WASHINGTON – Sen. Chuck Grassley, R-Iowa, has asked Office of Management and Budget Director Mick Mulvaney to tell him, in writing, the specific steps he would take to make sure the agency reviews and releases an interim final rule.
“This is important to me,” said Grassley during a Senate Budget Committee hearing this week.
The IFR, which has been stuckat the OMB since August, would provide relief from the competitive bidding program in rural areas.
Meanwhile, members of the Midwest Association of Medical Equipment Services asked House Speaker Paul Ryan to intervene in getting the IFR released during a Feb. 8 conference call with his deputy chief of staff, Allison Steil, according to a bulletin from the association.
During the call, MAMES members, led by provider Rick Adamich, the Wisconsin state chairman and president of Oxygen One in Waukesha, Wis., shared the impact of reimbursement reductions on patient access to care.
Steil told members that Ryan’s office is limited in what they can do, but they may be able to do something, according to MAMES.
Hill briefing: Associations tag team on access issues
WASHINGTON – AAHomecare and the American Thoracic Society held a well-attended Capitol Hill briefing on Feb. 14 to detail access problems for patients.
Al Dobson, president of Dobson DaVanzo & Associates and the lead on “Analysis on the Impact of Competitive Bidding on Medicare Beneficiary Access to Durable Medical Equipment,” a study commissioned by AAHomecare, detailed how 77% of case managers report difficulty discharging patients; and 52% of patients report difficulty accessing DME.
Those study findings are echoed by the ATS study, “Patient Perceptions of the Adequacy of Supplemental Oxygen Therapy,”which found that 51% of patients report problems with their oxygen service.
Giving the provider point of view, Mike Calcaterra, Northern Zone vice president for Norco and the Montana State Chair for Big Sky AMES, detailed how 20% of HME providers in Montana and 37% of providers in Idaho have closed their doors since 2013.
Health spending to hit 19.7% of GDP by 2026, report says
WASHINGTON – National health expenditure growth is expected to average 5.5% annually over 2017-2026, according to a report published last week by the Office of the Actuary at CMS.
Growth in national health spending is projected to be faster than projected growth in gross domestic product by 1% point during 2017-2026. As a result, health share of GDP is expected to rise from 17.9% in 2016 to 19.7% by 2026, the report says.
Drivers of growth: trends in disposable personal income, increases in prices for medical goods and services, and shifts in enrollment from private health insurance to Medicare that result from the continued aging of the baby-boom generation into Medicare eligibility.
For 2017, specifically, growth in national health spending is projected to have been 4.6%. For 2018, growth in national health spending is projected to be 5.3%.
Among the major payers for health care, Medicare is projected to experience the most rapid annual growth rate over 2017-2026 at 7.4%, largely driven by enrollment growth and faster growth in utilization from recent near-historically low rates.
Private health insurance is projected to experience the slowest growth rate at 4.7%, reflecting low enrollment growth and downward pressure on utilization influenced by, among other things, the increasing prevalence of high-deductible health plans.
Medicaid is projected to experience a growth rate of 5.8% over 2017-2026, slower than the 8.3% for 2014-2016.
Growth in personal health spending is projected to be 5.5% over 2017-2026.
KCI to lay off 68 employees
SAN ANTONIO – KCI USA, a subsidiary of Acelity, will lay off 68 workers in May, according to a notice filed with state labor regulators and reported by the San Antonio Express-News. No reason was given for the layoffs, and calls and emails to the company were not immediately returned, according to the newspaper. In 2016, Acelity, formerly Kinetic Concepts, said it was not awarded contracts for negative pressure wound therapy in the Round 2 re-compete of competitive bidding, due to a technicality.
Investment firm divests pediatric provider
HOUSTON – Main Street Capital has sold Marietta, Ga.-based SoftTouch Medical to a sponsor-backed strategic buyer, it announced Feb. 14. Main Street initially invested in SoftTouch, a provider of home medical equipment and services to pediatric patients in Georgia and Alabama, in 2014. SoftTouch’s product offerings include respiratory equipment, enteral nutrition, phototherapy and ventilators.
DASCO leverages Apacheta to gain efficiencies
WESTERVILLE, Ohio – DASCO Home Medical Equipment has added approximately 2,500 new confirmed orders each month, after tapping Apacheta’s mobile solution to gain more oversight of its delivery techs and streamline business operations. The provider has also reduced DSO by eight days, according to a press release. DASCO has implemented Apacheta’s Transport Manager, which enables managers and customers service reps to centrally plan, schedule and monitor field force activity via a cloud-based application; and Transport ACE, which streamlines mobile proof of delivery operations.
VMI launches accessible SUV
PHOENIX – Vantage Mobility International has launched the VMI Honda Pilot Northstar E, a spacious, accessible SUV. The SUV features VMI’s Access360 for expansive door opening width and height, 33.5 inches by 55.5 inches; an in-floor air ramp to keep dirt and debris out of the cabin; a 32-inch wide ramp to accommodate large power wheelchairs; and flexible seating to let the wheelchair user sit in the front passenger position of the mid row. “The introduction of the VMI Honda Pilot Northstar E accessible SUV with its innovative manual in-floor ramp offers the perfect combination of simplicity, space and style at a great price,” said VMI CEO Tim Barone in a press release.
