YARMOUTH, Maine – In the year since Round 2 of competitive bidding was implemented in 91 cities, the HME industry has seen a rapidly shrinking provider base.
In a story that’s being retold across the country, provider Rich King says he will wind down operations at ProMed DME on July 31st.
“It’s sad,” said King, CEO of the 30-year-old, family-owned company in Los Alamitos, Calif., a Round 2 competitive bidding area (CBA). “We had a good business for a lot of years and employed a lot of people—we took care of them and their families.”
Although there is no hard and fast data, there are plenty of anecdotes of providers closing shop or merging with other struggling providers in the past year.
ProMed had contracts for wheelchairs and low air loss mattresses, but King said Medicare makes it too difficult to qualify patients for equipment any more. So ProMed has dumped Medicare and will merge with another local provider.
“This company was the same as me—about to shut the doors,” he said. “We figured we’d consolidate expenses and with their sales we’d make a profit in the next two to three months.”
Without contracts, American Medical Equipment, which is located inside a hospital, turns away patients every day.
“They should never have started this bidding program,” said Masooma Tiwana, president of the Memphis, Tenn.-based company. “Patients are having trouble getting equipment, and we hear all the time that companies are shutting down because there’s no business.”
The one-year anniversary of Round 2 also means the time is up—or nearly so—for providers that opted to grandfather existing patients for certain HME.
“Grandfathering is a slow death,” said Doug Coleman, CEO of Longmont, Colo.-based Major Medical Supply. “Even if you’ve grandfathered patients, you don’t get to add new patients. The patients are dying or no longer need equipment so the patient count dwindles month over month.”
Although it’s hard to believe, the possibility of a third round of competitive bidding is just around the corner. That has providers worried that access issues will worsen.
“We can’t afford to lose any more players,” said Steve Ackerman, owner of Spectrum Medical in Silver Spring, Md. “There’s 10,000 people a day turning 65 and we’ve thinned the ranks down to the very minimal level.”
LEWISVILLE, Texas – Provider Tom Polston received his draft notice 30 days after he graduated from college. He spent 10 months in Vietnam’s central highlands in 1969 and, upon discharge, “buried everything” for decades. In May, he traveled to North Carolina to reunite with his fellow soldiers and the Vietnamese translator who helped them communicate with locals during their tour. The former first lieutenant and owner of Specialty Medical Sales spoke with HME News recently about his mission in life.
HME News: What made you look up your Vietnam buddies?
Tom Polston: About two years ago I had a lot of slide format pictures (from Vietnam) converted to digital. I’d never shared them with anybody. I thought, “There’s a story here.” I decided to see if I could find some of my old teammates. After six or seven days, by pure chance, I found my second lieutenant. That started a communication. One thing I tried to find out was, “Where is our Montagnard interpreter, Phian Siu?” Everybody had bits and pieces of information—they thought he got to the states. I made it my mission to find him.
HME: And he had settled in North Carolina?
Polston: He and his wife arrived there in 1988 or ’89. His son couldn’t get out. I rounded up four other guys that knew him in 1968-1970 and we agreed to meet him. He looked thinner and older, of course, but he still had that sparkle in his eyes. He had advanced liver cancer (Siu died in June). He probably contracted hepatitis C after he was taken prisoner in 1973.
HME: How has your military background served you in the HME industry?
Polston: In my 20s, I didn’t understand about building relationships, but clearly we did that in Vietnam. We were five Americans surrounded by everyone else. When I came back I felt like I had to put my nose to the grindstone so I got an MBA. After getting kicked around the corporate world for many years, I wanted to do something myself. I bought this floundering company, Specialty Medical Sales, in 1994, and tried to build a good quality team and do it the morally responsible way. If you do that, people think highly of you and they tell other people.
HME: What is your take on the Veterans Affairs scandal?
Polston: It’s been that way for a long time. It goes back to congressmen and political appointees and cronyism. I had to go to a veterans hospital in 1972. It was a dingy experience, just the smell, the look, the wait.
STRONGSVILLE, Ohio, and NORWELL, Mass. – Roscoe Medical and Carex Health Brands announced last week the new name and brand identity of their parent holding company: Compass Health Brands. The new brand includes a new corporate logo, website (www.compasshealthbrands.com) and message platform. “Compass Health was chosen to reflect the company’s deep industry knowledge, understanding of today’s health care and efforts to navigate its new direction for better patient outcomes and bottom-line growth,” a press release states. Roscoe Medical and Carex Health announced their merger in March. Under Compass Health Brands, Roscoe Medical and Carex Health plan to expand through the acquisition of subsidiaries that complement their portfolios, according to the release. Roscoe also recently acquired Revolution Mobility.
ResMed makes ‘unprecedented’ donation
SAN DIEGO – ResMed has donated more than 10,000 CPAP devices to the American Sleep Apnea Association’s CPAP assistance program (CAP), the association announced June 30. “A donation of this magnitude is unprecedented,” stated Tracy Nasca, executive director of the ASAA in a press release. CAP provides a package containing a CPAP device, tubing, filters and mask to patients who otherwise would not be able to afford them. CAP, which was launched in 2010, relies on the public and commercial sleep industry to help with equipment donations. “Supply has always been our challenge, but thanks to ResMed, we will now be in a position to increase the reach of our program,” Nasca said. ASAA encourages others to provide product or funding for the tubing and masks, etc., needed to complete the packages.
A/R Allegiance integrates with Universal Software Solutions
OVERLAND PARK, Kan. – A/R Allegiance has integrated its payment portal with Universal Software Solutions’ Healthcare Data Management System (HDMS), the company announced June 30. The integration means the cash posting of any credit card payments made through the payment portal will now be automatically entered into HDMS without human interaction. Another benefit: reoccurring charge generation. “This will significantly reduce the operational expense involved with collecting outstanding patient balances,” stated Christopher Dobiesz, president of Universal Software Solutions, in a press release. “Reducing steps in any process results in cost savings.” A/R Allegiance is also in the process of adding functionality to allow users to log in directly to the payment portal dashboard from the HDMS menu, making it easier to manage open private pay A/R in one location.
