In brief: AAH pulls out all the stops; Cigna, Express Scripts plan merger

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Friday, March 9, 2018

WASHINGTON – With it “increasingly possible” that a competitive bidding-related interim final rule may never be finalized by the Office of Management and Budget, AAHomecare is stepping on the gas on H.R. 4229.

“While this realization is a difficult pill to swallow, it also underscores the importance of our legislative efforts,” wrote Tom Ryan, CEO and president of AAHomecare, in the association’s weekly bulletin to members on Wednesday.

Those legislative efforts got a boost this week when a letter signed by 56 members of the House of Representatives was sent to leaders of the Appropriations Committee, asking them to include provisions from H.R. 4229 in upcoming budget legislation. The number of co-sponsors for H.R. 4229 also hit 128 this week.

AAHomecare acknowledges that including provisions from H.R. 4229 into the budget legislation will be an uphill battle, with hundreds of competing interests looking to influence or be part of the budget legislation.

“But we have one important factor in our favor: Thanks to your strong advocacy efforts, 20 members of the House Appropriations Committee are H.R. 4229 co-sponsors,” Ryan said.

AAHomecare encourages stakeholders to now target decision makers on both the House and Senate Appropriations Committees to reinforce the message of the recent sign-on letter, which was spearheaded by Cathy McMorris Rodgers, R-Wash., who also introduced H.R. 4229.

“Let’s build on this foundation and make a strong impression on these targets this week and next week,” Ryan wrote. “We’ve come too far to let this opportunity clip by without giving it our all.”

Cigna, Express Scripts plan merger

BLOOMFIELD, Conn. – Health insurance giant Cigna Corporation plans to acquire Express Scripts for $67 billion, it announced Thursday.

Express Scripts is the largest pharmacy benefits manager in the United States, covering more than 80 million lives, according to news reports.

“Cigna’s acquisition of Express Scripts brings together two complementary customer-centric services companies, well-positioned to drive greater quality and affordability for customers,” said David M. Cordani, president and CEO of Cigna in a press release. “This combination accelerates Cigna’s enterprise mission of improving the health, well-being and sense of security of those we serve, and in turn, expanding the breadth of services for our customers, partners, clients, health plans and communities.”

Cordani will assume the role of president and CEO of the combined company; Tim Wentworth, president and CEO of Express Scripts, will assume the role of president of Express Scripts.

While both organizations say the move will expand consumer choice and create better value, others disagree.

“We’re still assessing the implications of a Cigna-Express Scripts merger, but one thing is clear: Consolidation among health care giants leads to fewer choices for patients and plan sponsors,” said Douglas Hoey, CEO of the National Community Pharmacists Association, in a press release. “In addition, companies make claims of cost savings that will benefit patients and health plan sponsors, but the available evidence from previous consolidations suggests otherwise.”

The deal is the latest sign of upheaval in the market. In December, CVS Health announced a planned merger with Aetna. In January, Amazon announced it would partner with Berkshire Hathaway.

The deal is expected to be finalized in December 2018, subject to shareholder and regulatory approval.

QMES secures $175M in financing

NEW YORK – QMES has locked in a $157 million senior secured credit facility from CIT Group’s consumer finance business. QMES, a portfolio company of Quadrant Management, a private investment firm based in New York City, will use the new credit facility to refinance legacy debt, support growth and make strategic investments, according to a press release. “This new credit facility will enable us to expand beyond our core markets and further solidify our position in our current markets,” said Luke McGee, CEO of QMES, which serves 500,000 patients in the Mid-Atlantic and Northeastern states. “It will also allow us to continue to invest in our best-in-class technology solutions which continue to innovate our service offerings to providers and patients.” Last year, QMES secured a $65 million secured senior credit facility from CIT, and in 2014, it secured a $50 million credit facility.

Permobil launches consumer app

LEBANON, Tenn. – Permobil has launched the My Permobil consumer app as part of its Permobil Connect platform. The free app provides enhanced performance and usage data to help consumers get the most out of their connected wheelchairs. “In a world where everything is connected, it just makes sense for our wheelchairs to be, as well,” said Larry Jackson, president of Permobil Americas. “Our consumers want to be able to live their lives and not worry about things like battery levels, actuators or mechanical issues.” With the app, users can view data on everything from battery charge and status level to travel distance and seat function. Service technicians already use the Permobil Connect platform to perform remote diagnostics, allowing them to potentially diagnose an issue before it even occurs.

