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On the right track: VirtuOx tees up providers for better connectivity

HME News - Fri, 03/31/2017 - 11:46
03/31/2017Liz Beaulieu

CORAL SPRINGS, Fla. – VirtuOx is betting that its new tracking device is an idea with legs.

VirtuOx launched VirtuTrack after a national HME provider approached the company to help it track usage for its fleet of oxygen transfill systems.

“We started out with one idea, but we quickly realized there are a number of uses for this device,” said Kyle Miko, founder and COO of VirtuOx, a Medicare-approved IDTF for overnight oximetry and home sleep testing.

VirtuTrack’s chain-of-custody design secures the device to transfill systems or other capital-intensive equipment like non-invasive ventilators. From there, providers log into the VirtuOx portal to see if their equipment is being used.

The beauty of transfill systems is they “cut the cord” between providers and patients—they allow patients to fill their own tanks and providers to eliminate deliveries. But when patients become less mobile, the systems often go unused, Miko says.

“Then the provider has equipment out there that’s not being used as much as they’d like it to be used,” he said.

VirtuTrack helps providers determine when it’s time to transition a patient to a different modality, and frees them up to repurpose a transfill system for another patient, Miko says.

“Providers are buying new equipment for the next patient, when they could use existing equipment,” he said.

Beyond that, providers can use VirtuTrack to locate equipment when a patient dies. The device has a battery that last two weeks, allowing it to send a distress signal every 12 hours when it has been unplugged, Miko says.

“This is an issue for providers: The family members of deceased patients often arrange for their whole apartment to be picked up by Goodwill, including their equipment,” he said. “The provider doesn’t know any of this is happening and when they find out they don’t know where their equipment is.”

Big picture, Miko believes VirtuTrack better equips providers for an evolving healthcare market that increasingly values remote patient monitoring, and the improved care and reduced costs that go along with it.

“We’re already talking to ACOs and providers in the home health and HME space that are trying to earn that extra business,” he said. “They’re realizing that being able to monitor an oxygen patient on a real-time basis to find out if they’re using their therapy 24 hours a day like they’ve been prescribed, not just at night—that’s invaluable information. When you’re trying to compete and you all have the same equipment, it makes a difference.”

‘Now is the right time’

While monitoring has become ubiquitous in the sleep therapy market, where insurers require proof of compliance for continued reimbursement, the oxygen therapy market has been slower on the uptake.

But that’s all changing, says Kyle Miko, founder and COO of VirtuOx, which recently launched VirtuTrack, a device that allows providers to track usage and the whereabouts of capital-intensive equipment like oxygen transfill systems and non-invasive ventilators.

“We’re all used to having connected items in our homes, whether it’s a smart phone or a scale or a diabetes monitor or a pulse oximeter,” he said. “We’re all excited to monitor every bit of our lives with these things, so I think now is the right time. It has become more digestible and acceptable.”

Prior to VirtuOx launching VirtuTrack, O2 Concepts launched a portable oxygen concentrator with a built-in modem that allows providers to remotely perform software updates and check settings, usage and purity. ResMed has also shared plans to bring cloud connectivity to the POCs of Inova Labs, which it bought in 2016.

Also helping to push oxygen therapy toward connectivity, Miko says: The price to remotely monitor devices has become more reasonable. VirtuOx charges providers $75 for a VirtuTrack device, plus $3 per month for data.

“Five years ago, a data plan would have been $30 to $40 per month,” he said.

In brief: Philips buys pharmacy sleep services provider, Roche sues over alleged rebate scheme

HME News - Fri, 03/31/2017 - 11:45
03/31/2017HME News Staff

AMSTERDAM, the Netherlands, and SYDNEY – Royal Philips has signed an agreement to buy Australian Pharmacy Sleep Services, in a move that the company says will accelerate its home sleep testing offering through the pharmacy channel in Australia.

“With the addition of APSS to our sleep and respiratory care business in Australia, Philips will be able to provide better access to home sleep testing for those who need it, where and when they need it,” said Kevin Barrow, managing director at Philips Australia and New Zealand.

APSS, founded in 2011, offers a sleep apnea program for pharmacies that includes screening, home-based sleep studies based on CPAP therapy, training and services.

The retail pharmacy market provides a convenient and central local access point to offer simple and effective sleep screening, Philips says.

“This screening is aimed at assessing sleep quality and determining if subsequent sleep treatment may be required,” it stated in a press release. “APSS works closely with medical professionals for assessment and diagnosis of sleep problems, and subsequent sleep treatment.”

Philips expects to complete the transaction in the second quarter of 2017. It will not disclose financial details.

Roche sues pharmacies, supply companies

INDIANAPOLIS – Roche Diagnostics and Roche Diabetes Care have filed a lawsuit in the U.S. District Court of Indianapolis, claiming they have wrongfully paid millions of dollars in rebates and lost millions of dollars in legitimate sales for blood glucose test strips at the hands of an alleged scheme by six pharmacies and medical supply companies. The lawsuit, filed in the U.S. District Court of Indianapolis, charges the pharmacies and medical supply companies with allegedly obtaining test strips from Roche that were intended for reimbursement under DME plans but were sold for retail under pharmacy plans, according to the Indianapolis Business Journal. Test strips under pharmacy plans have a higher list price than strips under DME plans, but pharmacy plans receive larger rebates. “By purchasing strips from Roche at the lower DME list price and diverting them to sale in channels where they would be reimbursed at the much higher pharmacy plan rate, defendants and their co-conspirators made millions of dollars in illicit profits,” the lawsuit charges. Several defendants, including Binson’s Hospital Supplies of Centerline, Mich., and J&B Medical Supply of Wixom, Mich., had allegedly promised to sell the DME test strips only through DME channels, according to the lawsuit. Through a spokesman, J&B Medical said it stopped purchasing test strips from Roche in 2009. "This coincided with the FDA issues with the strips and numerous insurance companies asking J&B to stop purchasing from Roche," he said in an email. "Bottom line, J&B did not purchase from Roche during the timeframe detailed in the lawsuit." J&B said it its 100% confident it will be exonerated and removed from the lawsuit, the spokesman said. The other defendants named in the lawsuit were Northwood of Centerline; Olympus Global of East Lansing, Mich.; Delta Global of Flint, Mich.; and Alpha XE of Cheyenne, Wyo.

CMS says CGMs cannot be used with other technology

WASHINGTON – Medicare beneficiaries using Dexcom’s G5 Mobile continuous glucose monitoring system cannot use smartphone apps or tablets to display glucose data if they want to have the CGM device reimbursed, according to recently released guidance from CMS. If a beneficiary uses a non-DME device (smart phone, tablet, etc.) as the display device, either separately or in combination with the CGM receiver classified as DME, the supply allowance is non-covered. CMS in January said it would classify certain CGMs as DME. Currently, only the Dexcom G5 meets criteria.

AAHomecare pulls together resources

WASHINGTON – AAHomecare hascollected resources and talking points for providers and state associations to use in discussions with payers. Providers can link to information on the CURES letter, pricing comparison by region, HME suppliers/locations by state and an HME cost study by Dobson DaVanzo to show the impact of drastic reimbursement reductions. Laura Williard, senior director of payer relations for AAHomecare,is working with several state/regional associations to support their meetings with payers. Links to the information can be found here.

Supreme Court sides with SCA

STOCKHOLM – SCA says it has won an important victory in its seven-year patent infringement case against First Quality Products. A six-year statutory period of limitations, during which a patent infringement claim must be commenced, cannot be shortened based on the equitable doctrine known as laches, the U.S. Supreme Court ruled in a 7-1 decision on March 21. The decision allows SCA to proceed with its claim for pre-suit damages, the company announced in a press release. “We are thrilled the Supreme Court ruled in our favor,” said Michael Freenan, vice president of sales and marketing for SCA Incontinence Care North America. “SCA can now pursue all of the damages to which it is entitled.” In 2010, SCA sued First Quality in the U.S. District Court for the Western District of Kentucky for infringement of a patent covering adult incontinence products. A lower court dismissed SCA’s claim for pre-suit damages in response to a petition by First Quality. Now that the Supreme Court has reversed that decision, the case returns to Kentucky for trial on both pre- and post-suit damages.