Inova combines stationary, portable therapy
AUSTIN, Texas – Inova Labs has received FDA clearance for Activox Duo2, a fully integrated stationary and portable oxygen concentrator (POC) system. Activox Duo2 combines the benefits of a home-use stationary concentrator with the portability of Inova’s LifeChoice Activox POC. Activox Duo2 offers up to 5 LPM continuous flow oxygen for patients at home and up to 3 LPMeg Pulse-Wave oxygen delivery for active patients out of the home using the POC. “Activox Duo2 was designed to provide patients and providers with a non-delivery solution that can positively impact both quality of life and quality of service,” stated CEO John Rush in a release. “This system removes the hassle and burden of tanks and replaces it with true freedom and mobility.”
BOC to update pedorthist exam
OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) and its testing vendor recently convened subject matter experts to collaborate on a BOC Pedorthist Job Task Analysis, according to a release. The group will send a survey in July to as many as 5,000 pedorthists and other healthcare professionals to help update the exam’s content outline. “It was a very productive meeting, and I am pleased with the results of our collective efforts,” said Wendy Miller, BOC’s chief credentialing officer. “We sequenced the pedorthist task list from prescription to final fitting and evaluated each task to ensure our pedorthist certification candidates continue to be assessed on appropriate competencies.” Job task analyses are typically conducted every five to seven years, according to the release.
Invacare lives brand promise through games
ELYRIA, Ohio – Invacare sponsored the National Veterans Golden Age Games held June 28 to July 2 in Fayetteville, Ark., the manufacturer announced today. “Invacare is excited to once again be a part of the National Veterans Golden Age Games,” said Brian LaDuke, vice president, marketing and respiratory. “To see these veterans engaging in friendly competition and being active is really living the Invacare brand promise.” Veterans compete in sports such as swimming, cycling, horseshoes, bowling, field events and air rifles. Invacare has also sponsored teams in the Paralympic games and donated power wheelchairs to Youth Challenge’s Paralympic Power Soccer program.
Hasco Medical exits HME
ADDISON, Texas, and OCALA, Fla. – Hasco Medical has sold its Certified Medical business so that it can focus on its mobility vehicle business, it announced last week. "The divestiture represents our complete departure from the durable medical equipment business and makes HASCO the only public company operating in the retail market for handicap-accessible vehicles," said Hal Compton, Hasco CEO, in a release. Hasco offers handicap accessible vans, parts and services through 19 locations.
Review finds 70% error rate for VEDs
INDIANAPOLIS – In a first quarter 2014 widespread payment review of vacuum erection devices (VEDs), National Government Services examined 67 claims and denied 47, for an error rate of 70%, according to a release. The most common reasons for denial were: documentation that did not support diagnosis of impotence or erectile dysfunction; no medical records submitted; no documentation to support diagnosis of impotence or erectile dysfunction to allow coverage for the device; the proof of delivery record did not include the delivery service package identification number, supplier invoice number or alternative method to link supplier and delivery service records; or documentation did not show information justifying medical necessity. The Jurisdiction B DME MAC reminded suppliers that failure to respond to requests for additional documentation violates supplier standards.
Medtrade sessions prep providers
ATLANTA – Medtrade will offer a new “niche market” track at this year’s show. The six educational sessions address home modifications, ventilation services, support surfaces and therapeutic shoes. “Providers who dabble will likely not succeed, but those willing to put in the proper training and capital investment can establish a profitable business,” show organizers state in a press release. Medtrade takes place Oct. 20-23 at the Georgia World Congress Center in Atlanta.
The North Carolina Association of Medical Equipment Services (NCAMES) has recognized Rep. Renee Ellmers, R-N.C., with its “Champion of the Industry” award. Ellmers is expected to introduce a bill to reform the audit program. The award was resented during the association’s summer meeting June 25-27…Pediatric Home Service (PHS) was named a Top 100 Minnesota Workplace for the fourth year in a row. The Star Tribune also honored PHS with a Meaningfulness Award based on employee reporting…Brightreehas joined the CommonWell Health Alliance as the first dedicated post-acute vendor. The alliance, a not-for-profit trade association of health IT companies, says Brightree’s participation will open new opportunities for in-home health IT access for patients and their clinicians…RESNA plans to hold its 2015 annual conference at The Sheraton Denver Downtown. The submission deadline is Oct. 19 for workshops and instructional courses; Jan. 13 for scientific and student scientific papers; April 3 for student design competition registration; and April 17 for student design competition submission.
WASHINGTON – CMS on July 2 issued a proposed rule outlining how it plans to expand competitive bidding pricing nationwide and bundle payments for certain DME.
CMS proposes expanding competitive bidding pricing by:
· Adjusting fee schedule amounts for states in different regions of the country based on competitive bidding pricing from competitions in these regions. The regional prices would be limited by a national ceiling (110% of the average of regional prices) and floor (90% of the average of regional prices).
· Using the national ceiling as an adjusted fee for states that are predominantly rural or sparsely populated.
· Adjusting fee schedule amounts for non-contiguous areas based on the average of competitive bidding pricing from these areas or the national ceiling, whichever is higher.
Through a limited phase in, CMS also proposes swapping capped rental policies for bundled monthly payments for enteral nutrition, oxygen, standard manual and power wheelchairs, hospital beds, CPAP devices and respiratory assist devices furnished under competitive bidding. The payment would cover equipment, supplies, accessories and any necessary maintenance and repair.
Other provisions in the rule include:
· Updating the definition of minimal self-adjustment of orthotics to reflect program guidance on what specialized training is needed to provide custom-fitting services if providers are not certified orthotists.
· Establishing an exception to the prohibition against subdividing a competitive bidding contract that would allow a contract supplier to sell a distinct company that furnishes a specific product category or a specific competitive bidding area (CBA). Under this exception, CMS would sever the product categories and CBAs that the company services, along with the company’s locations, from the original contract; incorporate those product categories and CBAs and locations into a new contract; and transfer the contract to a new owner under specific circumstances.
CMS will accept comments on the rule until Sept. 2, 2014.
The rule is expected to appear in the July 11 Federal Register.
ELYRIA, Ohio – Invacare is sponsoring the National Veterans Golden Age Games being held June 28 to July 2 in Fayetteville, Ark., the manufacturer announced today.
