WATERLOO, Iowa – Upfront spending on durable medical equipment saves Medicare money in the long run, according to an updated study conducted by Leitten Consulting for The VGM Group.
For every dollar spent on DME, CMS could save from $11 to $29 in direct treatment payment, according to the study, titled “The Case for Medicare Investment in Durable Medical Equipment.” Overall, annual savings range from $23 to $41 for every dollar spent on DME.
“This study continues to reaffirm the true value of DME within health care and the savings that it offers,” said John Gallagher, director of government relations for VGM. “DME providers have been able to save the health care system millions of dollars annually by taking care of patients in their homes.”
The study updates a previous study conducted in 2014.
Since that initial study, CMS has expanded bid pricing to non-bid areas, escalating reimbursement cuts.
“This has led to a dramatic drop in DME providers serving the Medicare population, profit margins that are often thin or non-existent, and reduced access for beneficiaries,” the study says.
Tricare contractor agrees that rollback provision applies
WASHINGTON – Health Net Federal Services, the Tricare contractor for the north region, agrees that a provision in the 21st Century Cures Act impacts its payments for home medical equipment, according to AAHomecare. The association had called on the three Tricare contractors to reprocess six months of claims for HME, since its reimbursement rates are pegged to Medicare reimbursement rates by law and by current network agreements. The provision in the Cures Act rolls back Medicare reimbursement cuts for HME in rural areas from July 1, 2016, to Jan, 1, 2017. Health Net says it will need a directive issued by the Defense Health Agency to be able to reprocess these claims.
Verma hearing includes comments on bid program
WASHINGTON – Seema Verma, President Donald Trump’s nominee to run CMS, said during a hearing before the Senate Finance Committee on Feb. 16 that one-size-fits-all approaches to health care, like the agency’s competitive bidding program, don’t always work. Verma made the comment in response to a question from Sen. Mike Enzi, R-Wis., about whether or not she would be willing to continue to have a dialogue about how the program can ensure Medicare beneficiaries, especially those in rural states, get the medical equipment they need, according to The VGM Group. Verma told the senator: “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.”
New RAC posts new reviews
WASHINGTON – Performant Recovery, the new national recovery audit contractor (RAC) for DMEPOS and home health/hospice, has posted seven new reviews on its workload page, according to AAHomecare. They are: complex medical necessity chest wall oscillation devices; complex medical necessity tracheotomy suction catheters, suction pumps, catheters and other related supplies and equipment; automated nebulizers not in accordance with billing requirements; automated DME billed while inpatient; complex review osteogenesis stimulators; automated CPM billed without total knee replacement; complex Group 2 support surfaces without correct diagnosis of condition.
Brightree, ADSI close loop on oximetry, sleep testing
ATLANTA – Brightree has entered into an agreement to develop ordering and processing capabilities for overnight pulse oximetry and home sleep apnea testing with Advanced Diagnostic Solutions, Inc. (ADSI). Having those capabilities in Brightree’s software will create a “closed-loop diagnostic testing order and result workflow,” Brightree says. It will allow HME providers to order oximetry and sleep testing from ADSI directly in their workflow. Providers will be able to send information electronically through the interface to complete the ordering process, avoiding duplicate data entry and automating inbound results delivery as they order tests and process results. It will replace manual paper submissions done by fax and phone, or through a testing partner’s website. “Via our partnership with Brightree, we have created a solution that will streamline orders and enhance delivery processes, and thereby decrease paperwork and overall expenses,” said Brandon Womack, president of ADSI. “This integration will save HME providers a considerable amount of work and will speed up the entire ordering and results process.”
Permobil creates philanthropic arm
NASHVILLE, Tenn. – Permobil will launch the Permobil Cares Foundation at the International Seating Symposium on March 1. The manufacturer will donate proceeds from every Permobil, TiLite and Roho product sold toward funding the foundation. “With the help of the Permobil Foundation we hope that we can build impactful relationships with our customers and non-profit partners helping to fulfill a life of independence,” said Larry Jackson, president of Permobil North America. The foundation will work in partnership with non-profit organizations and agencies to provide support and services so individuals can “live a life without limitations.” Some areas of support will include sponsoring fundraising events, providing college scholarships, volunteering in the community and donating products. The foundation, which has the tagline “It’s a Work of Heart,” will be led by Ashley Davis, executive director.
