In brief: CMS releases 2019 fee schedule adjustments, study finds oxygen patients worse off

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Friday, December 14, 2018

WASHINGTON – CMS’s 2019 fee schedule provides a “modest” 2.5% CPI-U increase to single payment amounts for DME in former competitive bidding areas, according to AAHomecare.

The fee schedule also provides a 2.5% increase to SPAs for diabetes supplies as part of the mail-order program.

It provides a 2.3% increase to current rates for DME not included in the bid program.

As previously determined, by a final rule, DME in rural/non-contiguous areas will be paid a 50/50 blended reimbursement rate.

“While adjustments to keep pace with inflation are certainly welcomed by home medical equipment suppliers, they do nothing to offset the deep reimbursement cuts produced by the bidding program over the last seven years,” said Tom Ryan, president and CEO of AAHomecare. “Even with the games for rural suppliers and reforms for future rounds of the bidding program achieved in 2018, this fee schedule update reminds us that we are a long way from a sustainable Medicare reimbursement environment.”

AAHomecare pointed out that this round of adjustments is the highest applied since the bid program took effect. Previous increases have averaged 1.3%, with a high of 2.1% in 2015.

The association has reached out to CMS for clarification on whether non-rural areas outside of the former bid areas will get the indirect benefit of the CPI increase in the former areas.

Oxygen patients are worse off, report finds

NEW YORK – A new report published in the December Annals of the American Thoracic Society highlights the problems many patients with lung disease experience in getting and using supplemental oxygen.

In “Optimizing Home Oxygen Therapy: An Official American Thoracic Society Workshop Report,” 26 physicians, nurses, RTs, patients and patient advocacy groups, oxygen suppliers, and CMS and FDA officials detail the shortcomings of the current system of providing supplemental oxygen to 1.5 million adults living in the United states.

“The panel was unanimous in its finding that delivery of home oxygen services has worsened since the onset of CMS’s competitive bidding program nearly a decade ago,” a press release states.

The workshop authors reviewed available scientific oxygen studies and the results of a 2017 survey of nearly 2,000 supplemental oxygen users conducted by the ATS Nursing Assembly.

They found:

·     Half of respondents reported problems with their oxygen;

·     70% of all respondents reported they had no more than four hours of portable oxygen, yet 81% reported they wanted more than five hours;

·     Patients who have been hospitalized or gone to the ER in the last year were more likely to report problems; and

·     Liquid oxygen is often not available in many parts of the country, especially in rural areas.

The report attributes some of the problems patients report to the “unintended consequences” of the bid program and cuts in reimbursement to DME providers. These cutbacks, the authors believe, may have contributed to increased complaints about unreliable equipment, inconvenient delivery schedules, poor communication between providers and patients, and fewer RTs to educate and test patients at home.

Among other findings:

·     Many healthcare providers who prescribe oxygen lack the knowledge to prescribe the best oxygen delivery services for their patients;

·     Patients with certain lung diseases and those with higher oxygen needs must have greater access to lightweight, higher flow liquid oxygen systems within the constraints of CMS reimbursement;

·     Innovative approaches to patient education, such as remote monitoring and telemedicine, would likely improve the current state of absent or fragmented communication and follow up; and

·     Research is also needed to better determine which patients will benefit from oxygen therapy and to devise a new generation of portable oxygen devices.

OIG to CMS: Collect Medicaid overpayments

WASHINGTON – CMS did not collect $1.6 billion in Medicaid overpayments in 77 current period audits and $188.6 million in seven prior period audits, according to a new report from the Office of Inspector General.

The OIG reviewed CMS’s efforts to collect overpayments identified in 313 audits in fiscal years 2010-15 (the current period) that recommended recovering overpayments totaling $2.7 billion and 10 audits in 2004-09 (the prior period) that recommended recovering overpayments totaling $225.6 million. For these 323 audits, the OIG chose only the overpayments that it had recommended for recovery and with which CMS had concurred, totaling $2.6 billion for the current period and $191.3 million for the prior period.

“CMS had not recovered all overpayments covered by this review because its policies and procedures did not include timelines for resolving overpayment when state agencies disagreed with the recommendations,” the OIG stated. “CMS did not ensure that states correctly reported Medicaid overpayments because it did not always verify that states followed its guidance.

The OIG continued: “CMS did not retail documentation to support that overpayments were recovered because its standard operating procedures included a retention period that was inconsistent with federal retention guidelines.”

The OIG recommends that CMS recover the remaining $1.6 billion due the federal government from the current period and $188.6 million due from the prior period, and improve the timeliness of recovering overpayments by setting guidelines about the time CMS has to work with states to obtain documentation and issue disallowance letters to States. It also recommends that CMS verify that states report overpayments correctly, require states to resubmit corrected CMS-64s when they do not, and continue to educate states about their responsibility to report overpayments correctly.

CMS concurred with the OIG’s recommendations and described actions that it has taken or plans to take to address the recommendations.