“Invacare is excited to once again be a part of the National Veterans Golden Age Games,” said Brian LaDuke, vice president, marketing and respiratory. “To see these veterans engaging in friendly competition and being active is really living the Invacare brand promise.”
The games are a multi-event sports and recreational competition for older veterans. Veterans compete in sports such as swimming, cycling, horseshoes, bowling, field events and air rifles.
STRONGSVILLE, Ohio, and NORWELL, Mass. – Roscoe Medical and Carex Health Brands announced today the new name and brand identity of their parent holding company: Compass Health Brands.
The new brand includes a new corporate logo, website (www.compasshealthbrands.com) and message platform.
“Compass Health was chosen to reflect the company’s deep industry knowledge, understanding of today’s health care and efforts to navigate its new direction for better patient outcomes and bottom-line growth,” a press release states.
Roscoe Medical and Carex Health announced their merger in March.
Under Compass Health Brands, Roscoe Medical and Carex Health plan to expand through the acquisition of subsidiaries that complement their portfolios, according to the release.
Roscoe also recently acquired Revolution Mobility.
WASHINGTON – It wasn’t the HME industry’s first time testifying before the U.S. Small Business Administration (SBA) about overreaching regulatory burdens, but last week, something was different, stakeholders say.
“It was awesome,” said Peggy Walker, a billing and reimbursement advisor for U.S. Rehab, one of nine industry stakeholders to testify. “It was the best presentation we’ve ever done. I think we’ve finally gotten some attention.”
Stakeholders also testified before the SBA last year in June. While last year’s hearing focused primarily on competitive bidding, this year’s also focused on audits.
Numerous stakeholders who testified say members of the SBA approached them following the hearing to pledge their support.
“One of the members approached me and said she was really moved,” said Kristi Sanders, a billing manager for Northern Pharmacy based in Baltimore. “They’re not in the DME industry, but they’re all small business owners, and they’d like to know more. She said last year, they felt they were hearing a lot but not doing enough, and this year, they’ve made a commitment to do more.”
In the wake of the hearing, stakeholders are trying to determine how best to work with the SBA to achieve their goals of reforming both the competitive bidding and audit programs.
“We’re working on follow-up meetings,” said Tom Ryan, president and CEO of AAHomecare. “We asked them for their support and they all shook their heads. It’s a great opportunity.”
The SBA was taken aback by the escalation of the issues related to competitive bidding and audits since they last heard from stakeholders. In her testimony, Walker pointed out that, as of Jan. 1, 2014, more than 350,000 appeals are held up at the administrative law judge (ALJ) level.
“One provider is getting 85% of his denials overturned at the ALJ, but because of the backlog, he has $150,000 tied up,” she said. “They got a real sense for the breadth of the problem and how out of control it is.”
Specific examples of the impact of competitive bidding came thanks to Jeff Knight, owner and CEO of Premier Medical based in Louisville. He testified that his locations in bid and non-bid areas are on pace to lose $2.62 million in revenues due to reduced reimbursement from Medicare and other payers that have followed suit.
“We’ve lost 26 people and two execs,” he said. “I told them I knew that number to be exact because I personally had to let each of them go and it was painful.”
WASHINGTON – Medicare’s mail-order program for diabetes supplies has had a dramatic impact on the market, as evidenced by a pair of recent reports from the Office of Inspector General (OIG).
“This is a rough look at what’s available in the marketplace and it doesn’t represent what was available in the marketplace prior to bidding,” said Andrea Bergman, a vice president with McDermott+Consulting, the lobbying subsidiary of a law firm that represents the Diabetes Access to Care Coalition.
The reports looked at Medicare mail-order market shares of test strips in the three months before and after the July 1, 2013, implementation of the national mail-order program. Before the program, two types of strips accounted for 34% of the mail-order market share; after, two types of strips accounted for 45% of the market share.
The top strip in both cases: Prodigy’s AutoCode, which accounted for 23.9% of the market share. By contrast, for the three months ended December 2009, Prodigy’s AutoCode comprised 2.3% of the market, according a similar OIG report in 2010.
Such a spike in market share could be evidence of providers switching beneficiaries to lower-priced products, say stakeholders.
“You would never see a bunch of beneficiaries just one day say, ‘You know what, let’s all shift tenfold to this new available product,’” said Bergman. “You end up with a market where the suppliers are controlling the usage—not the beneficiaries, not the physicians.”
What’s more: the Medicare Improvements for Patients and Providers Act (MIPPA) requires suppliers to demonstrate that their bid covers at least 50%, by volume, of all types of test strips. The dramatic shift in market share could point to continued decreased access to major brands in any future rounds of the program, say stakeholders.
“The goal of the provision is to ensure that patients have access to the products they are currently using,” said healthcare attorney Seth Lundy, a partner with King & Spalding. “The OIG study shows almost no (major) branded products. That would potentially affect how suppliers can have successful bids without any branded products in their bids whatsoever.”
That, in turn, could drive the single payment amounts—currently at $10.41 per box of 50 strips—and the number of suppliers even lower, says Lundy.
“A lot of those contract suppliers are struggling to be able to stay in business at the bid rates and there do not seem to be a lot of suppliers looking to get into the market at the bid rates,” he said. “That’s a real issue in terms of whether there’s going to be a sufficient amount of bidders in Round 3.”
WASHINGTON – Activists who rolled into Washington, D.C., June 22-24 found that advocacy efforts are paying off, as more congressional offices are well versed in the issues facing people with disabilities, including the need for a separate benefit for complex rehab.
During the United Spinal Association’s third annual Roll on Capitol Hill, activists made 200 congressional office visits and talked about better access to health care, disability rights, employment opportunities, protection of social security benefits and accessible transportation.
“With regard to transportation and access to jobs, if you don’t have the right equipment, you can’t get out of the house and the rest doesn’t matter,” said Joe Gaskins, who participated in the event for the first time as president and CEO of United Spinal. “It’s putting the cart before the horse in some instances. If we don’t have the right medical equipment for people with disabilities, then they’re really restricted.”
Representing 26 states, Washington, D.C., and Puerto Rico, 120 activists attended the event.