Medicare keeps coverage for wheelchair trays

WASHINGTON – Medicare made a clerical error when it said it considered wheelchair trays, tables or similar products convenience items. The agency said claims for E0950 would be denied as statutorily non-covered, no benefit, according to an LCD and policy article revision posted by the DME MACs on March 16. The article was corrected on March 30. The change was set to take effect retroactively on Jan. 1, 2017. Concerns with the change included the medical necessity of these items and the timing. “They made they change retroactively without any comment period,” stated the Midwest Association of Medical Equipment Services in a bulletin to members. Stakeholders planned to bring up the change at upcoming meetings with the DME MACs in April.

Apria offers payment options

LAKE FOREST, Calif. – Apria Healthcare has partnered with CarePayment, a patient financial engagement company, to provide financing to patients. The 0% APR payment program allows individual to pay over time for their medical supplies and care, according to a press release. “Americans are increasingly burdened by the rising out-of-pocket costs in our healthcare system,” said Dan Starck, CEO for Apria. “Unfortunately, extended illnesses often leave them struggling to make ends meet. We are so pleased to be able to offer our customers a solution that can help reduce the financial anxieties of managing medical conditions at home.”

Respiratory Services opens fourth location

ROCHESTER, N.Y. – Respiratory Services of Western New York has a new retail store at 535 Summit Point Drive in Henrietta, N.Y. The provider held a ribbon cutting ceremony at the store on March 23, with members of the community, local hospital representatives and employees in attendance. “There was a big need in the Rochester area for a company such as us to facilitate referrals from hospitals in a fast manner and provide the level of service that has differentiated us in the marketplace,” said Patti Capitani, vice president of sales, in a press release. During the ribbon cutting, Respiratory Services offered tours of its showroom, which features compression stockings, bath safety equipment, ambulatory devices, aides to daily living, sleep apnea equipment, oxygen equipment, diabetic shoes, lift chairs, scooters and more. Established in 1997, Respiratory Services also has locations in Cheektowaga, Dunkirk and Arcade.

Sigvaris completes expansion

PEACHTREE CITY, Ga. – Sigvaris celebrates the grand opening of its expanded corporate headquarters today. As part of the festivities, the manufacturer is offering plant tours, and the opportunity to meet with corporate executives and members of the founding family from Switzerland. The 40,000-square-corporate headquarters now houses office, manufacturing and warehouse space, all under one roof. The grand opening at the corporate headquarters follows a ribbon cutting at a second new manufacturing facility in Holland, Mich., on March 28. Sigvaris focuses on the development, production and distribution of medical compression garments, including hosiery, socks and inelastic compression garments.

Convaid revamps website

TORRANCE, Calif. – Convaid has launched a new website to provide a more user-friendly experience and optimized functionality. The website makes it easy to explore the company’s line of pediatric wheelchairs, with how-to videos, customer insights, industry resources, an educational portal and an interactive community section. It also helps users “geo-locate” dealers anywhere in the world. The website is compatible with all browsers and mobile devices.

Conference updates: AAH, Medtrade, CRT

AAHomecare has shortened and slashed the price of its Washington Legislative Conference this year. The conference will take place at the Washington Court Hotel on May 24 and 25, but events will conclude at 2 p.m. on May 24, giving attendees more time to conduct meetings on Capitol Hill. “Whether you’re an experienced, regular attendee of the conference or this is your first time attending, your direct, in-person engagement with legislators and their staff members is the most effective means to advocate for better public policy for HME,” the association stated in a press release. AAHomecare is offering a rate of $49 for members and $99 for non-members this year, half the cost of last year’s conference. To increase the buzz around the conference, the association is encouraging stakeholders to share why they feel attending is so important on social media using #AAHWLC17. Register here…Show organizers have locked in Oct. 23-26 as the dates for this year’s Medtrade in Atlanta. “We believe Medtrade 2017 can be a huge focal point as the industry rebounds from very difficult times,” said Kevin Gaffney, group show director, Medtrade, in a press release. Organizers have also set Feb. 26-28, 2018, as the dates for the next Medtrade Spring in Las Vegas…Among the sessions at the upcoming National CRT Leadership and Advocacy Conference will be a panel presentation providing an overview of the healthcare issues, options and politics in Washington, D.C. Participating in the panel will be Eric Gascho, vice president of government affairs at the National Health Council; and Amy Cunniffe, principal, and Sarah Egge, senior manager, of the Washington Council at Ernst & Young. NCART says the session will be a “great primer” for the congressional visits on April 27 that will follow educational sessions on April 26. The conference takes place at the Hyatt Regency Crystal City in Arlington, Va.

Short takes: Medforce, Circadiance, AOPA, FODAC

Medforce Technologieshas joined the National Association for Home Care and Hospice. “We have experienced solid growth in the home health sector over the past several years,” said Esther Apter, Medforce CEO. “Joining NAHC was a logical choice to help us stay in tune with the latest challenges and continue to learn how to best serve this industry”…Circadiance has launched the SleepWeaver 3D Soft Cloth CPAP Mask in the U.S., following its recent 510(k) clearance from the U.S. Food and Drug Administration. The cloth mask provides an interface for CPAP or BIPAP therapy and is intended for single patient re-use…The American Orthotic & Prosthetic Association (AOPA) has announced that the American Board for Certification in Orthotics, Prosthetics & Pedorthics (ABC) will sponsor the Presidential Papers at the 2017 AOPA World Congress. The Presidential Papers represent the top 10 clinical education submissions of original research backed by a full manuscript and will be published in a special supplement of the Journal of NeuroEngineering and Rehabilitation. ABC will also be an official partner of the Congress, Sept. 6-9 in Las Vegas…Friends of Disabled Adults and Children (FODAC) will hold its 17th Annual Run Walk n’ Roll at Stone Mountain Park in Stone Mountain, Ga., on May 6. The 5-mile race and 2-mile walk is one of FODAC’s main fundraisers. Participants can run, walk or roll through the course—wheelchairs, strollers and walkers are all welcome.

Philips buys Australian pharmacy sleep services provider

HME News - Fri, 03/31/2017 - 10:56
03/31/2017HME News Staff

AMSTERDAM, the Netherlands, and SYDNEY – Royal Philips has signed an agreement to buy Australian Pharmacy Sleep Services, in a move that the company says will accelerate its home sleep testing offering through the pharmacy channel in Australia.

“With the addition of APSS to our sleep and respiratory care business in Australia, Philips will be able to provide better access to home sleep testing for those who need it, where and when they need it,” said Kevin Barrow, managing director at Philips Australia and New Zealand.

APSS, founded in 2011, offers a sleep apnea program for pharmacies that includes screening, home-based sleep studies based on CPAP therapy, training and services.

The retail pharmacy market provides a convenient and central local access point to offer simple and effective sleep screening, Philips says.

“This screening is aimed at assessing sleep quality and determining if subsequent sleep treatment may be required,” it stated in a press release. “APSS works closely with medical professionals for assessment and diagnosis of sleep problems, and subsequent sleep treatment.”

Philips expects to complete the transaction in the second quarter of 2017. It will not disclose financial details.

Survey: Mail-order program reduces access

HME News - Thu, 03/30/2017 - 12:40
03/30/2017HME News Staff

CHICAGO – Medicare’s national mail-order program for diabetes testing supplies has sharply reduced beneficiary access, says a new survey from the America Association of Diabetes Educators.

The “secret shopper” survey found that:   

• The number of brands available under the mail-order program has fallen 50% since the program started;

• The number of models of diabetes testing systems available under the mail-order program is less than half the number available in 2009, before the program started;

• Many suppliers do not offer models covering 50% of the market share of diabetes testing supplies; and

• Suppliers do not provide consistent information about inventory to customers.

“Evidence continues to show that the competitive bidding process is failing people with diabetes and putting them at unnecessary risk,” said Kellie Antinori-Lent, a diabetes clinical nurse specialist at the University of Pittsburgh Medical Center. “Patient safety and choice must come first.”