Invacare brings Swiss brand to U.S.
ELYRIA, OHIO – Invacare has launched the kuschall brand of high-active custom manual wheelchairs in the United States with three new wheelchairs: the K-Series attract, the Advance and the Champion. The kuschall brand features sleek designs for an active lifestyle, Swiss engineering and superior drivability and handling, according to a press release. “The kuschall brand is established in Europe as the leader in the high-active wheelchair category because they have a single focus: the user,” said Brian LaDuke, vice president of rehab product and channel marketing for Invacare. “This commitment to promoting independence and confidence for users excites us to bring kuschall products to the U.S.”
PharMerica sees significant decreases in net income
LOUISVILLE, Ky. – PharMerica Corporation, a national provider of specialty home infusion and other pharmacy services, has reported $534.4 million in revenue for the fourth quarter of 2016, a 2.7% increase compared to the same quarter in 2015. Net income was $7.7 million, a 61.9% decrease. PharMerica reported $2.091 billion in revenue for all of 2016, an increase of 3.1%. Net income was $21.6 million, a 38.5% decrease. For 2017, PharMerica projects revenue in the range of $2.3 billion to $2.4 billion for 2017.
Numotion offers ‘test drive’ of SoftWheels
BRENTWOOD, Tenn. – Numotion has launched a new demo program that allows manual wheelchair users to “test drive” a set of SoftWheels by Numotion for one week, free of charge and with no obligation to purchase. Numotion began making the offer available at its online store, www.shopnumotion.com, on Feb. 23. “People who have tried SoftWheels have described the experience as ‘life-changing,’” said John Pryles, senior vice president of sales for Numotion. “We want more people to have the benefits these wheels offer first hand so they can experience more comfort and advance their level of mobility.” SoftWheels is an in-wheel suspension system that absorbs bumps and vibrations from uneven terrain and surfaces, resulting in a smoother more comfortable ride.
NCPA reshuffles staff to boost advocacy efforts
ALEXANDRIA, Va. – The National Community Pharmacists Association has combined its government affairs and communications departments into an Advocacy Center. As a result, the association has added one staff member, and realigned others. NCPA has named Kevin Schweers director of the Advocacy Center and senior vice president of government and public affairs. He has served as the association’s senior vice president of public affairs since 2011. NCPA has named Scott Brunner as senior vice president of communications and state government affairs. He was previously CEO of the Georgia Pharmacy Association. It has also named Karry La Violette, who has been with the association since 2011, vice president of government affairs and advocacy; and Stephanie DuBois, who has been with the association since 2013, senior director of marketing communications.
AOPA World Congress gains two new partners
WASHINGTON – The American Orthotic & Prosthetic Association has announced that the Orthotics and Prosthetics Association of India (OPAI) and the Charcot-Marie-Tooth Association (CMTA) will participate in the 2017 AOPA World Congress, Sept. 6-9 at the Mandalay Bay Resort in Las Vegas. “CMTA recognizes that the use of orthoses improve the quality of life for people living with CMT, so it was a very natural partnership,” said Michael Oros, president of AOPA. “And OPAI serves a growing population of orthotic and prosthetic users in such an important market. We look forward to collaborating with members of OPAI at the World Congress.” Other partners are: Amputee Coalition, ConFairMed, Mexico-National Member Society of ISPO, Orthotics Prosthetics Canada, US Member Society of ISPO, and Uniting Frontiers.