“We had a lot of folks from the West Coast coming all the way over here,” said Alex Bennewith, vice president of government relations at United Spinal.
Congressional staffers were eager to hear what activists had to say, Gaskins said.
“I thought we were very well received and we have been getting good responses from congressional offices since the event that they are signing up to support our bills, including the CRT legislation,” said Gaskins.
With so many groups backing a separate benefit for complex rehab, “It’s hard to not know about it,” said Justin Richardson, director of communications and customer relations for Numotion and a member of the board of directors of the North Carolina Spinal Cord Injury Association.
For those congressional offices that didn’t—Gaskins hopes the visits will be a turning point.
“For some, it was a first-time opportunity to actually meet people that needed this equipment, so it gave them an opportunity firsthand to hear anecdotally some of the things people go through just to get through a regular day,” he said.
WASHINGTON – It’s no secret that audits are out of control, but without data it’s hard to build a case. That’s the problem AAHomecare hopes to help the industry fix with its HME Audit Key.
“We’re trying to make a stand that it’s over the top, but we don’t have any numbers to back that up,” said Kim Brummett, vice president of regulatory affairs for the association. “If we don’t have any numbers that we can share, at the end of the day, it’s all anecdotal stuff.”
With HME Audit Key, providers will use a secure electronic form to answer questions about audits, including how many they have at the redetermination, reconsideration and ALJ levels, and how many appeals they’ve won. The anonymous submissions will be compiled into a data set that AAHomecare can examine to see the impact of audits and share with lawmakers.
HME Audit Key is part of a multi-pronged effort that AAHomecare has undertaken since restarting its Audit Task Force last fall. The association has also been working closely with Rep. Renee Ellmers, R-N.C., on introducing a bill to reform the audit process.
AAHomecare’s goal is not to eliminate audits, but to reform them.
“We want smart audits,” Brummett said. “We want them to be thorough and good and make sense, and hold people accountable.”
While AAHomecare has been collecting anecdotes about audits via email, HME Audit Key is all about the numbers. And for valid statistics, it needs a large sample size.
“We need to get as many providers to participate as possible,” said Tom Ryan, president and CEO of AAHomecare. “Our goal is to get everyone to understand this is an industry-wide effort, not just an AAHomecare member effort.”
In June, AAHomecare kicked off a campaign to raise $250,00 over two years to develop HME Audit Key, and create and maintain a secure database to support it, Brummett said.
Brummett said AAHomecare expects HME Audit Key to be ready for a trial run, if not ready for use, by the end of 2014.
BALTIMORE – CMS’s Fraud Prevention System (FPS) prevented more than $210 million in improper Medicare payments in its second year of operations, more than double the previous year, according to a report sent to Congress last week. The FPS, which uses predictive modeling and other analytics to analyze billing patterns, also resulted in CMS taking action against 938 providers. “CMS is using the best of private sector technology to move beyond the ‘pay-and-chase’ approach to protect the Medicare Trust Funds,” stated CMS Administrator Marilyn Tavenner in a press release. In a report also released last week, the Office of Inspector General (OIG) concurred with most of CMS’s findings. It said, however, that the agency could increase savings further by 1.) providing contractors with written instructions on how to determine when savings from an administrative action should be attributed to the FPS and 2.) requiring contractors to maintain documentation to support how FPS information contributes to an administrative action.
Separate benefit bill lands more co-sponsors
WASHINGTON – Twenty-three additional lawmakers have signed on to co-sponsor bills to create a separate benefit for complex rehab in the past month, according to an email bulletin from NCART Executive Director Don Clayback. There are now 141 co-sponsors in the House of Representatives and 16 in the Senate, including Sen. Mike Bennet, D-Colo., a member of the Finance Committee and the HELP Committee. The bills were one of the topics of discussion at the United Spinal Association’s third annual Roll on Capitol Hill last week (see related story), where Clayback; Alex Bennewith, United Spinal vice president-government relations; and Jenn Wolff, director of Users First, hosted a panel discussion on H.R. 942 and S. 948.
Lawmakers extend deadline for letter
WASHINGTON – The deadline has been extended for the “Dear Colleague” letter asking the Office of Inspector General (OIG) to study the impact of competitive bidding before CMS expands the program in 2016. The original June 30 deadline has been extended until after the July 4 congressional recess, according to a bulletin from The VGM Group. The letter, initiated by Reps. Tom Price, R-Ga., Tom Reed, R-N.Y., and Tammy Duckworth, D-Ill., has 25 co-signers, with a goal of more than 100.
Inogen makes play in stationary market
GOLETA, Calif. – Inogen has received clearance from the U.S. Food and Drug Administration (FDA) for a home oxygen concentrator called Inogen At Home. The company, better known for its portable oxygen concentrators (POCs), plans to start selling the devices later this year. “Inogen’s release of the Inogen At Home, combined with its Inogen One family of products, positions the company with a complete product portfolio to be able to fulfill the clinical requirements of most oxygen therapy patients,” it states in a press release. “While the Inogen One product line is clinically validated for 24/7 use, the Inogen At Home gives Inogen a compelling solution for nocturnal-only oxygen therapy patients that do not yet require a portable solution, which are estimated to represent 30% of total oxygen patients in the United States.” Features of the Inogen At Home include five liter per minute continuous flow, a weight of 18 pounds and low power consumption.
MEDIchair goes private equity
TORONTO – Centric Health has entered into a definitive agreement to sell its MEDIchair and Motion Specialties retail home medical operations to Canadian-based Birch Hill Equity Partners for $50 million. MEDIchair and Motion Specialties specialize in the sale of home accessibility equipment, mobility devices and home medical supplies through a network of 47 franchised and 30 corporate stores. “We believe that working together, with not just management, but also the sales reps, store managers, franchisees and other staff, we can position MEDIchair and Motion to thrive in a fast growing industry,” stated Thecla Sweeney, a partner at Birch Hill, in a press release. Centric Health is selling MEDIchair and Motion Specialties as the first step in a strategic repositioning to focus on healthcare services businesses with low working capital requirements and low reliance on government funding, according to the release. The sale doesn’t include Performance Medical Group, which offers custom orthotics, off-the-shelf orthotics, custom bracing, and laser and shockwave therapy at 50 locations across Canada.