Rotech leverages MetTel to double patient outreach

NEW YORK and ORLANDO, Fla. – MetTel and Rotech Healthcare have deployed more than 700 customized Samsung tablets to field technicians, eliminating manual log sheets and generating increased scheduling efficiency and productivity, the two companies have announced. The techs also have the ability to be more flexible in adjusting their schedules based on new patient or delivery data. “Prior to our engagement with MetTel, we faced a number of challenges: paper-based processes, problematic legacy systems, inefficient back-end operations, lack of interoperability and delayed payments,” said CIO Mesha Sookdeo. “Now we are in the process of digitally transforming all aspects of our front-end and back-office operations, which has served as a force multiplier for our business. We have been able to more than double the patients we see each day.” Rotech is in the process of digitally standardizing processes across the board and integrating security measures to protect patient data. MetTel is a provider of integrated digital communications solutions for enterprise customers.

Highmark prioritizes home infusion

PITTSBURGH – Highmark will increase the ability of their members to receive home infusion starting Jan. 1. As part of a new site of care program from the health insurer’s pharmacy team, members will be able to receive infusion therapies in their home, doctor’s office or at an infusion site, pending a prior authorization process, instead of in a hospital outpatient setting. “By receiving infusion therapies at other sites, members can reduce transportation times, see more flexibility in their schedules and receive their treatment in a more comfortable and private environment,” said Sarah Marche, vice president, Pharmacy Services. “However, if a hospital setting is the appropriate option, a member’s care will continue to be covered and uninterrupted.” Initially, the change will be applicable to fully insured commercial members in all regions of Highmark’s core insurance markets, including Pennsylvania, West Virginia and Delaware, and national customers. Members taking advantage of alternative sites of care will be able to choose from a vast network of home infusion therapy providers.

SoClean expands international reach

PETERBOROUGH, N.H. – SoClean is bringing its automated CPAP cleaner and sanitizer directly to consumers in key international markets, it announced Dec. 11. In 2018, the company expanded to Canada and the United Kingdom, and soon it will expand to France, Germany, Italy, Spain, Japan and Australia. “As SoClean has grown in the U.S. market, we’re in the perfect position to expand globally,” said CEO Robert Wilkins. “By doing so, we want to change lives around the world and help educate CPAP patients on the benefits of our sanitizing solution.” SoClean’s device uses natural ozone technology to kill 99.9% of germs and bacteria that can be found in CPAP equipment, including the mask, hose and reservoir, the company says.

InfuCare Rx makes buy

ASTON, Pa. – InfuCare Rx has acquired Factor One Source Fast Pharmacy, a specialty pharmacy focused on conditions related to hemophilia, rheumatology, dermatology, immunoglobulin therapy and gastroenterology. The Cumberland, Md.-based Factor One, with branch locations in Louisiana and Texas, can serve all 50 states, according to a press release. The deal is in line with InfuCare’s plans to integrate and expand its services, said Deven Patel, InfuCare CEO. “This acquisition drives significant operating synergies and enables us to maximize our clinical focus and expand our market reach nationally," he said. Factor One will operate as a wholly owned subsidiary of InfuCare. Paragon Ventures acted as an advisor to Factor One.

Numotion rolls out app

BRENTWOOD, Tenn. – Numotion has launched the myNumotion app to improve information transparency with its customers. Available on desktop and mobile, the app provides personalized information about a customer’s equipment, order status, invoices, appointments and service requests, and offers a live chat feature. A myOrders feature on each individual’s home page provides a visual that makes it easy to follow where their order is in the process. “We wanted to keep everything about the myNumotion app simple and intuitive so that no matter if a customer was using it from a mobile device or their computer, it would be a consistent experience,” said Dan Prestegaard, CIO. The app currently has more than 4,400 registered users in 27 states. It will be fully deployed by the end of January 2019.

BOC names Jim Newberry recipient

OWINGS MILLS, Md. – BOC has named James Hewlett, BOCO, as the 2018 recipient of the Jim Newberry Award for Extraordinary Service. A past member, secretary, vice chairman and chairman of BOC’s board of directors, Hewlett played a key role in developing BOC’s original accreditation standards and worked as a subject matter expert for certification exam development. In 2009, he founded Consultants PRN and continues to work as an author, educator and consultant for HIPAA compliance, ethics and billing. “Like Jim Newberry, Jim Hewlett has and continues to work tirelessly in support of BOC, its programs, certificants and stakeholders,” said Harry “J.R.” Brandt, BOCO, CO, LO, the inaugural Newberry Award recipient. “He is always making himself available to assist in any capacity needed.” Hewlett was nominated by Newberry’s widow, Lynn.