To ensure beneficiary safety and well-being, a complete review of the program is necessary, says the AADE.

The association applauds the recent announcement by CMS to delay Round 2019 of the competitive bidding program. It hopes the process can be overhauled to reflect evidence-based data and best practices.

‘Right this wrong,’ providers tell CMS

HME News - Fri, 03/24/2017 - 13:00
Callers to forum outline problems related to drastic rate cuts03/24/2017Theresa Flaherty

WASHINGTON – From Martha’s Vineyard to the Pacific Northwest, rural HME providers are struggling to survive in a post-competitive bidding world, they told CMS officials during a call March 23.

CMS was mandated by the 21st Century Cures Act to take into account stakeholder input on future pricing in non-bid areas, which got their first taste of the program in 2016.

“We’ve been forced to dig into our personal savings to keep our business afloat this year and continue to provide much needed supplies and services in our area in anticipation that Medicare will right this wrong,” said Rebecca Erickson of Star Valley Medical Supply in Afton, Wyo.

Signed into law in December, the Cures Act rolled back cuts that went into effect in non-competitive bidding areas from June 30, 2016, to Dec. 31, 2016, allowing providers in those areas to recoup six months worth of payments.

With that cut, and a first round of cuts that went into effect on Jan. 1, 2016, it’s unrealistic of Medicare to expect providers to be able to absorb cuts of 50% or more, say providers.

“It’s devastating to us, but, more importantly, the beneficiaries,” said one provider from Washington state. “When I tell them it will be billed on assignment, they walk out without the item and end up having further issues. CMS is forcing non-adherence. As a medical provider, I can’t even grasp where that makes sense.”

During the call, CMS sought input on: average travel distance and costs associated with furnishing items and services in an area; and average volume of items and services furnished by suppliers in the area.

Providers argue that, in rural areas, you can’t make up for reduced reimbursement with volume.

“One of the keystones of the program is that your volume goes up,” said Josh Shields of BetaMed in Bryan, Texas. “We are serving the same volume, but at a lower price.”

As a result, beneficiaries must wait longer for deliveries, and they have less choice in equipment, Shields said.

CMS also sought input on the number of suppliers in an area. Most callers said, in their area, they are it.

“I’m the sole provider of oxygen, CPAP and DME for Martha’s Vineyard,” said John Curelli of Island Home Medical. “We are hoping we don’t have to leave Martha’s Vineyard (located seven miles off the coast of Massachusetts) without a provider. The Cures Act needs to help cure this industry.”

While CMS has set an implementation date of July 3 to make repayments, that’s too long of a wait, say providers.

“Beds in central Virginia are down to $8.46 a month,” said Ronnie Rankin of Culpepper Home Medical in Culpeper, Va. “We can’t get out the door for that. We’d like to see a fast resolution to the Cures Act and definitely a better reimbursement rate based on a lot of factors that you deal with in a rural area.”

 

New RAC starts ‘slow and steady’

HME News - Fri, 03/24/2017 - 12:58
03/24/2017Liz Beaulieu

LIVERMORE, Calif. – Performant Recovery was officially up and running as of March 8, but the new national RAC for HME is taking its time ramping up its activities.

Peformant posted seven new reviews for everything from chest wall oscillation devices to complex Group 2 support surfaces in February. But it had not posted any additional reviews as of late March.

“I would expect that they would add one or two edits every seven days to staff up to where they were at previously with known issues,” said Andrea Stark, a reimbursement consultant with MiraVista. “They may be taking a slow and steadier approach.”

There are others signs that the RAC process under Performant will be a smoother and more manageable one for HME providers.

Right out of the gate, Performant opened a line of communication with providers by hosting two webinars in conjunction with the two DME MACs, Noridian and CGS.

“That’s the first time we’ve seen a RAC do any kind of outreach,” Stark said. “That kind of early communication can’t be undervalued.”

Also, while providers have worried about whether or not Performant will apply the correct coverage policies—their reviews will span three years—that may not be an issue under the new RAC, stakeholders say.

“Initial discussions with the RAC do not indicate that this will be a concern,” said Wayne van Halem, president of The van Halem Group, a division of The VGM Group. “They’re aware of the fact that they must apply the rules in place on the date of service in question.”

Finally, providers have a more meaningful discussion period under Performant that will work in their favor. There’s always been a discussion period, but because previous RACs immediately signaled the MAC to start the overpayment process, the only way providers could hold onto their money was to file appeals. Now they have 30 days to work the process until anything is forwarded to the MAC.

“Oh yeah,” said Kim Brummett, vice president of regulatory affairs at AAHomecare, when asked whether or not she thinks providers will take advantage of the discussion period. “They should.”

Are you RAC ready?

Since it’s been so long since providers have had to grapple with a RAC, stakeholders offered these pieces of advice:

Be proactive.“Suppliers must have an internal quality assurance and compliance program that regularly monitors the claims that are being submitted,” van Halem said. “They should review the RAC website regularly to perform a risk assessment on their proactive audits. Suppliers can minimize the impact of these audits for themselves.”

Read carefully.“Some are medical necessity reviews and some are documentation reviews,” Brummett said. “Pay attention to your audit request letters and know which you are dealing with.”

Keep organized.“Use separator sheets to tell the auditors, this is where the face-to-face evaluation is, this is where the proof of delivery is,” Stark said. “They’re going to itemize the things they want you to send back to them, so make it as easy as possible on them. It predisposes you to a favorable opinion.”

 

Lymphedema advocates leverage personal connections

HME News - Fri, 03/24/2017 - 12:56
‘During these meetings, the light goes on,’ Woodward says03/24/2017Theresa Flaherty

WASHINGTON – With recently reintroduced legislation in hand, more than 70 lymphedema advocates will visit Capitol Hill this week to build on previous support.

The Lymphedema Treatment Act would amend Medicare statute to pay for compression garments, bandages and supplies to reduce lymphedema-related swelling and prevent recurrence. Currently, Medicare only pays for pneumatic compression pumps, and therapy provided by physical and occupational therapists.

“We’re looking forward to keeping this on their radar,” said Judy Woodward, chairwoman of awareness for the Lymphedema Advocacy Group, a volunteer organization that was founded specifically to help get the bill passed. “More and more, we are realizing that many people do have a personal connection to lymphedema and, during these meetings, the light goes on.”

The biggest concern for lawmakers about the bill is cost, says Woodward, but treating lymphedema appropriately prevents the need for more costly care—like hospitalizations—down the road.

A positive sign: The bill, which was reintroduced in the House of Representatives on Feb. 10 and in the Senate on March 2, has quickly garnered 70 and 16 co-sponsors, respectively. Such an early introduction with a large number of co-sponsors right out of the gate bodes well, says Woodward.

“Obviously, there’s a lot going on in Washington, D.C., but we are encouraged that, despite all of the focus on so many big issues, the number of supporters we have already speaks a lot,” she said.

Although the bill could get passed on its own, it’s more likely to get attached to a larger vehicle, like a Medicare bill that is expected later in the year, says Woodward.

“We’ve been told by our lead sponsors that all options are on the table,” she said.

 

In brief: AAH, VGM call on Price to take action; stakeholders question CMS’s authority to bundle

HME News - Fri, 03/24/2017 - 12:50
03/24/2017HME News Staff

WASHINGTON – AAHomecare has outlined several recommendations for fixing the competitive bidding program in a new letter to Health and Human Services Secretary Tom Price.

Those recommendations are:

• Use market clearing price to determine the single payment amount for any item included in competitive bidding.

• Use historical claims data to determine supplier capacity.

• Increase transparency of the competitive bidding program.

• Reform competitive bidding product categories.

• Apply uniform payment rules for transitioning DMEPOS competitive bidding beneficiaries.

• Remove CMS’s authority to move forward with bundled payments for CPAP and standard power wheelchairs.

“HME suppliers, patient groups and leading economists and auction experts have voiced concerns about major structural problems with the bidding program since it first took effect,” said Tom Ryan, president and CEO AAHomecare.  “With the next round of the bidding program set to consolidate the two rounds into one entity, the time is right for CMS to make these much-needed and common-sense changes.”