Binson’s provides scholarships to children with diabetes
CENTER LINE, Mich. – Binson’s Home Health Care Centers will cover all or part of the cost for 24 children to attend diabetes camp, according to a release. Scholarship applicants wrote short essays explaining why they wanted to attend a week of the American Diabetes Association Camp Midicha in Fenton, Mich. “There is no better way to give back to the community than providing opportunities to children with diabetes,” said Glen Closurdo, Binson’s director of diabetes services. “Camp is a great place for kids to gain self-confidence, while having fun and meeting other kids with diabetes.” Last July, Binson’s was awarded a contract as part of Medicare’s national mail-order program for diabetes supplies.
Use of home monitoring devices to hit 19.1M, report says
YARMOUTH, Maine – Three million patients used connected home medical monitoring devices worldwide at the end of 2013, according to a new report from Berg Insights. Researchers estimate that number will grow to 19.1 million by 2018. Driving growth: Trends in incorporating more connectivity in medical devices, and using personal mobile devices as health hubs. Connectivity is most common for implantable cardiac rhythm management devices, followed by sleep therapy. Glucose monitoring and air-flow monitoring are gaining momentum. Revenues for monitoring devices were 4.3 billion Euro in 2013 and could reach 19.4 billion Euro by 2018, according to the report.
New Charm website allows online orders
PEMBROKE, Mass. – Charm Medical Supply’s new website enables customers to place orders online. “With this new website, we intend to make our comprehensive selection of home healthcare supplies and medical equipment available to a much wider audience,” said Peter Tallas, CEO. Using the new website, customers may also enroll in the company’s DeliverEase recurring delivery program. Charm offers a range of home healthcare products, including incontinence supplies, mobility products, wound care dressings, pediatric supplies and personal care products.
NSM makes buy in Rhode Island
NASHVILLE, Tenn. – National Seating and Mobility has acquired Providence, R.I.-based Major Medical Supply. “Complex rehab products and home access solutions are our greatest areas of expertise,” said Damon Bradley, CRTS, ATP and branch manager for Major Medical Supply, which has been in business since 2005. “Specifically, we provide custom mobility and seating solutions, combined with home access solutions, lifts and ramps.” Major Medical Supply’s six complex rehab professionals are now part of NSM Providence and offer 25 years of combined experience.
Review finds 63% error rate for CPAP devices
FARGO, N.D. – A pre-payment review by Noridian found potential improper payment rates of 63% for CPAP devices from February to May 2014. The Jurisdiction D DME MAC reviewed 2,873 claims with the KH modifier (first month of billing) and 1,663 claims with the KJ modifier (4th-13th month of billing). It found most denials were due to invalid proof of delivery; no documentation in response to the additional documentation request letter; documentation submitted did not demonstrate that face-to-face clinical re-evaluation criterion were met for continued coverage beyond the first three months for KJ claims; and documentation submitted did not support that face-to-face criterion was met. Noridian says it will continue its prepayment service specific review.
Hasco’s Ride-Away to market BraunAbility vans
ADDISON, Texas and BALTIMORE – Hasco Medical subsidiary Ride-Away, a provider of handicap-accessible vans, parts and services, has secured the rights to market BraunAbility wheelchair accessible vans in the Baltimore area. Hasco expects to announce a new dealership in the Baltimore area in the third quarter of 2014. “When our new Baltimore location opens, we expect its more convenient location to attract both existing and new customers from as far as northern Delaware and southern Pennsylvania,” said Hal Compton, CEO of Hasco Medical. BraunAbility offers minivans from Dodge/Chrysler, Honda and Toyota.
Study: Pharmacists can help reduce hospital readmissions
YARMOUTH, Maine – Hospital readmissions could be reduced by 20% if high-risk patients received counseling and medication management from a community pharmacist, according to a new study from the University of Cincinnati’s James L. Winkle College of Pharmacy. The ongoing study seeks to pair 1,000 high-risk patients with community pharmacists. Researchers will focus on patients with heart failure, COPD, pneumonia, myocardial infarction or diabetes.
CareTouch offers billing system integration
WESTMINSTER, Colo. – CareTouch Communications has enhanced its CareTouch360 platform to communicate with most billing systems. The platform now supports one-way billing integration, allowing the HME provider to pull patient order reports and manually enter them; and two-way billing integration, allowing the provider to upload patient orders directly into its billing system. “CareTouch is always looking for ways to make it easier for our customers to keep their patients healthy,” commented Matthew Dolph, CEO of CareTouch. “Adding the integration element takes our solution to the next level, resulting in happy patients and increased revenues.”
BALTIMORE – CMS’s Fraud Prevention System (FPS) prevented more than $210 million in improper Medicare payments in its second year of operations, more than double the previous year, according to a report sent to Congress today.
The FPS, which uses predictive modeling and other analytics to analyze billing patterns, also resulted in CMS taking action against 938 providers.
“CMS is using the best of private sector technology to move beyond the ‘pay-and-chase’ approach to protect the Medicare Trust Funds,” stated CMS Administrator Marilyn Tavenner in a press release.
In a report also released today, the Office of Inspector General (OIG) concurred with most of CMS’s findings. It said, however, that the agency could increase savings further by 1.) providing contractors with written instructions on how to determine when savings from an administrative action should be attributed to the FPS and 2.) requiring contractors to maintain documentation to support how FPS information contributes to an administrative action.
WASHINGTON – How has the national mail-order program for diabetes supplies affected brand choice?
CMS now has a before and after picture thanks to the Office of Inspector General (OIG).
The OIG published this week the results of a study to determine the market shares of test strips for the three-month period prior to the start date of the program on July 1, 2013. It found:
· Two types of strips accounted for about 34% of the Medicare mail-order market share;
· Four types of strips accounted for 51%; and
· Ten types accounted for 75%.
In a previous study to determine the market shares of test strips for the three-month period after the start date of the program, the OIG found:
· Two types of test strips accounted for about 45% of the Medicare mail-order market share;
· Three types accounted for 59%; and
· Ten types accounted for 90%.