BOC establishes award
OWINGS MILLS, Md. – The Board of Certification/Accreditation has established the Jim Newberry Award for Extraordinary Service. The award will recognize individuals who perform outstanding service to BOC and its community. Newberry, a BOC board member with more than four decades in practice, died in 2016. “Jim was completely devoted to BOC and to the O&P profession,” said wife Lynne Newberry. “He cared so deeply about helping others and wanted nothing more than to make a positive difference in this world.” To submit a nomination: www.bocusa.org/NewberryAward.
Pedors launches mobile-friendly website
ROSWELL, Ga. – Pedors has re-designed its B2B ordering website to be mobile responsive. The site now enables foot care professionals to easily order product using a smart phone, laptop or desktop device 24/7. “The rapid advances in mobile technology over the past two years have had an enormous impact on how healthcare is delivered,” said John O’Hare, co-founder and CEO of Pedors. “The advent of electronic health records allows a patient health record to move with them. Most practitioners use a mobile device for one purpose or another while delivering care.” Pedors manufactures orthopedic footwear, including the Pedors Classic, which features Pedoprene heat moldable technology that can be easily modified to accommodate the most severe forefoot deformity.
State roundup: Colorado, New York, Kentucky
The Colorado Department of Health Care Policy and Financing has issued a proposed rule requiring a face-to-face exam no more than six months prior to the initiation of certain durable medical equipment and services. The rule further defines DME and disposable medical supplies, and adds a previously approved benefit coverage standards for speech generating devices. Comments on the proposed rule are due April 12 and a hearing is scheduled for April 17 in Denver…The New York Department of Health has delayed a reimbursement cut for incontinence supplies until March 15. The cut of nearly 30% was scheduled to go into effect Feb. 15. Stakeholders, including AAHomecare and the Northeast Medical Equipment Providers Association, have expressed concerns regarding the unsustainability of the cuts…Provider David Chesnut has been elected president of the Kentucky Medical Equipment Suppliers Association. Chesnut, owner and president of Pennyrile Home Medical in Cadiz, Ky., has been a member of the association for more than 25 years.
Changes at top for Home Care Medical
NEW BERLIN, Wis. – John Teevan, president and CEO of Home Care Medical, plans to retire April 1 from the role he’s held since 1990. Kandette Raether, current vice president of sales and marketing, will assume the role of interim president March 1. During Teevan’s tenure, Home Care Medical has enjoyed substantial organizational growth, financial stability and industry recognition. It was named the WAMES Provider of Year in 2014, 2013 and 2012. "It has been an honor to lead this great company with its 43-year legacy of enhancing the lives of those we serve,” said Teevan in a press release. “As Kandette takes the helm, I am confident that Home Care Medical will continue to build upon our strong foundation of serving our referrals, our customers and the community."
Doug Kerr joins VGM Canada
WATERLOO, Iowa – Doug Kerr has joined VGM Canada as director of member and supplier relations. He will be responsible for expanding the offerings provided by VGM to HME providers in Canada. “I look forward to leveraging my experience in the industry to assist VGM help suppliers save money and grow together,” Kerr said. Most recently, Kerr ended his tenure as executive vice president of Motion Specialties, a company he co-founded in 1985, steered through an acquisition in 2012 and left in late 2014. Motion Specialties is a mobility and accessibility solutions provider with locations throughout Ontario, Alberta and British Columbia. He also founded The Motion Group, which was acquired by VGM in 2003. VGM Canada, established in 1998, is a division of The VGM Group.
LAS VEGAS – Exhibiting at Medtrade Spring has a different dynamic than the big fall show, but vendors say they are attracted to the smaller, more intimate feel.
The slower-paced environment, they contend, allows for more engaging discussions, relationship building and the opportunity for meaningful outreach.
“Medtrade Spring is about quality interactions and relationship building with providers,” noted Mark E. Smith, general manager of public relations for Exeter, Pa.-based Pride Mobility Products. “It allows not only product display, but concentrated time to discuss with providers their needs and how we can best meet them. We appreciate the time to discuss providers’ needs in-depth and deliver proven solutions in the Medtrade Spring format.”
Specifically, Smith said he is anxious to hear from providers about how Pride can help them develop a strong retail platform.