AAHomecare recommends CMS go through the formal rulemaking process to instate the proposed reforms.

This week’s letter follows a letter in February to Dr. Price requesting a repeal of the full phase-in of the Medicare adjusted fee schedule rates for non-competitive bidding areas that went into effect July 1, 2016.

VGM calls on Price to take action

WATERLOO, Iowa – The VGM Group outlined three priorities that need “immediate action,” including relief for HME providers rural areas, in a March 20 letter to Health and Human Services Secretary Tom Price.

The top priority: speeding up six months of payments owed to HME providers as part of a retroactive delay of reimbursement cuts that went into effect in non-competitive bidding areas on July 1, 2016. A provision in the Cures Act delayed the cuts until Jan. 1, 2017. CMS in February notified the DME MACs that they could begin dispersing payments on May 1, with implementation by July 3.

“This delay is unnecessary as more suppliers are forced to close their businesses on a weekly basis while waiting for payments on services provided nearly one year prior,” VGM stated in the letter.

The other two priorities: delaying these cuts to non-bid areas indefinitely, until an impact analysis is released; and correcting CMS’s application of two different statutes to determine payment methodologies for oxygen concentrators.

Additionally, VGM called on Price to reform the overall competitive bidding program; implement a broader prior authorization program to reduce audits; establish a separate benefit for complex rehab; and work with Veterans Affairs and Tricare to match their reimbursement rates to Medicare’s fee schedule.

“With the implementation of these proposed regulatory recommendations to the administration, we firmly believe that home medical equipment suppliers across the nation will have a renewed ability to provide care to the most vulnerable patients in the healthcare system,” the letter states.

Stakeholders question authority to bundle

WASHINGTON – CMS does not have the authority to implement bundled bidding programs for CPAP or other HME, because it would jeopardize patient access to specific equipment, say industry stakeholders.

Bundling a CPAP device, consumable items, maintenance and service into a single monthly payment will cause disruption for suppliers and will provide an incentive to furnish inferior products and provide a lower quality of care to compensate for shrinking margins, said AAHomecare in its weekly newsletter.

Additionally, “it could substantially increase co-payments and out-of-pocket expenses for beneficiaries,” said Larissa D’Andrea, government affairs director for ResMed. “Plus, layering untested bundled payments on top of expanded competitive bidding program rates could compound existing access challenges caused by these other cuts.”

AAHomecare and industry groups like AdvaMed, the CQRC and The VGM Group are developing a unified response to Medicare’s proposal to bundle payment for CPAP in future rounds of competitive bidding. They plan to outline their response a forthcoming letter to CMS.

CMS on Jan. 31 announced it had added 10 new competitive bidding areas for the CPAP category. In five of those CBAs, payment for CPAP devices, related accessories, and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like all other existing CBAs.

Brightree links to AirView, myAir

ATLANTA – Brightree has enhanced the integration between its HME billing and business management module and ResMed’s AirView and myAir. The enhanced capabilities include creating and updating patients in AirView, minimizing duplicate entry; receiving automatic patient compliance notifications from AirView, eliminating the need to check multiple systems; and inviting patients to register with myAir, helping to engage patients in their own therapy. “As the healthcare industry shifts to an outcomes-based model, Brightree and ResMed are working to provide innovative, seamless solutions to create greater visibility into performance and smarter decision making,” said Matt Mellott, Brightree’s president and CEO. AirView is a cloud-based sleep and respiratory care patient management platform; myAir is a patient engagement platform. ResMed bought Brightree in 2016.

Upstate HomeCare doubles down on specialty infusion

CLINTON, N.Y. – Upstate HomeCare now has a dedicated management team, strategic plan and sales force for its specialty infusion services business. The provider shifted away from retail pharmacy into specialty infusion services last summer. “We’re very excited to be expanding our services and aligning our strengths with our mission,” said Gregory LoPresti, CEO of Upstate HomeCare. “This shift builds upon our strength, which is home infusion services and associated core therapies.” Upstate HomeCare will be serving patients across New York from Albany to Buffalo. The company also provides a full line of respiratory therapies, from oxygen concentrators to CPAP devices to ventilators.

Spring time at the Capitol: NCPA, United Spinal plan events

The National Community Pharmacists Association has scheduled its 2017 Congressional Pharmacy Fly-In for April 26-27. As part of the event, hundreds of community pharmacists will visit the Capitol to advocate for their businesses and their patients. The fly-in will feature a legislative briefing with former Rep. Jim McCrery, now a partner at Capitol Counsel; and a breakfast keynote by Jayne O’Donnell, a healthcare reporter for USA Today. Register at www.ncpanet.org/flyin…The 6th Annual Roll on Capitol Hill Legislative and Advocacy Conference will take place June 11-14. The United Spinal Association hosts the event to advocate for the health, independence and quality of life of individuals with spinal cord injuries. Last year’s event drew more than 150 attendees from 33 states. FMI: www.unitedspinal.org.

Governor recognizes GF Health Products for export excellence

ATLANTA – Georgia Gov. Nathan Deal, in conjunction with the Georgia Department of Economic Development (GDEcD), recently presented Graham-Field with the Georgia Launching Opportunities by Exporting (GLOBE) Award. “It is gratifying to know how well Graham-Field’s USA-manufactured medical equipment is respected throughout the world,” said President and CEO Ken Spett, who accepted the award. It is because of companies like Graham-Field that Georgia has earned a reputation as a leader in international trade, said the commissioner of the GDEcD. “With our strong international presence, Georgia is ready and able to support companies looking to achieve new levels of success,” Pat Wilson said. Graham-Field and its more than 300 employees make healthcare products for the acute care, extended care, homecare and primary care markets. Its brands include Basic American, American Medical Products, Everest & Jennings, Grafco, John Bunn, Labtron, Lumex and Lumiscope.

Sigvaris launches measurement system

PEACHTREE CITY, Ga. – Sigvaris has added an “initial pressure measurement system” to three of its inelastic compression wraps, the company announced March 21. The new system allows clinicians to prescribe a specific compression level (20-30mmHg, 30-40mmHg or 40-50mmHg) and patients to set the level themselves. “This product is going to change the market for inelastic wraps and finally give clinicians the confidence that patients will be able to accurately set their garment to the correct compression level at home,” said Scot Dubé, president and CEO of Sigvaris North America. The patent-pending Accutab system comes standard on Compreflex, Compreflex Lite and Compreflex NF.

Sleep therapy could help certain heart failure patients, ResMed study shows

SAN DIEGO – Further study is needed to determine how using adaptive servo-ventilation (ASV) therapy to treat sleep-disordered breathing helps people who have heart failure with preserved ejection fraction, according to a study published March 20 in the Journal of the American College of Cardiology. The overall results of the study were neutral, but they showed a statistical significant improvement in the primary endpoint for people with moderate to severe sleep-disordered breathing and this type of heart failure, ResMed stated in a press release. The primary endpoint was cardiovascular outcomes measured as a Global Rank Score that included survival free from cardiovascular hospitalization and change in functional capacity as measured by the six-minute walk distance. The study also assessed changes in functional parameters, arrhythmias, biomarkers, quality of life, and sleep and breathing. Leading cardiologists say the improvement for these patients signals a potential breakthrough in treatment, according to ResMed. "There are no recommended therapies specific for HFpEF patients, which accounts for half of all people living with chronic heart failure," said Dr. Christopher O'Connor, the study's lead investigator, a cardiologist and CEO of the Inova Heart and Vascular Institute. "These results from CAT-HF suggest we need to further study the role of whether addressing sleep-disordered breathing can help people who have heart failure with preserved ejection fraction." The study, the "Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure – The CAT-HF Trial," is a multicenter, randomized, controlled Phase II trial funded by ResMed to broaden the understanding of how best to treat diagnosed sleep apnea in patients that also have a particular form of heart failure.

ResMed-Brightree make Deal of the Year

SAN DIEGO – ResMed’s acquisition of Brightree was named Deal of the Year by Mergers & Acquisitions magazine. The deal underscores the ongoing shift in U.S. healthcare from a fee-for-service model to a value-based model, and the need for players across the healthcare continuum to use informatics and data analytics as tools to share information and deliver care more efficiently, said ResMed in a release. ResMed acquired Brightree for $800 million in February 2016.