“CMS may choose to use the results of this report for program analysis purposes and to evaluate the effect of the competitive bidding program on brand choice,” the OIG states.
To conduct its most recent study, the OIG used a sample of 1,210 claims for a population of about 1.36 million claims for test strips provided to beneficiaries from April to June 2013.
A requirement outlined in the Medicare Improvements for Patients and Providers Act (MIPPA) prohibits CMS from awarding contracts for test strips to suppliers that don’t demonstrate that their bid covers at least 50%, by volume, of all types of test strips.
NASHVILLE, Tenn. – CGS Administrators has agreed to make two concessions that should make audits less hair-raising for HME providers in Jurisdiction C.
The first: In a June 3 bulletin, the DME MAC detailed its plans to start sending providers detailed written letters explaining why their claims were denied as part of prepayment or complex medical reviews.
“We’re encouraged that they’re taking our feedback and that we’re finding those areas where collaboration is possible,” said Andrea Stark, a reimbursement consultant for MiraVista and chairwoman of the Jurisdiction C Council.
CGS started sending the letters on May 30, but only to providers that bill for oxygen and diabetes supplies. It will expand to other providers throughout the year. In addition to the reasons for denials, the letters also contain claim-specific information, such as dates of service and submitted charges.
Typically, providers that want more information about denials have to log in to myCGS, but they say the web portal doesn’t always have what they need.
“We still find ourselves calling a lot and that’s very time consuming,” said Sylvia King, general manager of Thrift Home Care, a member of the council, and vice president of the Mississippi Association of Medical Equipment Suppliers. “Anything that will save us time getting paid, especially with reimbursement cuts, is so valuable.”
With a written record of the reasons for denials, providers will also be better positioned to train not only their staff but also their referral sources, King says.
“We can tell our referral sources, ‘This is what Medicare is telling us,’ and it’s on their letterhead,” she said. “That will be more real to them.”
Stark puts it this way: “It triggers a more direct response and intervention.”
The second concession: CGS has also started excluding providers with low error rates from service-specific audits.
“Exclusion from the edit is not forever, but it’s long enough to catch your breath, pat yourself on the back and celebrate your success,” wrote Robert Hoover, the medical director for Jurisdiction C, in a letter.
While CGS doesn’t specify what it considers a low error rate, Stark says 20% or less is a good goal for providers to have.
“That’s a good place to start and fine tune from there,” she said. “Very few providers have 0% error rates. There are going to be things that happen.”
The two initiatives together should go a long way toward empowering providers to “get in front of what’s impeding their reimbursement,” Stark says.
“A lot of times, I think providers have a high error rate because of the difficulty they have in tracking this process from start to finish,” she said. “Getting these letters is really going to allow providers to start managing this in a different way.”
As for whether or not other jurisdictions will follow suit: “I haven’t heard any talk,” Stark said.
WASHINGTON – CMS officials last week acknowledged that some providers feel “angst” about prior authorizations (PAs), but they say, given a chance, the process will prove beneficial.
“We know there is some level of angst out there about this new process,” said Connie Leonard, acting deputy director of the Provider Compliance Group, during a Special Open Door Forum June 17. “That’s understandable.”
CMS scheduled the call to provide information “on all of the prior authorization initiatives.” In the May 28 Federal Register, the agency outlined its plans to implement a PA process for certain DME.
During the call, however, officials didn’t provide any specific information on DME. They did, however, try to address some common questions, including whether there would be a form (no) and whether claims with a PA attached would be subject to audits (unlikely).
“It goes for most, if not all of the PA affirmations, that a claim that has the PA decision isn’t typically reviewed again,” said Leonard. “That’s some peace of mind for the supplier that, three years later, Medicare is not going to come looking for the claim.”
CMS officials also discussed the PMD demo project, which it will expand to an additional 12 states. They said the agency remains committed to its continued success.
“We do have frequent meetings with the MACs to be sure things are running smoothly,” said one official. “We do spot checks to make sure everything is appropriate.”
It’s the success of that project that’s pushing CMS to implement PAs for other equipment, Leonard said.
“Some of you may remember that you did not want this and thought it was the worst thing that ever happened to Medicare,” she said. “Today, CMS believes that, for the most part, most suppliers actually like the demonstration or would like to be part of it.”
CMS is accepting comments on the proposed rule until July 28.
ROCKY HILL, Conn., and FRANKLIN, Tenn. – The capped rental rule will squeeze cash flow and generate more paperwork, national mobility providers say, but it’s not altering their strategies just yet.
The rule, which went into effect in April, requires providers to send claims to Medicare and secondary payers each month of a 13-month rental period to receive full payment.
“There may be a time in the future where we have to assess what products we put out the door,” said Kevin Harmon, vice president of finance for National Seating & Mobility (NSM). “We haven’t made that decision yet as a company how we’re going to approach that.”
Another impact of the rule: Although custom chairs require adjustments and fixes over time, providers aren’t paid for repairs, and should a patient pass away, the company is only paid for the rental up to that point, Harmon said.
Though the rental rule will affect cash flow, Numotion isn’t holding back.
“We have no plans to hold off on acquisitions,” said Spokesman Justin Richardson.
The rule shows Medicare doesn’t understand the needs of complex rehab patients, Richardson said.
“The mobility systems utilized by this portion of the Medicare population are not commodity type items and should not be treated as such,” he said. “This presents an entire set of unique circumstances never before experienced by this portion of the Medicare population.”
For example: A person with a purchased Group 3 power chair could end up using a rented replacement tilt actuator, or a person could be sitting in purchased seating system paired with a rented base.
The code most affected by the rule is E1161, an adult tilt-in-space wheelchair, which CMS says is a custom code, said Harmon.
“They’ve designated it custom, it requires a specialist evaluation and ATP involvement up front, and yet CMS has determined this should be a rented item, which really doesn’t make any sense,” said Harmon.
WASHINGTON – A new bill that would increase sleep apnea screening requirements for Medicare beneficiaries is a positive step, but it overlooks problems in the program when it comes to therapy, say providers.
“I think it’s great to see so much attention placed on screening,” said Lisa Feierstein, president and co-founder of Raleigh, N.C.-based Active Healthcare.“But the other side of the regulatory framework just sets everyone up for failure by making it difficult for patients to get treated and providers to get paid.”