“We hear a lot of excitement from providers about retail and their desire for even greater success,” he said. “Therefore, there’s a lot of interest around learning more about revenue-generating retail products and successful retail business strategies.”
Ryan Moore, vice president of sales for Middleburg Heights, Ohio-based Compass Health Brands, says because Medtrade Spring is a smaller venue, the company looks forward to more face-to-face time with customers at the booth and around the various Las Vegas venues.
“Medtrade Spring has always been a fun show and we really enjoy spending quality time with our customers at the show and afterward,” he said.
Created through the merger of Roscoe Medical and Carex Health Brands, Compass Health has continued to expand with the recent acquisitions of ProBasics and Meridian Medical, as well as a partnership with Brightree for electronic data interchange. As a result, the company has a more diversified product offering to share with attendees, Moore said.
“We now have a greater selection and better value-added programs to help customers thrive in a competitive bidding and managed care world,” he said. “With HME providers taking hard looks at how they run their businesses and how to improve their bottom lines, Compass Health stands ready to drive that success.”
New-to-the-scene GCE Healthcare, based in Malmo, Sweden, wants to make a good impression with its oxygen product line, says General Manager Jim Clement. GCE Healthcare hit the North American market with a portable oxygen concentrator under the Zen-O brand in July. The company acquired the exclusive rights to market the Zen-O from Auburn Hills, Mich.-based Oxus America, a division of Korea-based Oxus, in 2014.
“Our goal for the show is to continue introducing the GCE brand to the USA market,” Clement said. “Since we are new to North America, we feel that exhibiting at Medtrade Spring is a good way to meet as many providers as possible.”
YARMOUTH, Maine – One of the leading providers of home infusion therapy has stopped taking new Medicare patients and others are likely to follow suit if a “payment gap” is not closed.
“We are not able to take these patients that are directly impacted on our service and provide them the level of care that we deliver for the level of reimbursement that we make,” said Paul Mastrapa, CEO of Option Care, which is still caring for its active patients. “We are working with patients to get them referrals.”
As of Jan. 1, per a provision in the 21st Century Cures Act, Medicare pays for Part B infusion drugs under an average sales price model, a move that reduces payments so drastically that, essentially, they no longer cover services. Another provision in the act provides payments for these services, but not until 2021.
Infusion stakeholders have been pushing back hard on the change. A letter circulated by the National Home Infusion Association urging lawmakers to act quickly to address the “payment gap” garnered 170 signatures. The association is planning to track how many of its members may stop accepting new Medicare patients or stop serving them altogether, says Ken van Pool, vice president of legislative affairs.
“We are hearing from some members that they are holding off on taking new patients and some are working to transfer their patients out,” he said.
In New York state, which has a heavy managed care population, the impact has been milder, but no less challenging.
“We always do a case-by-case analysis,” said Gregory LoPresti, senior vice president and CEO of Clinton, N.Y.-based Upstate HomeCare. “We try to work with the patient; we try to get them on cheaper drugs.”
LoPresti has been preparing for the change since at least last summer.
“It’s never a good thing to have a unilateral change where they cut the drugs and they know there’s a technical component to this,” he said. “It’s irresponsible.”
Stakeholders have made inroads in the past year or so in their years-long quest for better Medicare coverage, but the industry really needs a long-term solution, says Mastrapa, who has taken the lead on Keep My Infusion Care at Home, a coalition charged with sharing stories of the impact of the changes on patients.
“We have to clearly articulate and share what is the value of what we do,” he said. “Any provider no matter how big or small, needs to take up arms to address this.”
HARTFORD, Conn. – A recently announced change to CareCentrix’s authorization process for oxygen patients covered under a Medicare Advantage plan has stakeholders scratching their heads.
The change, issued earlier this month, states that an initial request for oxygen will be approved for only one month, with subsequent months requiring additional authorization.