VGM objects to bid program including vents, orthoses

WATERLOO, Iowa – With the complex care required for vent patients and with few suppliers serving the market, it’s best to keep the product category out of Medicare’s competitive bidding program, VGM says. In recently submitted comments to CMS, the company pointed out that: Vent patients are highly vulnerable and require care from highly skilled RTs, and can’t be subject to delays in care or access issues. It also pointed out that the market for vents is small and niche, with fewer than 400 providers. On orthoses, VGM acknowledged the increase in utilization for off-the-shelf knee and back braces, but drew a distinction between the mail-order suppliers that it says are driving much of that increase and certified practitioners. “We don’t believe it is in the best interest of the beneficiary to competitively bid these products to reduce over utilization,” it stated. “Orthoses, if not properly fitted, have the potential to have lasting negative effects.” The deadline for commenting on CMS’s proposals to include vents and orthoses in the next round of bidding is Dec. 17. Send comments to DMEPOS@cms.hhs.gov.

Solara makes third buy, adds to nat’l network

CHULA VISTA, Calif. – Solara Medical Supplies, a provider of diabetic devices, has acquired Pal-Med, a provider of insulin pumps and testing strips in South Carolina. It’s the third acquisition for Solara following its investment from Linden Capital Partners in May. Jennie Jordan, vice president of Pal-Med, will remain with Solara. “We are proud of our commitment to our patients and are excited to enhance our offering by joining Solara,” she said. Pal-Med was founded by Harold Jordan in 1994. Earlier this month, Solara acquired Huey’s Home Medical in Illinois…Solara has also added Sun Health, a community nonprofit, to its national network of diabetes prevention program (DDP) providers. Based in the metro Phoenix area, Sun Health offers a variety of wellness services, philanthropy and senior living programs. As of April 1, 2018, Medicare began paying qualified providers to deliver the Medicare Diabetes Prevention Program (MDPP), an evidence-based set of services aimed at preventing Type 2 diabetes through a year-long program. “With five locations across the greater-Phoenix area, we can impact more than a thousand local residents each year through the DPP classes we offer,” said Jennifer Drago, executive vice president of population health for Sun Health.

Short takes: AeroCare, ResMed

Orlando, Fla.-based AeroCare, a private equity backed provider of home respiratory therapy products and services, is gearing up for a sale process, according to Buyouts Insider. Triple Tree has been engaged to advise the provider, Buyouts reports, citing three sources. AeroCare, led by former Rotech president Steve Griggs, has been a major consolidator in the HME industry since forming in 2003…San Diego-based ResMed has been named one of America’s top 100 corporate citizens for the third straight year by Forbes and JUST Capital, a nonprofit that analyzes and ranks companies based on how they serve the priorities of the American people. ResMed ranked No. 18 out of 890 large publicly traded companies and No. 1 out of 32 “health care equipment & services” companies. Companies were compared on issues like worker compensation and wellbeing, customer treatment, product and environmental impact, community support and job creation.

Short takes from AAH: Ventec, Williard, supplier numbers

AAHomecare has a new corporate partner: Ventec Life Systems. The company, which makes the multi-function ventilator VOCSN, has joined the association to help advocate for respiratory suppliers and patients, with a particular interest in ensuring Medicare doesn’t include vents in the next round of competitive bidding. “Competitive bidding reimbursement rates limit access to innovative technology for the sickest patients in home care,” said Chris Kiple, president and COO of Ventec. “Without access to new technology, the divide between care available in the hospital and the home will only grow larger. Over the long term, this will result in increased hospital visits and unexpected costs as homecare patients are denied access to new care changing solutions.” CMS is accepting comments on its proposal to include vents in the bid program until Dec. 17. Email comments to DMEPOS@cms.hhs.gov…Laura Williard, AAHomecare’s vice president of payer relations, has been appointed to the board of directors for both the Pennsylvania Association of Medical Suppliers (PAMS) and the South Carolina Medical Equipment Services Association (SCMESA). “Both PAMS and SCMESA are working to develop strong relationships with Medicaid authorities and other payers in their states, and making sure policymakers understand the critical role that HME plays in controlling overall costs and delivering good clinical outcomes for their constituents,” she said. “It’s great to be working more closely with these groups to defend HME interests in Pennsylvania and South Carolina”…The number of unique traditional DMEPOS suppliers and traditional DMEPOS locations decreased 1% in the most recent quarter, according to an analysis by AAHomecare. As of October 2018, there are 6,385 unique traditional DMEPOS suppliers and 9,445 traditional DMEPOS locations. Since the inception of Medicare’s competitive bidding program, however, those numbers represent 35% and 33% decreases, respectively.

Beat SmartSaver deadline for Medtrade Spring

LAS VEGAS – SmartSaver Conference Passes for Medtrade Spring, April 16-18 at the Mandalay Bay Convention Center in Las Vegas, expire on Dec. 22. The passes are $99 and allow full access to educational sessions and the expo hall. SmartSaver Expo Passes are $25 and allow full access to the expo hall. “For those who already know they are going to Medtrade Spring, these are the rates to grab,” said Sarah Varner, marketing director. “The conference pass offers a $100 savings over Early Rates and an expo pass saves $25.”