H.R. 4695, introduced last month by Reps. Michael Burgess, R-Texas, and Bobby Rush, D-Ill., seeks to add a screening questionnaire for obstructive sleep apnea to the initial preventive physical exam for new Medicare beneficiaries.
That could be especially helpful when a longtime CPAP user ages into the Medicare program and, not surprisingly, doesn’t have a copy of the original sleep study, say providers.
“We just had a call for a patient who’s been on CPAP since 2003,” said Debra Drillen, a respiratory therapist with Sleep Well in Brewer, Maine. “We’ve spent a lot time explaining to the doctor what needs to happen.”
Still, the legislation comes at a time when CMS is already looking to put more controls on CPAP therapy. A recent proposal seeking to implement a prior authorization process for “frequently over-utilized” DME includes CPAP. Increased utilization typically means increased audit activity, say providers.
“Would this bill raise utilization?” said Eric Parkhill, vice president of clinical operations/corporate compliance for Home Medical Professionals in Gainesville, Ga.
Overall, more and more health professionals are aware of the dangers of sleep apnea—but not everyone knows how best to treat it, say providers.
“Everybody’s asking about sleep but there’s a lot who are in the dark,” said Helen Kent, president of Progressive Medical in Carlsbad, Calif. “A lot of our doctors don’t really have much of a background in sleep.”
WASHINGTON – Reps. Pat Tiberi, R-Ohio, and John Larson, D-Conn., have introduced a bill that would require providers to obtain bid bonds as part of future rounds of competitive bidding. H.R. 4920, the Medicare DMEPOS Competitive Bidding Improvement Act of 2014, would also require providers to prove they meet licensure requirements before they submit bids. “AAHomecare is putting the full weight of the industry behind this practical piece of legislation,” stated Tom Ryan, president and CEO of the association, in a press release. “All providers and manufacturers should immediately ask their elected officials to support H.R. 4920.” Per the new bill, if a provider receives and accepts a contract from CMS, the bid bond would turn into a performance bond. If a provider receives a contract offer but does not accept it and its bid is at or below the bid price, CMS has the option to collect on the bond. AAHomecare believes the bill will “incentivize more responsible bids.” “When bids don’t have to be honored, the whole process becomes hollow,” stated Robert Steedley, president of Barnes Healthcare Services and chairman of the association’s board of directors.
SBA to take up industry issues at next hearing
WASHINGTON – The Small Business Administration (SBA) will discuss the impact of competitive bidding and audits at its National Regulatory Fairness Hearing on June 25. The meeting is an opportunity for business organizations, trade associations, chambers of commerce and related groups that serve small businesses to report unfair or excessive federal regulatory enforcement affecting their members, according to a notice from the SBA. Several members of the HME industry are scheduled to testify, including Tom Ryan of AAHomecare, Peggy Walker of U.S. Rehab and seven HME providers. The hearing will take place 9:30 a.m. to 1 p.m. at the Environmental Protection Agency, William Jefferson Clinton East Building. It’s open to the public, but advance registration is required. The SBA last took up competitive bidding a year ago.
Medtronic buys Covidien
MINNEAPOLIS and DUBLIN – Medtronic has agreed to buy Covidien in a cash-and-stock transaction valued at about $42.9 billion, the companies announced June 15. The combined company will have a comprehensive product portfolio, a diversified growth profile and broad geographic reach, with 87,000 employees in more than 150 countries, according to a press release. “We are excited to reach this agreement with Covidien, which further advances our mission to alleviate pain, restore health and extend life for patients around the world,” stated Omar Ishrak, chairman and CEO of Medtronic, in the release. The boards of directors of both companies have approved the transaction. After the transaction is completed, Medtronic and Covidien will be combined under a new entity called Medtronic plc. It will have principal offices in Ireland, where Covidien’s current headquarters reside and where both companies have a longstanding presence. Medtronic plc will be led by Ishrak and will continue to have operational headquarters in Minneapolis, where Medtronic currently employs more than 8,000. Per the transaction, each outstanding share of Covidien will be converted into the right to receive $35.19 in cash and 0.956 of an ordinary share of Medtronic plc. The per-share consideration represents a premium of 29% to Covidien’s closing stock price on June 13, the last trading day prior to the announcement. The transaction will allow Medtronic to enhance its existing portfolio, offer greater breadth across clinical areas and create entry points into new therapies. It will also allow the company to better package complementary therapies and solutions to drive value and efficiencies in healthcare systems. Finally, it will boost its capabilities in emerging market R&D and manufacturing.
More education, communication needed between COPD patients, physicians
WASHINGTON – More than half of COPD patients don’t fully understand their disease or how to manage it, according to a new survey from the COPD Foundation. The two-part Chronic Obstructive Pulmonary Experience (COPE) surveyed both patients and physicians. Nearly 62% of patients said they don’t know much about COPD exacerbations—a leading cause of hospitalization in the United States. Another 16% said they don’t know what an exacerbation is at all, and 60% said they don’t have a plan for dealing with an exacerbation. By contrast, 98% of physicians said they discuss exacerbations with patients and 92% said they develop action plans with them. The survey also found that many patients aren’t being diagnosed early enough. On this, patients and physicians appear to agree. Patients said they experience symptoms of COPD for two years and nine months, on average, before diagnosis; physicians said that 39% of their patients had reached a “severe” or “very severe” disease state by diagnosis. “COPD can be treated—but it’s crucial for doctors to diagnose it early and for patients to follow the appropriate therapeutic strategies to improve symptoms, increase activity, and reduce the chances of exacerbations,” said MeiLan Han, M.D., M.S., associate professor of Medicine in the Division of Pulmonary and Critical Care at the University of Michigan.
Does mail-order program meet requirement?
