In brief: Access survey slams bid program, CMS withdraws O&P rule

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Friday, October 13, 2017

WASHINGTON – More than 60% of case managers report an increase in the number of Medicare beneficiaries who have developed medical complications, received emergency care or were readmitted to a hospital due to issues related to obtaining proper and/or timely access to DME, according to a final report from Dobson DaVanzo & Associates.

“(The competitive bidding program has) negatively affected beneficiaries’ access to DME services and supplies, adversely impacted case managers’ ability to coordinate DME for patients, and placed an additional strain on suppliers to deliver quality products without delay,” states the report, completed in conjunction with AAHomecare. “If timely adjustments are not made, there is little doubt the beneficiaries, case managers and suppliers will continue to face adverse outcomes, particularly in rural areas.”

The report, “Access to Home Medical Equipment: Survey of Beneficiary, Case Manager and Supplier Experiences,” was based on a survey of more than 1,000 beneficiaries, case managers/discharge planners and HME providers.

Other findings from the report:

·      74.3% of beneficiaries report a discontinuity or disruption in their ability to receive oxygen and supplies since July 1, 2016, when a second wave of reimbursement cuts went into effect in non-bid areas as part of a national rollout of the program.

·      75.2% of case managers report issues accessing and coordinating oxygen therapy for their patients.

·      85% of suppliers report beneficiaries have privately purchased DME and supplies, opting not to use their Medicare benefits to file claim.

“This report empirically validates the problems we have been experiencing with the competitive bidding program for the past several years,” said Steve Ackerman, chairman of AAHomecare’s board of directors, and president of Spectrum Medical. “The eager response to the survey from beneficiaries and discharge planners shows that these are problems adversely affecting the entire homecare community.”

AAHomecare had already shared preliminary findings from the survey with staff at Health and Human Services, CMS and the Office of Management and Budget.

CMS rescinds proposed orthotics rule

WASHINGTON – CMS has announced it is withdrawing a proposed rule that would have required any practitioner or supplier who provides custom orthotics to be licensed in states where it is required.

The rule, released in January, was strongly opposed by physicians, physical therapists and occupational therapists. The rule has actually been a law since 2000, but it has never been fully implemented.

CMS said it was withdrawing the rule due to “the cost and time burdens that the proposed rule would create for many providers and suppliers, particularly the cost and burden for those providers and suppliers that are small businesses.”

The Trump administration has pledged to reduce regulatory burdens on businesses.

Industry associations like the American Orthotic and Prosthetic Association and the National Association for the Advancement of Orthotics and Prosthetics, however, supported the rule.

“AOPA is disappointed that CMS decided to withdraw the proposed rule that would finally create regulations to implement a law that was passed more than 17 years ago,” the association said in a press release. “The withdrawal of the proposed rule once again exposes the Medicare population to no regulation regarding what qualifications are required to provide custom orthotic and prosthetic services.”

In May, Sen. Chuck Grassley R-Iowa, and Reps. Glenn “GT” Thompson, R-Pa., and Mike Thompson, D-Calif., introduced The Medicare Orthotics and Prosthetics Improvement Act of 2017 in both the Senate and House that calls on CMS to enforce a law that O&P providers be certified to receive payments under Medicare. Similar bills have been introduced in previous sessions of Congress.

Permobil expands seating, positioning portfolio

LEBANON, Tenn. – Permobil continues to consolidate the seating and positioning market with its acquisition of Comfort Company.

The Bozeman, Mont.-based Comfort Company manufactures seating and postural support systems for customers with a wide range of rehabilitation needs. It joins the ROHO Group, a Belleville, Ill.-based manufacturer of seating and positioning systems, under the Permobil umbrella.

“Following the purchase of ROHO in 2015, the acquisition of Comfort Company further strengthens Permobil’s position within both the complex rehab and long-term care markets,” said Tom Borcherding, president of Permobil seating and positioning systems. “We see tremendous synergies with the addition of Comfort Company’s portfolio together with ROHO’s solutions.”

Comfort Company manufactures from a facility in New Berlin, Wis., and has more than 200 employees.

Eric Murphy, president of Comfort Company, says Permobil is a good fit, because it shares its vision of providing a high level of quality and service.

“Comfort Company has always had a strong focus and passion for the customer across the pediatric, geriatric and bariatric segments,” he said.

Permobil is on a buying spree as of late: It announced earlier in October that it was taking over operations of TiLite New Zealand and earlier this year that it had acquired Durable Medical Equipment Ltd.

Provider Gary Sheehan named Homecare Champion

ATLANTA – HME Provider Gary Sheehan has been named the 2017 Van Miller Homecare Champion, AAHomecare announced this week.

The award, which will be presented at the Stand Up for Homecare reception on Oct. 24 during Medtrade, recognizes AAHomecare members for outstanding service in the HME industry.

Sheehan, CEO of the 40-year-old Sandwich, Mass.-based Cape Medical Supply, has advocated for HME at both the state and regional level, building strong relationships throughout New England, as well as Capitol Hill.

Sheehan has also served in several leadership roles with the Home Medical Equipment and Services Association of New England and has presented at numerous conferences and conventions.

Missy Cross was the recipient of the inaugural award, created in 2016 when AAHomecare renamed its Homecare Champion Award to honor The VGM Group’s Van G. Miller, who died unexpectedly in 2015.

ALJ wait time nears three years

WASHINGTON – The average wait time to get a hearing before an Administrative Law Judge is 1,082 days, a 41-day increase from earlier this year and a 205-day increase since last year, according to AAHomecare. The overturn rate at the ALJ is 28.3%. The Office of Medicare Hearings and Appeals recently said it will no longer publish detailed workload information showing the breakdown of the number and type of appeals at the ALJ; however, it has offered to share DMEPOS-specific data with AAHomecare.