Connecticut providers face steep cuts

HARTFORD – The Connecticut Department of Social Services has published a bulletin outlining its plans to reduce reimbursement rates for HME, supplies, O&P and complex rehab by 50% to 60% on April 1, according to the Home Medical Equipment and Services Association of New England. HOMES, in collaboration with AAHomecare and NCART, is planning a multi-pronged approach to fighting the cuts, first with a survey of providers in the state. The provider survey, which closed March 9, asks for information about their participation in the Medicaid program, how the cuts would affect the products and related services they provide, and what business/operational changes would be made. HOMES plans to keep individual results confidential but share combined results with state officials. The association says to “stay tuned” for other efforts to fight the cuts.

Texas providers beat back rate cuts

AUSTIN, Texas – Providers in Texas have staved off reimbursement cuts proposed by Superior HealthPlan, a managed care company that oversees part of the state’s Medicaid program.

Providers were notified in February that Superior was reducing rates for certain product categories from 85% of Texas Medicaid rates to 60%, with a few providers receiving a reduction of 65% to 70%, effective May 1. Providers were given 30 days to accept or reject the plan.

In response, VGM Group organized a conference call with providers, encouraging them to voice their concerns with Superior, the Texas Health and Human Services Commission and state lawmakers.

“Providers stepped up and answered the call for action by engaging with public officials to display their opposition to these egregious cuts,” said Collin Brecher of VGM Government Relations. “While states are looking to trim their budgets, these proposed cuts are going to continue to appear, and providers in all states must remain proactive by building relationships at the state level to prevent these types of harmful cuts from being implemented.”

In an online notification on Feb. 26, Superior stated it was suspending the reimbursement changes at this time.

“We will be working with the Texas Health and Human Services Commission (HHSC) to address DME costs as directed by the 85th Legislature in potentially a different type of provider based initiative at a later date,” it stated.

Superior has come under fire in recent months for its plan to contract with Medline to serve as the “preferred provider” of DME and supplies to Medicaid beneficiaries.

Medicare announces electronic initiative

WASHINGTON – CMS has announced a new initiative, MyHealthEData, to give patients control of their healthcare data. Under the initiative, patients would have access to their entire health record electronically and be able to share the data with whomever they want to make informed decisions about their care. CMS Administrator Seema Verma also announced the launch of Medicare’s Blue Button 2.0, which allows beneficiaries to access and share their health data and connect their claims data to secure applications, providers, services and research programs. Additionally, CMS plans to overhaul its Electronic Health Record Incentive Programs to refocus on interoperability, and to reduce the time and cost required of providers to comply with requirements.

NCART, UPitt launch CRT survey

PITTSBURGH – The University of Pittsburgh’s Department of Rehabilitation Science and Technology has partnered with NCART to survey complex rehab professionals. The online survey will assess the current industry and personnel landscape, and address future planning needs. “There is a big shift toward aging in place and keeping people out of hospitals or long-term care facilities,” said Mark Schmeler, associate professor at the UPitt and study co-investigator. “CRT and providers play a critical role in this shift alongside other healthcare professions. But we need to assess the current and future capacities of CRT professionals.” All ATP-certified supplier and manufacturer representatives are invited to complete the anonymous survey by April 15. Respondents will have the opportunity to enter a random drawing for one of 10 free unlimited access passes to the RSTCE library of CEU accredited webinars for one full year.

Sleep apnea grows in rural areas 

NEW YORK – Private insurance claims for sleep apnea increased by 911% between 2011 and 2014 in rural America, according to FAIR Health, a national, independent, nonprofit organization dedicated to bringing transparency to healthcare costs and health insurance information. Claims in urban areas increased by 839% and, nationally, claims for sleep apnea increased 850%, according to a press release. "Sleep apnea is a public health issue of increasing interest and concern," said FAIR Health President Robin Gelburd. "FAIR Health is ready to contribute its data resources and analytical capabilities to help researchers, policy makers and others address this issue."

Show organizers, exhibitors offer free passes
LAS VEGAS – Advance rates for the upcoming Medtrade Spring show are in effect until March 18, show organizers have announced. Advance rates are $100 for an expo pass and $249 for a conference pass. Expo passes are available for free, however, by contacting any Medtrade Spring exhibitor, show organizers say. Medtrade Spring is scheduled for March 27-29 at the Mandalay Bay Convention Center in Las Vegas. Register here