WASHINGTON – CMS may want to consider whether subsequent rounds of its national mail-order program for diabetes supplies meet a 50% requirement outlined in the Medicare Improvements for Patients and Providers Act (MIPPA). The Office of Inspector General (OIG) says 22 suppliers submitted at least 43 types of test strips for the three-month period from July to September 2013. Two types of test strips accounted for about 45% of the Medicare mail-order market share, three types accounted for 59% and 10 types accounted for 90%. The 50% requirement prohibits CMS from awarding competitive bidding contracts for diabetes supplies to suppliers that don’t demonstrate that their bid covers at least 50%, by volume, of all types of test strips. The OIG’s report is based on a sample of 1,210 claims drawn from a population of about 505,000 claims for test strips provided to beneficiaries during this period.
ResMed CEO sells 3,200 shares
NEW YORK – ResMed CEO Michael Farrell sold 3,200 shares of company stock on the open market June 16. Farrell sold the shares at an average price of $53.20 for a total of $170,240. He now directly owns 106,655 shares valued at approximately $5.7 million. Farrell is one of a number of execs at the company who has sold shares in May and June.
ASP: Brovana sees another increase
BALTIMORE – Payment increased for brand-name drug Brovana (J7605) in the third quarter of 2014 to $6.39 per dose, up 25 cents from the previous quarter, according to average sales price (ASP) figures released June 17. By contrast, Perforomist (J7606) saw payment decrease 29 cents to $6.62 per dose. Payment for budesonide (J7626) decreased 20 cents to $4.90 per dose. Payment for albuterol (J7613) stayed relatively flat at just over 13 cents per dose, and payment for ipratropium (J7644) was unchanged at just under 12 cents per dose.
Senior Medicare Patrol saves $9 million
WASHINGTON – Medicare/Medicaid recoveries attributed to Senior Medicare Patrol (SMP) projects increased 50%, to $9.1 million from 2012 to 2013, according to a report from the Office of Inspector General (OIG). However, total savings to beneficiaries decreased from $133,971 to $41,718. As part of SMP projects, 5,406 active volunteers conducted 148,235 one-on-one counseling sessions and held 14,924 group education sessions in 2013. SMP trains retired professionals and other seniors to recognize and report patterns of healthcare fraud.
HME provider faces prison time, fines
BATON ROUGE, La. – A federal court jury has found Ahaoma Boniface Ohia, owner of All-Star Medical Supplies, guilty of wire fraud, it was announced June 12. Ohia was accused of billing Medicare for durable medical equipment that was less expensive than what was provided or that wasn’t provided at all, according to a press release. Ohia, who was taken into custody after the verdict, faces up to 140 years in prison, fines of up to $1.75 million, and restitution to victims.
Wheelchair team gets replacement chairs
CEDAR RAPIDS, Iowa – It’s a happy ending for the wheelchair basketball team Iowa Chairiots. On June 14, the team received 20 new wheelchairs to replace wheelchairs that were stolen back in December. Tim Barrett, program director, told a local news outlet that the theft was actually a “blessing.” “Our equipment was outdated and unsafe, and now we have brand new equipment,” he said. In April, police arrested Rick Smith in the theft. Smith had many of the stolen wheelchairs in his home, but most of them were destroyed. The new wheelchairs have a value of about $30,000 and were paid for by donations, including a $12,000 donation from The VGM Group.
Performance Health buys TheraPearl
AKRON, Ohio – Performance Health, the manufacturer behind TheraBand, Biofreeze, Perform, Cramer, Bon Vital and Hygenic branded products, has acquired TheraPearl, a creator of hot and cold therapy products. The acquisition brings strength and scale to Performance Health’s emerging retail business, the company states in a press release. TheraPearl’s products use a proprietary Pearl Technology that allows them to be chilled or heated. They conform to the body and can be used for 20 minutes of hot/cold therapy. The products are available at most retailers throughout the U.S. and Canada, including Walmart, Rite Aid, Dick’s Sporting Goods and Target. In March, they became available in Europe at the pharmacy chain Boots. TheraPearl will continue to operate from its headquarters in Maryland.
Aeroflow updates website
ASHEVILLE, N.C. – Aeroflow has launched a new website that makes it easier for customers to find information on products and services. The website features the following new tools: patient/parent education resources; a cost savings calculator to help customers make informed decisions about whether to get equipment through insurance or buy online; a search function; a blog; a medical equipment look-up tool by zip code; and forms that make qualifying online easier. “We realized Aeroflow’s website is a first-impression to many seeking medical equipment or cost-assistance through insurance,” stated Maria Eilers, online marketing manager, in a press release. “The new website does a better job reflecting our mission to provide quality care by offering more for the convenience of those we serve.”
New Berlin, Wis.-based Home Care Medical has received reaccreditation from the Joint Commission, the provider announced June 18. Home Care Medical says it was the first accredited provider in the state in 1990.
WASHINGTON – Reps. Pat Tiberi, R-Ohio, and John Larson, D-Conn., have introduced a bill that would require providers to obtain bid bonds as part of future rounds of competitive bidding.
H.R. 4920, the Medicare DMEPOS Competitive Bidding Improvement Act of 2014, would also require providers to prove they meet licensure requirements before they submit bids.
“AAHomecare is putting the full weight of the industry behind this practical piece of legislation,” stated Tom Ryan, president and CEO of the association, in a press release. “All providers and manufacturers should immediately ask their elected officials to support H.R. 4920.”
Per the new bill, if a provider receives and accepts a contract from CMS, the bid bond would turn into a performance bond. If a provider receives a contract offer but does not accept it and its bid is at or below the bid price, CMS has the option to collect on the bond.
AAHomecare believes the bill will “incentivize more responsible bids.”
“When bids don’t have to be honored, the whole process becomes hollow,” stated Robert Steedley, president of Barnes Healthcare Services and chairman of the association’s board of directors.
WASHINGTON – The Small Business Administration (SBA) will discuss the impact of competitive bidding and audits at its National Regulatory Fairness Hearing on June 25.
The meeting is an opportunity for business organizations, trade associations, chambers of commerce and related groups that serve small businesses to report unfair or excessive federal regulatory enforcement affecting their members, according to a notice from the SBA.
Several members of the HME industry are scheduled to testify, including Peggy Walker of U.S. Rehab and seven HME providers.
The hearing will take place 9:30 a.m. to 1 p.m. at the Environmental Protection Agency, William Jefferson Clinton East Building. It’s open to the public, but advance registration is required.
The SBA last took up competitive bidding a year ago.