Hargan named acting secretary at HHS

WASHINGTON – President Donald Trump has named Eric Hargan as acting secretary for the Department of Health and Human Services. Last week, Hargan was confirmed 57-38 to fill the No. 2 position at HHS. Hargan will fill the post vacated by Tom Price, who resigned in the wake of criticism of his frequent use of costly charter flights to travel to government engagements. Hargan, a former attorney, served at HHS during the Bush administration in various roles, including deputy general counsel, principal associate deputy secretary and acting deputy secretary. He was also was part of Trump’s HHS transition team.

MED partners with HealthCall

LUBBOCK, Texas – The MED Group, a Managed Health Care Associates company, has formed a strategic partnership with HealthCall, a Crown Point, Ind.-based medical communications company and the first provider of patented Automated Patient Response solutions. With the partnership in place, MED’s Clinical Pathways Program, or MCPP, will now provide access to the HealthCall technology platform, enabling its members to deliver a continuum of care through services and software for use in post-discharge and chronic care management, as well as automated patient response. "We believe The MED Group and HealthCall's partnership realizes a new and exciting chronic care opportunity,” said Ed Izbicki, Jr., senior vice president, Alternate Site Division, MHA.“By closing a vital gap in the transition of patients from hospital to home, the partnership enables MED members to provide optimum patient care, and stay competitive.”

Lawsuit charges Cigna with applying excessive co-pays

BLOOMFIELD, Conn. – Cigna allegedly developed and directed a fraudulent billing scheme that required benefit managers like CareCentrix to charge patients excessive co-pays, co-insurance or deductible payments for home care, according to a lawsuit filed in federal court in Connecticut on Oct. 6. The lawsuit was filed by a plan participant who alleges he paid almost 350% more than he should have for a disposable filter to treat sleep apnea, Bloomberg reports. The participant bought the filter from an authorized CareCentrix provider and was charged a $25.68 deductible, despite a contract to provide the filter for $7.50, according to Bloomberg. The difference—$18.18—was allegedly pocketed by Cigna, Bloomberg reports. The lawsuit charges Cigna with violating the contract and the Racketeering Influenced and Corrupt Organizations Act, as well as breaching its fiduciary duties under the Employee Retirement Income Security Act. The patient seeks class treatment for thousands of other patients across the country.

Bill seeks to strengthen protections for diabetes patients

WASHINGTON – Sens. Mark Warner, D-Va., and Tim Scott, R-S.C., have introduced a bill to strengthen the patient protections that are part of Medicare’s national mail-order program for diabetes testing supplies. The bill, the “Diabetes Supplies Act of 2017,” would reinforce existing protections that ensure beneficiaries are able to continue accessing familiar supplies through the program. It would also establish new surveillance programs and requirements for mail-order suppliers to better guard consumer access. “We want to ensure seniors can access the life-saving supplies and technologies that work best for them,” Warner said. “This will allow Medicare to continue employing innovative, cost-saving payment models, while also guaranteeing patients’ access to necessary medical supplies.” The bill is in response to reports that a “50 Percent Rule” requiring suppliers to make available at least 50% of all types of diabetes supplies has been inadequate in protecting beneficiary choice.

NSM reaches statewide service in Texas

NASHVILLE – National Seating & Mobility has expanded its presence in West Texas with its acquisition of Mobility Unlimited. NSM will assume operations of Mobility Unlimited’s locations in Midland and Abilene, rounding out its statewide service in Texas. “This acquisition positions NSM to serve clients across Texas,” said Bill Mixon, CEO. Three ATPs (Bill Cavender, Steven Neie and Korey Davis), one RTS and a general manager (James Leddy) will transition to the NSM team to serve clients from these branches. NSM also has locations in San Antonio, Austin, Dallas, Houston, Beaumont and McAllen.

German court sides with ResMed

SAN DIEGO – ResMed says that a Munich District Court has decided that its AirSense 10 and AirCurve 10 CPAP devices and its Lumis ventilators, along with their humidifiers, do not infringe a Fisher & Paykel short-term patent, StreetInsider reports. Despite the decision, ResMed plans to continue its challenge of the validity of F&P’s patent before the German Patent and Trademark Office. ResMed says, to date, no court has found that its products infringe F&P patents in any of the three cases brought by F&P against ResMed in Germany. ResMed says the same German court in September, however, found that F&P’s Simplus, Eson and Eson 2 masks infringe ResMed patents. The court also stayed proceedings, pending the outcome of invalidation proceedings. ResMed says it is now defending its own patents in the European Patent Office.

Convaid sponsors documentary

TORRANCE, Calif. – Convaid R82 is the official sponsor of “Roll With Me,” a documentary that premiers this weekend at the 18th annual Woodstock Film Festival. The film tracks Gabriel Cordell’s 3,100-mile journey across 13 states in 100 days in an unmodified wheelchair. It was chosen for the festival from more than 2,000 entrants from around the globe.

Vendor short takes: Golden Technologies, Mediware

Old Forge, Pa.-based Golden Technologies has launched a new scooter accessory: a battery docking station. The station is portable and charges the interlocking U1 batteries of the Buzzaround EX scooter models. The company says the station offers a convenient way of keeping a set of charged batteries on-hand, particularly when visiting family and friends, or when vacationing…Lenexa, Kan.-based Mediware Information Systems has signed on CSI Pharmacy for its CareTend cloud-based software. The national specialty and home infusion pharmacy believes the software will help take it to the next level. “We chose the cloud-based version of CareTend due to improved access at multiple locations and for team members who work remotely,” said James Sheets, CSI Pharmacy CEO. “We also felt it offered an advantage to our nurses in the field for following care plans and improving documentation and, ultimately, patient outcomes.”