“I’m trying to get to see why they are doing what they are doing and talk them out of it," said Laura Williard, senior director of payer relations for AAHomecare, who reached out to the health plan manager to seek clarification. "A one-month authorization is crazy.”
It’s unclear from the "Provider Newsflash," stakeholders say, whether additional authorization would be needed on a monthly basis for subsequent months, or just a second time.
Jennifer Russo, director of marketing at CareCentrix, said the initial request is an "expedited process so patients can get their oxygen without delay."
"Re-authorizations for acute patients are for two months," she added. "Re-authorizations for chronic conditions can be what the prescriber indicates for up to 11 months."
Russo said CareCentrix plans to issue a clarification to its members.
CareCentrix, which supports and coordinates homecare for more than 23 million lives, says in its “Provider Newsflash” that “these changes are being implemented as a result of recent CMS publications noting the high utilization of oxygen.” Russo pointed to the "Medicare Fee-for-Service 2016 Improper Payments Report" issued in December.
Most patients who require oxygen—like those with COPD or congestive heart failure—truly need it, often for the rest of their lives, stakeholders point out.
“They don’t do it just to have an oxygen tank in their home and not use it,” said Williard.
With the change effective April 10, provider Tyler Riddle is keeping an eye out for that clarification.
“We are watching it closely,” said Riddle, vice president of Albany, Ga.-based MRS Homecare. “But if they are expecting to require this every month, or even just going back to do it another time, that’s absurd, not only for us but also for the physicians.”
WASHINGTON – Industry stakeholders are throwing their support behind expanding a demonstration project that allows providers to speak with reconsideration professionals by phone to try and resolve their appeals.
AAHomecare on Feb. 22 submitted commentsto CMS, recommending that the agency also consider applying the phone demo to the first level of appeals. Currently, it applies only to the second level of appeals.
“Although the demonstration at the second level of appeals has been a positive experience for suppliers, we believe instituting a discussion at the first level of appeals will enable CMS to significantly reduce the backlog at the Office of Medicare Hearings and Appeals,” wrote Kim Brummett, vice president of regulatory affairs for the association.
The backlog at the administrative law judge level, the third level of appeals, was 877.2 days in fiscal year 2016, according to AAHomecare.
The association also recommends that CMS gather data on the type and volume of denials that are overturned and that are found to be errors by the processing contractor.
“To improve the appeals backlog, education on claims processing must target both suppliers and contractors,” Brummett wrote.
Finally, AAHomecare recommends that CMS “evaluate policies that are disproportionally contributing to the appeals backlog and adjust the language to meet the intent of the requirement by allowing for some flexibility,” Brummett wrote.
C2C Innovative Solutions, the Qualified Independent Contractor that is conducting the phone demo, is already doing this on an informal basis, says Andrea Stark, a reimbursement consultant with MiraVista. CMS has made the unprecedented move of giving C2C “discretion” to overlook minor technical errors that would, otherwise, sink a claim, she says.
“That’s something we haven’t seen before,” she said. “For example, if there’s a doctor’s signature and there’s a fax date, they can accept that as the signature date as long as it’s before claim submission, versus saying there’s no signature date. C2C can make those kinds of connections that give providers the benefit of the doubt.”
CMS has also been expanding the demonstration on its own. In March, C2C Innovative Solutions will begin considering cases for manual wheelchairs, external infusion pumps, power wheelchairs, prosthetics, miscellaneous respiratory products and surgical dressings.
“Where the ALJ is seriously backlogged, this is really the first CMS innovation that is really worth a darn,” Stark said.
In February, C2C began considering cases for orthotics, medications, NPWT, lymphedema pumps and repairs; and in January, for CPAP devices, hospital beds, enteral nutrition, support surfaces, nebulizer meds, ostomy and urological supplies, and therapeutic shoes. When C2C kicked off the five-year demo in 2016, it considered cases only for oxygen equipment and diabetes testing supplies.
C2C is also working with larger providers to work on consolidating multiple cases to make the process more streamlined, Stark says.
“Otherwise, they’re doing them all onesie-twosie,” she said.