Shield HealthCare expands into Arkansas
VALENCIA, Calif. – Shield HealthCare has expanded into Arkansas, demonstrating its commitment to the “ongoing growth of the company as a nationwide medical suppler leader,” it says. “We are excited to open up the Arkansas market,” said Roger Miller, chief marketing officer. “We believe that Arkansas customers using medical supplies need exactly what Shield offers.” Shield now operates in Arkansas, California, Colorado, Illinois, Texas and Washington. The company, which delivers incontinence, urological, ostomy, enteral nutrition, wound care and breastfeeding supplies, serves more than 180,000 patients. It offers home delivery, monthly order reminders, language translators and direct billing to insurance.
Invacare confirms move to France
ELYRIA, Ohio – Invacare will transfer production of Küschall manual wheelchairs from its facility in Witterswil, Switzerland, to its facility in Fondettes, France, by the end of the third quarter of this year. The move, which will allow the company to better optimize its facility in France, is expected to generate an incremental $1.7 million in annualized pre-tax savings in the Europe business segment. The front office of the Swiss facility will remain open, continuing to serve as Invacare’s European headquarters and research and development center, as well as its Swiss sales office. Invacare had made known its intentionto relocate in a Form 8-K but it first had to complete a “consultation procedure” with potentially affected employees per Swiss law. Invacare has already shifted production of its Rea manual wheelchairs from its facility in Dïo, Sweden, to its facility in France.
ATS, ResMed award $100,000 grant for vent research
SAN DIEGO – Dr. Jeremy Orr of the University of California, San Diego, has been awarded the new ATS Foundation/ResMed Research Fellowship in Noninvasive Ventilation in COPD. Dr. Orr’s $100,000 award will support his research focused on the impact of NIV on cardiovascular biomarkers in COPD. “Noninvasive ventilation during sleep is one of the few treatments in COPD that improves survival, but we don’t really understand the underlying mechanisms,” Orr said. “This grant will facilitate my research into the potential systemic and extra-pulmonary benefits of NIV.” The American Thoracic Society aims to improve global health by advancing research, patient care and public health in respiratory disease, critical illness and sleep disorders. ResMed manufactures NIV devices for treating COPD in the home and hospital.
FODAC receives two grants worth $80K
STONE MOUNTAIN, Ga. – Friends of Disabled Adults and Children has been named the winner of two “2018 Collaborative Innovation Grants” totaling $80,000. FODAC will use the funds to create new partnerships with Children’s Healthcare of Atlanta and Goodwill Industries of North Georgia. The “Hospital to home support keeps children with disabilities moving” program with Children’s Healthcare will help to ensure that children hospitalized for a severe injury or illness can acquire the DME needed for home recovery. The “Expand recycling and access to home medical equipment” program with Goodwill will establish 10 new locations for collecting DME donations. The annual “Collaborative Innovation Grant” is an invite-only competition for nonprofits in the Building Community Network led by the Georgia Center for Nonprofits and The Home Depot Foundation. The network is a collective of nonprofit leadership, bringing together 200-plus Atlanta-area organizations.
FOSTER CITY Calif. – After a lengthy tenure at Apria Healthcare, Lauren Barranti says taking the helm at the much smaller CHME presents exciting new challenges.
It’s a great opportunity to go back to a very local health care operation and the service that we provide—there’s fewer and fewer of us out there,’” she said. “I love the challenge and I want to make good on that whole cliché that health care is a local business and want to keep proving those services locally and grow this company.”
Barranti was promoted in January to president and CEO, succeeding industry veteran Bernie Zimmerman. She originally came onboard in June 2017 as executive vice president.
Marrying the margins
CHME offers a full line of DME and respiratory equipment, enteral nutrition, negative pressure wound therapy, medical supplies and complex rehab.
Those last two product categories are something many HME providers shy away from these days, says Barranti.
“Not every product has a good margin, but we have been able to marry the margins, if you will, of the good with the bad to continue to have a full scope of services,” she said. “We are always looking for new products that will complement the type of patients we are taking care of.”
Managing the cycle
One of the biggest challenges Barranti believes HME providers face is revenue cycle management, a never-ending cycle of purchasing items upfront, getting them delivered quickly to patients, then waiting—and waiting—to get paid, a lag time which has only increased.
“I spend my time trying to shore up these cycles so I can know my turnaround time for getting paid is shortly thereafter,” she said.
Musing the future
It’s no secret that the HME industry is, like so many others, male-dominated. When asked whether she thinks the industry will see more women move into the C suite, Barranti says she hopes she’s not an anomaly.
“It does seem to be the ‘Year of the Woman’ with everything that’s in the news and all the movements,” she said. “It’s coincidental but I happened to be lucky to get into this position at this time and I believe that in the future that will be (more common).”