AAHomecare calls on Price to take action

HME News - Fri, 03/24/2017 - 12:39
03/24/2017HME News Staff

WASHINGTON – AAHomecare has outlined several recommendations for fixing the competitive bidding program in a new letter to Health and Human Services Secretary Tom Price.

Those recommendations are:

• Use market clearing price to determine the single payment amount for any item included in competitive bidding.

• Use historical claims data to determine supplier capacity.

• Increase transparency of the competitive bidding program.

• Reform competitive bidding product categories.

• Apply uniform payment rules for transitioning DMEPOS competitive bidding beneficiaries.

• Remove CMS’s authority to move forward with bundled payments for CPAP and standard power wheelchairs.

“HME suppliers, patient groups and leading economists and auction experts have voiced concerns about major structural problems with the bidding program since it first took effect,” said Tom Ryan, president and CEO AAHomecare.  “With the next round of the bidding program set to consolidate the two rounds into one entity, the time is right for CMS to make these much-needed and common-sense changes.”

AAHomecare recommends CMS go through the formal rulemaking process to instate the proposed reforms.

This week’s letter follows a letter in February to Dr. Price requesting a repeal of the full phase-in of the Medicare adjusted fee schedule rates for non-competitive bidding areas that went into effect July 1, 2016.

Stakeholders question authority to bundle

HME News - Thu, 03/23/2017 - 14:41
03/23/2017HME News Staff

WASHINGTON – CMS does not have the authority to implement bundled bidding programs for CPAP or other HME, because it would jeopardize patient access to specific equipment, say industry stakeholders.

Bundling a CPAP device, consumable items, maintenance and service into a single monthly payment will cause disruption for suppliers and will provide an incentive to furnish inferior products and provide a lower quality of care to compensate for shrinking margins, said AAHomecare in its weekly newsletter.

Additionally, “it could substantially increase co-payments and out-of-pocket expenses for beneficiaries,” said Larissa D’Andrea, government affairs director for ResMed. “Plus, layering untested bundled payments on top of expanded competitive bidding program rates could compound existing access challenges caused by these other cuts.”

AAHomecare and industry groups like AdvaMed, the CQRC and The VGM Group are developing a unified response to Medicare’s proposal to bundle payment for CPAP in future rounds of competitive bidding. They plan to outline their response a forthcoming letter to CMS.

CMS on Jan. 31 announced it had added 10 new competitive bidding areas for the CPAP category. In five of those CBAs, payment for CPAP devices, related accessories, and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like all other existing CBAs.

Prior authorization: CMS clarifies stance on accessories

HME News - Wed, 03/22/2017 - 09:41
Agency also agrees to change delivery timeframe03/22/2017Liz Beaulieu

WASHINGTON – During a second Special Open Door on March 21, CMS officials gave examples of what accessories are covered under a new prior authorization process for K0856 and K0861 power wheelchairs.

Accessory codes required to make a coverage decision on the base include, but are not limited to, power seating system combination tilt and recline (E1007); head control interface (E2327, E2328, E2329, E2330); sip-n-puff interface (E2325); joystick other than a standard proportional joystick (E2312, E2321, E2373); multi-switch hand control interface (E2322); and seat cushions.

Accessory codes not required to make a coverage decision for the overall review include, but are not limited to, headrests (E0955); lateral hip/trunk supports (E0956); swing-away hardware (E1028); electronics (E2310, E2311); leg rests (K0195, K0108, E1012); and batteries.

During the first forum on March 16, CMS officials said if an accessory is essential to the functioning of a K0856 or K0861 wheelchair, it would be considered part of the base and covered under the prior authorization process. While providers were happy to hear that, they encouraged CMS officials to develop a formal list of those accessories.

Back at the March 21 forum, CMS officials encouraged providers to review their DME MAC LCDs, which detail the coverage criteria required for K0856 and K0861. They said those coverage criteria are often tied to the need for certain accessories. CMS officials also noted their decision whether or not to affirm a prior authorization request would be based on the base and accessories, together. They said they would not provide separate decisions.

Additionally, CMS officials announced they would change the timeframe for delivering K0856 or K0861 wheelchairs from 120 days from the face-to-face evaluation to six months. During the first forum, providers noted they prefer the six-month timeframe, which is line with the advance determination of Medicare coverage (ADMC) process.

VGM calls on Price to take action

HME News - Tue, 03/21/2017 - 09:22
03/21/2017HME News Staff

WATERLOO, Iowa – The VGM Group outlined three priorities that need “immediate action,” including relief for HME providers rural areas, in a March 20 letter to Health and Human Services Secretary Tom Price.

The top priority: speeding up six months of payments owed to HME providers as part of a retroactive delay of reimbursement cuts that went into effect in non-competitive bidding areas on July 1, 2016. A provision in the Cures Act delayed the cuts until Jan. 1, 2017. CMS in February notified the DME MACs that they could begin dispersing payments on May 1, with implementation by July 3.

“This delay is unnecessary as more suppliers are forced to close their businesses on a weekly basis while waiting for payments on services provided nearly one year prior,” VGM stated in the letter.

The other two priorities: delaying these cuts to non-bid areas indefinitely, until an impact analysis is released; and correcting CMS’s application of two different statutes to determine payment methodologies for oxygen concentrators.

Additionally, VGM called on Price to reform the overall competitive bidding program; implement a broader prior authorization program to reduce audits; establish a separate benefit for complex rehab; and work with Veterans Affairs and Tricare to match their reimbursement rates to Medicare’s fee schedule.

“With the implementation of these proposed regulatory recommendations to the administration, we firmly believe that home medical equipment suppliers across the nation will have a renewed ability to provide care to the most vulnerable patients in the healthcare system,” the letter states.

With Verma in place, it’s time to get to work

HME News - Fri, 03/17/2017 - 12:38
03/17/2017Theresa Flaherty

WASHINGTON – Seema Verma, the new CMS administrator, is a relative unknown as far as HME is concerned, but stakeholders say having new leadership in place offers new opportunities to press forward on a host of issues.

“I’m excited to see that she’s been confirmed so we can get to work with her and the rest of the CMS staff to extend the interim relief for rural suppliers that was part of the Cures Act,” said Tom Ryan, AAHomecare president and CEO. “We also want to engage CMS on longer-term improvements for future rounds of the bidding program and other HME public policy priorities.”

The Senate on March 13 voted 55-43 to approve Verma’s nomination. Verma, the president, CEO and founder of SVC, an Indianapolis-based national health policy consulting company, will oversee a $1 trillion agency that serves more than 100 million Americans that access healthcare services through Medicare, Medicaid, CHIP and the Marketplace.

Verma’s biggest claim to fame: redesigning Indiana’s Medicaid program. She expanded eligibility but required recipients to pay premiums, contribute to health savings accounts and receive incentives for healthy behavior.

“Feedback from Indiana folks is that the system worked compared to the other systems that were failing,” said John Gallagher, vice president of government relations for The VGM Group.“It was a patient-centric approach, so that falls in line with Dr. Price’s approach.”

While Tom Price, the new Health and Human Services Secretary,is a long-time industry champion and outspoken critic of Medicare,Verma has little experience with the program. Still, her background with Medicaid should translate well to the HME industry, says Ryan.

“She’s certainly aware of the important role that HME plays in allowing patients to remain in their homes and avoid more costly clinical interventions,” he said.

At a Feb. 16 hearing before the Senate Finance Committee, Verma said that one-size-fits-all approaches to healthcare, like CMS’s competitive bidding program, don’t always work and that it’s important to understand how policies impact providers.

“We don't want to see that our policies and our programs are actually preventing providers—that we're losing providers and that they don't want to see Medicaid or Medicare beneficiaries anymore,” she said. “So, we'll be very careful with policies so that we're not pushing providers out of the system, but that we're actually attracting providers to the program.”

While stakeholders say they look forward to working with Verma and Price, that won’t happen right away, thanks to a mandate from President Trump that restricts federal agencies from communicating with the public, says Gallagher.

