-changing care to billions of people worldwide,” said Mick Farrell, CEO of ResMed and a 1998 alumnus of the program. ResMed will launch its internship program in June 2021 with projects that aim to shape the future of health care, the company says. Six-month internships in the company’s San Diego and/or European and Asia Pacific locations will focus on optimizing global supply chains to provide access to information and empower rapid decision making, using data science techniques to personalize patient therapy, and exploring machine learning solutions to improve operational efficiency. The MIT LGO program now was 25 partner companies, 18 of which are in the Fortune 500 or Global Fortune 500. 

Silverfern, One Equity Partners buys wound care provider 

NEW YORK – The Silverfern Group, an investment management firm, has partnered with One Equity Partners to buy American Medical Technologies, an Irvine, Calif.-based provider of wound care and ancillary supplies in long-term care settings, including skilled-nursing facilities. AMT manages the treatment of more than 250,000 wounds annually and offers ancillary services in ostomy, urology and tracheostomy services and supplies. “We believe AMT is well positioned to benefit from strong secular trends benefitting the U.S. post-acute health care sector as the U.S. population ages, as well as from growth opportunities through expansion within different segments of the SNF market,” said Deepak Ghosh, managing director, Silverfern. Targeting $25 million to $50 million equity per investment in partnership with qualified local investment partners, Silverfern invests in buyouts, build-ups, acquisitions, growth equity and recapitalizations. 

Short takes: Soleo Health, HomeCare Connect 

Frisco, Texas-based Soleo Health has ranked 10th among the 50 Fastest-growing Middle Market Companies in Dallas by the Dallas Business Journal. The journal ranks the 50 fastest-growing local companies that are headquartered in the Dallas-Forth Worth areas with annual revenues of $10 million to $1 billion based on their growth over the three-year period from 2017-19. Soleo Health says it achieved 79.5% growth in revenues and double-digit in its patient census over that period. The company has made the list for the third consecutive year…Winter Park, Fla.-based HomeCare Connect has welcomed Jason Luce as director of sales. His responsibilities include overseeing the daily activities of the sales team, increasing the growth of accounts and the sales team, overseeing training programs and developing accounts. Previously, Luce worked in various capacities for One Call, most recently as vice president of business development. 

PE firm buys Paragon Healthcare

Tue, 09/15/2020 - 19:30
09/15/2020HME News Staff

AUSTIN, Texas – An affiliate of Peak Rock Capital, a middle-market private equity firm, has completed its acquisition of Paragon Healthcare, a provider of ambulatory and home infusion services and specialty pharmacy services.

The Dallas-based Paragon Healthcare has pharmacy and infusion operations in nine states: Alabama, Georgia, Tennessee, Louisiana, Texas, Oklahoma, Colorado, Oregon and Washington.

“The Paragon team has an impressive track record of rapidly growing its infusion services to patients across multiple, low-cost settings of care,” said Spencer Moore, managing director of Peak Rock. “We are excited to partner with Paragon management and employees in supporting the company’s continued strong growth in high quality patient care through organic initiatives and strategic acquisitions.”

Peak Capital acquired Paragon Healthcare, founded in 2002, in partnership with the company’s management team.

Rick Allen, co-founder and CEO of Paragon Healthcare, says the acquisition will allow the company to “facilitate continued growth in access to lower cost care.”