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.
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.
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.
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.
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 hereto 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 firstname.lastname@example.org 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.