“They can’t have meetings,” he said. “We’re still really working through members of Congress to arm them with information, as they work with the bureaucracy within CMS.”

 

Accessories remain gray area for prior authorization process

HME News - Fri, 03/17/2017 - 12:36
03/17/2017Liz Beaulieu

WASHINGTON – CMS officials spent much of a Special Open Door Forum on March 16 discussing whether or not accessories will be covered under a new prior authorization process for two complex power wheelchair codes.

During a Power Point presentation during the forum, CMS officials said accessories are not included in the process because all codes subject to prior authorizations must be included on a previously released “master list” of codes. To be included on that list, a code must have a fee schedule purchase amount of $1,000 or more, or a rental amount of $100 or more, or be the subject of review by the Office of Inspector General or the General Accountability Office, or be included in a recent Medicare improper payment report.

Accessories for power wheelchairs do not meet these criteria, CMS officials said.

But if an accessory is essential to the functioning of the power wheelchair, like a sip-and-puff, it will be considered part of the base and included as part of the prior authorization, they said.

While providers who called into a subsequent Q&A session were happy to hear that, they encouraged CMS officials to develop a formal list of accessories that they consider essential to the functioning of the power wheelchair to help providers avoid any grey areas.

Other items discussed during the Q&A session:

ADMC vs. PA

Providers who called into the forum noted that they prefer the six months they have to deliver equipment from the face-to-face evaluation as part of the advance determination of Medicare coverage process, versus the 120 days for the prior authorization process. CMS officials said they are open to that and would look into incorporating that into future guidance for the prior authorization process.

Existing claims

CMS officials said they would pass through all existing claims that have been approved by the ADMC process. When a provider shared that a reviewer with Noridian told her that any claims submitted through the ADMC process before March 19, even those she hadn’t received a determination for, would stand, CMS officials told her to follow those instructions.

CMS officials noted that the provider feedback during the forum gave them information to think about and ideas for improving the process going forward.

CMS officials will hold the second in its series of Special Open Door Forums on the prior authorization process this Tuesday.

CMS contractors CGS and Noridian on March 6 began accepting prior authorization requests for K0856 and K0861 for dates of delivery on or after March 20. The first phase of the process applies to Illinois, West Virginia, Missouri and New York, with a national rollout slated for July 17.

Majority of providers keep business functions in the US

HME News - Fri, 03/17/2017 - 12:34
03/17/2017Liz Beaulieu

YARMOUTH, Maine – Outsourcing business functions may be on the upswing, but outsourcing them out of the country is still a rarity in the HME industry, according to a recent HME Newspoll.

Seventy nine percent of respondents to the poll reported they don’t outsource any business functions out of the country, though they’re increasingly tempted to, due to razor-thin margins.

“We chose not to outsource out of the country, although we have reviewed it several times,” commented one respondent. “For us to do so, when serving Medicare, especially did not seem right. That being said, because we did not, we were not able to participate in the latest rounds of bidding, which in our category, reimbursement is barely covering the cost of goods.”

For the 21% that do outsource out of the country, the most common business functions to outsource are billing and collections, followed by insurance verification.

The combination of steep reimbursement cuts with, in some states, a high minimum wage, means outsourcing out of the country is a necessity for some respondents.

“Medicare reimbursement cuts + California $15 minimum wage = offshore labor,” commented one respondent, who outsources basic data entry, insurance verification, documentation, and billing and collections. “As of July 2016, we are actively replacing American workers with offshore labor. We anticipate replacing 20 jobs with 30 offshore jobs at over half the cost.”

While there may be a stigma associated with outsourcing out of the country, one respondent said the quality of work is high and the cost is low.

“We employ nurses with four-year degrees (BSN) to do insurance verification, billing and collections, clinical support and intake, because we can employ them very inexpensively,” said Pamela Bowen of Classic SleepCare in California.

A number of respondents also noted that, while they don’t personally outsource out of the country, the billing and collections companies or software companies they use do. For one respondent, that was a deal-breaker.

“I was unaware that our billing company outsourced our work,” commented the respondent. “We now use a company located in New York state.”

CCS Medical ‘Connects’ diabetes patients

HME News - Fri, 03/17/2017 - 12:33
‘We never dismiss or discharge anyone’03/17/2017Kelly Bothum

FARMERS BRANCH, Texas – CCS Medical is seeing 25% higher testing rates for hemoglobin A1c, blood pressure, cholesterol, kidney and eye tests, and reductions in emergency room visits and hospitalizations for patients in its virtual diabetes education program.

Most diabetes education programs are offered only in-person, usually in a class setting with an educator available on a limited schedule. That’s not the case with CCS Connects, which allows people with diabetes to work individually with a certified diabetes educator by phone, email, webinar or Skype to get the information and support they need.

“Traditionally, people go to diabetes education classes and work on goals,” said Kristine Erdman, vice president of clinical services for CCS Medical. “Then they’re done and you never see them again. But people are still struggling with their management and self-care. We never dismiss or discharge anyone from the program.”

CCS Connects was recently named a Diabetes Education Accreditation Program by the American Association of Diabetes Educators.It’s the longest-running diabetes education program of its kind, with 18 years of improved outcomes.

CCS Connects uses health assessments and smart devices to help members with medication adherence, goal setting and other behavioral modifications. It also can be combined with CCS Living Connected, an interactive wellness program that provides round-the-clock monitoring and access to a team of RNs, dietitians, pharmacists and diabetes educators. Wireless glucose meters provide instant results for CDEs, so if a member has an adverse glucose reading they can immediately intervene.

“With the technology now, you can have a direct view in real-time how they are doing,” Erdman said. “We don’t have to call and ask ‘Do you need supplies?’ because we can text from the device.”

In the future, CCS Medical plans to develop similar programs focused on hypertension, diabetes prevention and asthma.   

In brief: ResMed, Philips highlight research on World Sleep Day, national specialty pharmacy providers merge

HME News - Fri, 03/17/2017 - 12:30
03/17/2017HME News Staff

AMSTERDAM – Adults recognize that sleep is important, but they still prioritize other things in their lives over sleep, according to a new international survey published by Royal Philips on World Sleep Day.

Ninety-two percent of 6,461 adults across five countries who were surveyed by Harris Poll said sleep is crucial to their overall health and wellbeing. They say even one bad night of sleep can result in looking tired, being less productive and feeling unmotivated.

Yet 84% of adults say other things in their lives are more important than a good night’s sleep, including family time and job responsibilities.

Twenty-eight percent of adults also say that, despite all the literature that screens should be turned off well before sleep, watching TV is the last thing they do before bed.

“Sleep is vitally important to the ‘healthy lifestyle’ equation, but it is often cast aside as less important compared to the other fundamental elements such as eating well or exercising,” said Dr. Teofilo Lee-Chiong, sleep clinician and chief medical liaison, Philips. “We need to start thinking of health and wellness as a table with four legs, each of which representing proper nutrition, exercise, positive mental health and sleep—if we’re only focusing on diet and exercise, that table isn’t going to be balanced.”

Philips aims to use the survey, “Unfiltered Sleep: A Global Prioritization Puzzle,” to start a conversation about the importance of sleep to overall health and wellbeing.

ResMed highlights sleep research

SAN DIEGO – ResMed has picked the top five research findings among more than 3,000 studies published last year in recognition of World Sleep Day.

“Unnecessary hospital readmissions and inefficient practices are huge drivers of today’s exorbitant healthcare costs,” said Adam Benjafield, ResMed vice president of medical affairs. “Recognizing sleep apnea is associated with many other life-threatening conditions and knowing early detection makes a world of difference, treatment efficacy and efficiency have become even more paramount. The research we’ve highlighted today shows that we’re moving in the right direction.”

Summaries of the research are:

·      There is a high prevalence of sleep-disordered breathing among stable chronic heart failure patients (Arzt M et al. JACC Heart Fail 2016).Of 6,876 stable chronic heart failure (CHF) patients across 138 German centers, the prevalence of moderate to severe sleep-disordered breathing (SDB) was 46%, with a significant difference seen between thesexes (36% in women vs. 49% in men). Risk factors included body mass index, left ventriculardysfunction, age, atrial fibrillation and male sex.