WASHINGTON – NCART and NRRTS have three, ideally two, legislative asks for their National CRT Leadership & Advocacy Conference, April 25-26.
Finish the job
The first, and there’s a possibility that this will be taken care of before the event takes place: stop competitive bidding-related pricing for accessories for complex manual wheelchairs. Stakeholders plan to use the Capitol Hill visits on April 26 to push H.R. 3730, which had 84 co-sponsors at press time, possibly as part of larger legislation.
“We’ve gotten almost 30 more co-sponsors in 30 days and we’ve gotten some encouraging comments about that,” said Don Clayback, executive director of NCART, in mid-January. “Congress has bills to pass, so there are opportunities.”
Stakeholders have previously succeeded in getting CMS to back off on the cuts for accessories for complex power wheelchairs.
Back seat no more?
If the more immediate accessory issue is taken care of before the event, efforts to create a separate benefit for complex rehab, a long-standing goal, will take center stage. Stakeholders plan to use the visits to increase support for H.R. 750, which had 98 co-sponsors at press time. Clayback also says a companion bill in the Senate should be introduced in time for the event.
“The separate benefit had to take a back seat, but now that we have the majority of the accessory issues finished, we’re gearing up for a big push on the separate benefit,” he said.
Not a Cure at all
Finally, stakeholders plan to use the visits to express concerns with a provision in the 21st Century Cures Act that requires CMS to limit the federal contribution to Medicaid payments to bid-influenced Medicare payments. The change affects 37 complex rehab codes, Clayback says.
“There are fewer and fewer companies that are providing complex rehab and any reduction in reimbursement will create serious access consequences,” he said.
The opportunity is real
Clayback knows that time and money are tight, but the advocacy work that takes place during the event really makes a difference, he says.
“When you look back at last year, when we got a fix for accessories for complex power wheelchairs in June, being in Washington, D.C., in the spring was a good thing,” he said. “It had significant influence.”
WASHINGTON – CMS has changed the guidelines for reporting a patient’s oxygen flow rate on a CMN, a move that will have two serious implications for providers, particularly those servicing the critically ill, says Andrea Stark.
First, through new modifiers laid out in a Feb. 15 joint DME MAC publication, CMS has instructed that for patients whose oxygen use differs between day and night, the average flow rate, not the highest flow rate, must be reported on question 5 of the CMN.
“They say this is going to simplify the process, but it makes things ten times more complicated,” said Stark, a reimbursement consultant for MiraVista LLC.
CMS has added three new modifiers, set to go into effect April 1: QA (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is less than 1 liter per minute); QB (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts exceeds 4 liters per minute and portable oxygen is prescribed); and QR (prescribed amounts of stationary oxygen for daytime use while at rest and nighttime use differ and the average of the two amounts is greater than 4 liters per minute).
Second, by modifying existing modifiers QE, QF and QG, CMS has instructed that patients must now need more than 4 liters of oxygen per minute “at rest,” not at exertion, to qualify for a high-volume adjustment that increases reimbursement from $70.74 per month to about $106 per month.
“This will exclude patients who previously qualified for high-volume adjustments,” Stark said.
The reimbursement difference for a patient considered standard volume and high volume is about $20 to $30, a change that may be hardly worth the savings when you consider the upheaval to the documentation process and the possible threats to patients, Stark says.
“With the existing reimbursement cuts, this is just one more blow,” she said. “These high-liter-flow patients are the most expensive patients to take care of, and providers aren’t going to be paid nearly enough.”
WASHINGTON – Industry stakeholders say they are as surprised as anyone by a proposal to expand Medicare’s competitive bidding program to rural areas.
“We don’t know who is proposing this or what evidence there is that this idea is prudent,” said Jay Witter, senior vice president of public policy for AAHomecare. “We are going to demand answers.”
The proposal is included in the budget for the Department of Health and Human Services for fiscal year 2019, which was released Feb. 12. The provision would also eliminate the requirement that CMS pay a single payment amount based on the median bid amount, and, instead, pay contract suppliers at their own bid amounts.
HHS says these changes will result in $6.5 billion in savings over 10 years.
“I am aghast that there’s belief in the budget that there’s $6.5 billion that can be take out of the DME benefit,” said Tom Ryan, president and CEO of AAHomecare. “We’ve already stripped the benefit and I don’t think there’s any more savings to be had.”
HHS says in the event that less than two suppliers submit bids in a rural area, CMS will use a reference price from other, similar rural areas. In many of those areas, there could very well be fewer than two suppliers bidding. At a well-attended Capitol Hill briefing Feb. 14, provider Mike Calcaterra, Northern Zone vice president for Norco and the Montana State Chair for Big Sky AMES, detailed how 20% of HME providers in Montana and 37% of providers in Idaho have closed their doors since 2013.
“There’s a real access issue,” said Ryan. “We have a solution. We need to get the interim final rule moved forward and we need support for H.R. 4229.”
Other DME-related provisions in the HHS budget include:
Eliminating the face-to-face requirement; testing whether using a benefit manager will result in fewer improper payments and lower utilization; and expanding prior authorizations to orthotics and prosthetics.