·      Early recognition of obstructive sleep apnea in patients hospitalized with COPD exacerbation isassociated with reduced readmission rates (Konikkara J et al. Hosp Pract 2016).Patients consulted for COPD exacerbation underwent a sleep test upon discharge and received positive airwaypressure (PAP) therapy as appropriate. The mean change in the number of clinical events six months prior tointervention compared to six months following intervention favored the group who used their PAP therapy,demonstrating early recognition and treatment of obstructive sleep apnea (OSA) in patients admitted withCOPD exacerbation may be associated with reduced hospital admission rates and emergency room visits.

·      CPAP significantly improves quality of life, sleepiness and cerebrovascular measures in patients with obstructive sleep apnea (McEvoy RD et al. N Engl J Med 2016).While results in the landmark SAVE trial were neutral on the primary endpoint of whether CPAP can reducemajor cardiovascular events in those with OSA and heart disease, the 2,700-patient study did show that CPAPcan significantly improve the quality of life for people with OSA, and—when used more than four hours pernight—may also lower the risk of stroke and other cerebral events.

·      Access to digital engagement tools improves patient compliance on CPAP therapy (Crocker M et al.CHEST (Suppl) 2016). A study of 128,000 sleep apnea patients found patients with access to digital engagement tools demonstratedimproved adherence to CPAP therapy over a three-month period. Nearly 90% of patients using a patientengagement tool in the study reached this important healthcare standard—a 24% relative increase overpatients who were only managed remotely by a provider.

·      A telehealth program for CPAP adherence reduces labor and yields similar adherence and efficacywhen compared to standard care (Munafo D et al. Sleep Breath 2016).A study evaluating the effectiveness and coaching labor requirements of a web-based automated telehealthmessaging program compared to standard care in newly diagnosed OSA patients found a significant reductionin the number of minutes coaching required per patient in the telehealth vs. standard of care group (23.9 vs.58.3). The majority of patients in this group stated the new approach met or exceeded their expectations.

National specialty pharmacy providers merge

LOUISVILLE, Ky. – PharMerica, a national provider of institutional and specialty pharmacy services, has acquired CareMed Specialty Pharmacy, a New Hyde Park, N.Y.-based national provider of specialty pharmacy services licensed in all 50 states. “The CareMed acquisition is in line with the company’s diversified business strategy and further bolsters our position in the rapidly growing specialty pharmacy market,” said Greg Weighar, CEO of PharMerica. Terms of the deal were not disclosed. PharMerica serves the long-term care, hospital pharmacy management services, specialty home infusion and oncology pharmacy markets. It operates 98 institutional pharmacies, 19 specialty home infusion pharmacies and four specialty oncology pharmacies in 45 states.

Somnoware taps into Respironics’ EncoreAnywhere

SANTA CLARA, Calif. – Somnoware says Philips Respironics has agreed to give it direct access to all CPAP usage data stored in the EncoreAnywhere patient management system with consent from the physician or health system. As a result, the data will be accessible to independent and network practices via Somnoware’s new care management module. By having access to this data, sleep physicians can use Somnoware’s module to set up their patients with CPAP devices faster and provide them with better long-term care, the company stated in a press release. The module allows physicians to monitor the progress of a CPAP device order and, once a patient is set up on the device, monitor their compliance by reviewing real-time updates. Somnoware says its sleep management platform is being used by one in five sleep physicians. It has two versions of the platform, one for sleep physicians and one for sleep centers.

ACHC, SCMESA renew agreement

CARY, N.C. – The Accreditation Commission for Health Care has renewed its partnership with South Carolina Medical Equipment Services Association. The agreement allows SCMESA members to receive significant discounts and savings on ACHC accreditation programs, as well as discounts on Accreditation University educational resources that help with accreditation. “Our partnership with ACHC is an important way SCMESA supports member goals of keeping their businesses compliant and competitive,” said Bobby Horton, executive director of SCMESA. “We are pleased to continue the relationship.”

Registration opens for legislative conference

WASHINGTON – Registration is now open for the AAHomecare Washington Legislative Conference, May 24-25 at the Washington Court Hotel. The association says the annual event provides an excellent opportunity to engage directly with lawmakers and their staff members on industry issues, including rural relief, competitive bidding, audits and complex rehab accessories. The event is open to both members and non-members. Early bird room reservations are available through April 28. Click here to register.

Heartland Conference announces keynote

WATERLOO, Iowa – Kevin Lacz, a former Navy Seal, will deliver the keynote address at this year’s VGM Heartland Conference, June 12-15. Lacz’s presentation, “A Morning with Kevin Lacz: Risk vs. Reward,” will take place June 1 at 8 a.m. Lacz will discuss the importance of identifying, mitigating and overcoming risks, using his own journey from student to decorated Navy Seal. Lacz is also the author of a New York Times bestselling memoir, “The Last Punisher.” Following the keynote address, Heartland attendees will have an opportunity to meet Lacz and to purchase his book during a book-signing event.  

Women’s conference seeks speakers

MINNEAPOLIS – Essentially Women is seeking speakers for its annual FOCUS conference, scheduled to take place here on Sept. 16. “We are actively seeking presenters on a variety of topics relevant to women’s health care providers,” said Christa Miehe, president of Essentially Women. “We offer our attendees a diverse selection of education sessions, including mastectomy, audits and compliance, marketing, professional and personal development, marketing and retail sales, to name a few.” Those who are interested should contact Miehe at christa.miehe@vgm.com by April 15. VGM acquired Oxford, Mich.-based Essentially Women in late 2015.

U.S. Rehab’s Greg Packer among complex rehab honorees

NASHVILLE, Tenn. – Greg Packer has been recognized for his work as an advocate for complex rehab technology by the University of Pittsburgh’s Department of Rehabilitation Science and Technology. Packer, president of U.S. Rehab, has been working with Mark Schmeler, director of the continuing education program and assistant professor of the Department of Rehabilitation Science and Technology at UPitt, on the Functional Mobility Assessment outcomes tool. The tool recently helped U.S. Rehab secure a Humana contract. Packer, along with several other complex rehab advocates, was awarded a medal during the Reach of RST Reception, held March 3 during the International Seating Symposium.

SCA exec Janet Stephens recognized

BOWLING GREEN, Ky. – Janet Stephens, director of planning & initiatives, SCA Global Hygiene Supply Personal Care Americas, has been named the recipient of the Women in Manufacturing STEP (Science, Technology, Engineering and Production) Ahead Award given by the Manufacturing Institute. The awards recognize women who have demonstrated excellence and leadership in their careers. Stephens has been with SCA for 28 years and has been instrumental in leading the company’s Bowling Green facility, which manufactures its TENA line of incontinence care products, to become one state-of-the-art and a benchmark in production efficiency.

Binson’s makes Impact

CENTER LINE, Mich. – Binson’s Medical Equipment and Supplies is a 2017 Michigan Works! Impact Award Winner. The award was established in 1987 to foster high-quality employment and training programs to provide support activities and a forum for information exchange for Michigan’s workforce development system. Since July 2014, nearly 50 on-the-job training contracts have been written with Binson’s. In February, the provider also received the 2017 Corporate Citizen Award from Macomb County.

Philips, ResMed highlight research on World Sleep Day

HME News - Fri, 03/17/2017 - 09:54
03/17/2017HME News Staff

AMSTERDAM, the Netherlands – Adults recognize that sleep is important, but they still prioritize other things in their lives over sleep, according to a new international survey published by Royal Philips on World Sleep Day.

Ninety-two percent of 6,461 adults across five countries who were surveyed by Harris Poll said sleep is crucial to their overall health and wellbeing. They say even one bad night of sleep can result in looking tired, being less productive and feeling unmotivated.

Yet 84% of adults say other things in their lives are more important than a good night’s sleep, including family time and job responsibilities.

Twenty-eight percent of adults also say that, despite all the literature that screens should be turned off well before sleep, watching TV is the last thing they do before bed.

“Sleep is vitally important to the ‘healthy lifestyle’ equation, but it is often cast aside as less important compared to the other fundamental elements such as eating well or exercising,” said Dr. Teofilo Lee-Chiong, sleep clinician and chief medical liaison, Philips. “We need to start thinking of health and wellness as a table with four legs, each of which representing proper nutrition, exercise, positive mental health and sleep—if we’re only focusing on diet and exercise, that table isn’t going to be balanced.”

Philips aims to use the survey, “Unfiltered Sleep: A Global Prioritization Puzzle,” to start a conversation about the importance of sleep to overall health and wellbeing.

ResMed highlights sleep research

SAN DIEGO – ResMed has picked the top five research findings among more than 3,000 studies published last year in recognition of World Sleep Day.

“Unnecessary hospital readmissions and inefficient practices are huge drivers of today’s exorbitant healthcare costs,” said Adam Benjafield, ResMed vice president of medical affairs. “Recognizing sleep apnea is associated with many other life-threatening conditions and knowing early detection makes a world of difference, treatment efficacy and efficiency have become even more paramount. The research we’ve highlighted today shows that we’re moving in the right direction.”

Summaries of the research are:

  • There is a high prevalence of sleep-disordered breathing among stable chronic heart failure patients (Arzt M et al. JACC Heart Fail 2016).Of 6,876 stable chronic heart failure (CHF) patients across 138 German centers, the prevalence of moderate to severe sleep-disordered breathing (SDB) was 46%, with a significant difference seen between thesexes (36% in women vs. 49% in men). Risk factors included body mass index, left ventriculardysfunction, age, atrial fibrillation and male sex.
  • Early recognition of obstructive sleep apnea in patients hospitalized with COPD exacerbation isassociated with reduced readmission rates (Konikkara J et al. Hosp Pract 2016).Patients consulted for COPD exacerbation underwent a sleep test upon discharge and received positive airwaypressure (PAP) therapy as appropriate. The mean change in the number of clinical events six months prior tointervention compared to six months following intervention favored the group who used their PAP therapy,demonstrating early recognition and treatment of obstructive sleep apnea (OSA) in patients admitted withCOPD exacerbation may be associated with reduced hospital admission rates and emergency room visits.
  • CPAP significantly improves quality of life, sleepiness and cerebrovascular measures in patients with obstructive sleep apnea (McEvoy RD et al. N Engl J Med 2016).While results in the landmark SAVE trial were neutral on the primary endpoint of whether CPAP can reducemajor cardiovascular events in those with OSA and heart disease, the 2,700-patient study did show that CPAPcan significantly improve the quality of life for people with OSA, and—when used more than four hours pernight—may also lower the risk of stroke and other cerebral events.
  • Access to digital engagement tools improves patient compliance on CPAP therapy (Crocker M et al.CHEST (Suppl) 2016). A study of 128,000 sleep apnea patients found patients with access to digital engagement tools demonstratedimproved adherence to CPAP therapy over a three-month period. Nearly 90% of patients using a patientengagement tool in the study reached this important healthcare standard—a 24% relative increase overpatients who were only managed remotely by a provider.
  • A telehealth program for CPAP adherence reduces labor and yields similar adherence and efficacywhen compared to standard care (Munafo D et al. Sleep Breath 2016).A study evaluating the effectiveness and coaching labor requirements of a web-based automated telehealthmessaging program compared to standard care in newly diagnosed OSA patients found a significant reductionin the number of minutes coaching required per patient in the telehealth vs. standard of care group (23.9 vs.58.3). The majority of patients in this group stated the new approach met or exceeded their expectations.

Verma is your new CMS administrator

HME News - Tue, 03/14/2017 - 07:53
03/14/2017HME News Staff

WASHINGTON – The Senate has voted 55-43 to approve the nomination of Seema Verma, a health policy consultant from Indiana, as CMS administrator.

Verma, the president, CEO and founder of SVC, an Indianapolis-based national health policy consulting company, will oversee a $1 trillion agency that serves more than 100 million Americans that access healthcare services through Medicare, Medicaid, CHIP and the Marketplace.

Verma, along with new Health and Human Services Secretary Tom Price, will be tasked with transforming Medicaid and overhauling the Affordable Care Act.

Verma has made a name for herself redesigning Indiana’s Medicaid program. She helped the state expand eligibility, but she required recipients to pay premiums, contribute to health savings accounts and receive incentives for healthy behavior. She has also helped to develop many other Medicaid reforms, including waivers in Iowa, Ohio and Kentucky.

Verma has comparatively little experience with Medicare.

Prior to full approval by the Senate, Verma was approved by the Senate Finance Committee on March 2 by a vote of 13-12.

During a hearing before that committee on Feb. 16, Verma said that one-size-fits-all approaches to healthcare, like CMS’s competitive bidding program, don’t always work. She made the comment in response to a question from Sen. Mike Enzi, R-Wyo., about whether or not she would be willing to continue to have a dialogue about how the bid program can ensure Medicare beneficiaries, especially those in rural states, get the medical equipment they need.

“I think what you're bringing up in terms of the competitive bidding is an excellent example where, we've got some providers who are being paid—they're rural providers, but they're being paid at a rate that's more appropriate for an urban area. And, so I think that's the type of policy where understanding how that's going to impact our rural provider on the front-end and having that discussion so that we're not having problems later on down the line. And, if we are having issues, we need to be responsive to that because we want to make sure…that seniors and other folks that depend on CMS programs always have high quality care and that they have accessibility. We don't want to see that our policies and our programs are actually preventing providers—that we're losing providers and that they don't want to see Medicaid or Medicare beneficiaries anymore. So, we'll be very careful with policies so that we're not pushing providers out of the system, but that we're actually attracting providers to the program.”

Verma replaces Acting Administrator Dr. Patrick Conway, who is also deputy administrator for Innovation and Quality.

It’s a bumpy start for prior authorizations

HME News - Fri, 03/10/2017 - 13:20
03/10/2017Liz Beaulieu

WASHINGTON – CGS and Noridian have begun accepting prior authorization requests for K0856 and K0861, but complex rehab providers say they still don’t have all the information they need to comply with the program.

The contractors on March 6 began accepting requests for dates of delivery on or after March 20.

“We’re as prepared as we can be, with all the unanswered questions,” said Doug Westerdahl, president and CEO of Rochester, N.Y.-based Monroe Wheelchair, who, because of the uncertainty, planned to push out the door as many wheelchairs as possible before March 20.

CMS is phasing in prior authorizations for the two codes, with this first phase applying to Illinois, West Virginia, Missouri and New York. A national rollout is slated for July 17.

Stakeholders aren’t pleased that CMS has moved forward with prior authorizations despite cancelling a Special Open Door Forum on the topic in January. The agency also included it as an agenda item for a general forum in February and dropped it at the last minute. It finally scheduled another Special Open Door Forum on March 9 for March 16th.

“We’ve gotten no official response on why it was cancelled and taken off the agenda,” said Don Clayback, executive director of NCART. “We understand that there are changes going on at CMS, but our position is, this is ridiculous.”

Stakeholders pointed out it wasn’t until the last minute that they had access to an operational guide, a document that paved the way for a smooth transition when CMS began requesting PAs for standard power wheelchairs as part of a demonstration project that’s now running in 19 states.

“That’s the one document that has been extremely important for providers who are currently doing the demo,” said Seth Johnson, vice president of government affairs for Pride Mobility Products. “That really has the necessary information that providers need to implement this and educate their employees.”

Additionally, stakeholders would like further guidance on, among other things, why the prior authorizations, unlike the advance determination of Medicare coverage process currently being used by many providers, only cover the base and not accessories.

“That’s a vague area that could get a little scary,” said Chuck Spiedel, the rehab manager for Springfield, Ill.-based Personal Mobility, who says he’s now sending documentation to the quality review team a second time to make sure it meets all the necessary criteria. “In my opinion, they shouldn’t be doing that. It’s a package of complex equipment.”

While CMS’s implementation hasn’t been seamless, stakeholders stand by the essence of prior authorizations.

“The demo has worked really well for us,” Westerdahl said. “So going into this, we’ve had a positive approach to it.

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