In brief: CMS releases new new fee schedule, study assesses impact on rural areas

Friday, December 11, 2015

WASHINGTON – After finding several errors in its revised 2016 DMEPOS fee schedule, CMS last week posted an updated version to its website.

The fee schedule maps out adjusted payment amounts for 11 product categories as part of the national roll out of competitive bid pricing on Jan. 1.

The first version of the revised fee schedule was released on Nov. 23.

CMS has developed payment amounts for non-bid areas by using the average pricing in the competitive bidding areas in the region for regional areas, and the national weighted average plus 10% for rural areas.

The agency plans to phase-in the new pricing over six months. Starting Jan. 1, pricing will be based on a 50/50 blend of the current and adjusted payment amounts. On July 1, it will be based only on the adjusted amounts.

AAHomecare says it’s currently reviewing the updated fee schedule and will inform members of any major changes. 

Rural residents will have to travel dozens of miles for HME

WATERLOO, Iowa – Residents in rural states will have to travel further to reach an HME provider when Medicare applies competitive bid pricing nationwide on Jan. 1, according to a new study.

Residents living in rural areas in Montana, North Dakota, Oregon, Washington state, West Virginia and Wisconsin will all be affected by the change, according to the study from the GeoTree Center at the University of Northern Iowa in Cedar Falls.

In North Dakota, for example, residents in rural areas will have to travel 53 miles to access an HME provider. The study estimates there will be 6,171 square miles per provider in the state.

“HME suppliers in rural areas contend with different business challenges, such as the cost of delivery and smaller patient volume, that are not accounted for in this across-the-board cut,” said John Gallagher, vice president-government relations for VGM, in a release. “Businesses will be put in dire situations, forcing coverage reduction or even closures. Naturally, when there are fewer providers, patient access suffers, hospital discharges are delayed, which costs the government more money.”

The study, commissioned by The VGM Group, is a continuation of an earlier study published in August that showed similar results for five other rural states.

Since Medicare launched competitive bidding, there has been a 17% decrease in the number of providers throughout the U.S., according to VGM.

Stakeholders are trying to stave off the expansion of bid pricing to rural areas with bills in both the House of Representatives and Senate.

Sleep therapy devices lead in remote monitoring, study says

GOTHENBURG, Sweden – Remote monitoring of patients with cardiac rhythm management devices and sleep therapy devices accounted for 81% of all connected home medical monitoring systems in 2015, according to a new study from Berg Insight. Additionally, sleep therapy devices accounted for the majority of the market growth in 2015, the report states. “ResMed was especially successful with its new Air Solutions family of sleep therapy devices that includes a cellular M2M module as standard and is supported by a range of health informatics software that enables healthcare organizations to provide better care more efficiently,” the report states. ResMed has surpassed Medtronic as the world’s largest provider of connected healthcare solutions for remote patient monitoring in 2015, according to the report. Overall, the number of remotely monitored patients grew by 51% to 4.9 million in 2015 as the market entered a growth phase fuelled by rising acceptance in key vertical markets, the report states.

CareCentrix, Fallon extend contract

HARTFORD, Conn. ¬– CareCentrix and Fallon Community Health Plan have extended a contract that gives Fallon’s membership continued access to diagnostic testing and therapy adherence programs for sleep-related disorders like obstructive sleep apnea. Since 2009, Fallon and CareCentrix subsidiary Sleep Management Solutions have helped more than 11,000 patients receive testing and therapy in the comfort of their own homes. “In-home sleep tests, coordinated by SMS, typically represent an over 50% cost-savings as compared to a hospital or physician-run sleep clinic,” stated Thomas Gaffney, CareCentrix’s chief customer officer, in a press release. The SMS program helps members get started on the right sleep therapy and then supports their progress by remotely monitoring data from their devices to ensure the therapy is working and to intervene when they’re experiencing difficultly. “Working with SMS has enabled us to offer our members with sleep disorders more choices, so that they can receive the quality, cost-effective care they need in the comfort of their home,” stated Patrick Hughes, Fallon’s president and CEO. CareCentrix and Fallon Health have extended their contract for three years.

Harbour Group buys SP Industries

ST. LOUIS – Harbour Group has acquired SP Industries, which, in 2014, bought Bel-Art Products, the parent company of Maddak. Warminster, Pa.-based SP Industries designs and manufactures scientific equipment, biological drug manufacturing solutions and precision labware. It has been part of Graham Partners’ portfolio since March 2011. "SP's brand strength, breadth of product and in-house manufacturing capabilities fit very well with our experience in the manufactured products sector," said Jeff Fox, chairman and CEO of Harbour. "We will accelerate their investment in new product development, geographical expansion and complementary acquisitions, as we have done with our companies for the last 40 years.” Terms of the deal were not disclosed. 

OMHA publishes updated manual

WASHINGTON — The Office of Medicare Hearings and Appeals (OMHA) has made several changes to its Case Processing Manual, according to a notice posted in the Federal Register. The updated manual now includes several new chapters, including: Chapter 4 – Parties to an ALJ Hearing; Chapter 5 – Roles and Responsibilities of Parties to an ALJ Hearing; and Chapter 6 – Contractor Roles to an ALJ Hearing. OMHA is asking providers to review the requirements to represent a beneficiary in an ALJ hearing and the roles of providers as representatives, as well as the limitations on DME MACs and QIC participation.  

Convaid throws support behind complex rehab bills

TORRANCE, Calif. – Convaid Products has endorsed S. 2196, a bill introduced in October that would prevent CMS from applying competitive bid pricing to accessories for complex rehab wheelchairs. The bill is a companion to H.R. 3229, which was introduced in July. "Convaid has been advocating both bills on an ad hoc basis throughout the year, however, with only a few weeks left to make a difference, we felt it was critical to yield as much visible support to both bills that are critical to the special needs community we serve," said Convaid CEO Chris Braun. The bills have 11 and 74 co-sponsors, respectively.

Alaska seeks to cover reused DME

ANCHORAGE, Alaska – The Alaska Department of Health and Social Services and the state legislature want to amend Medicaid regulations to allow reimbursement for reused durable medical equipment, according to a local newspaper article. The reimbursement would be lower than that for new equipment but the equipment would have to meet the same standards for use and have no defects. “(This is) part of bringing the cost down of Medicaid,” said Sen. Peter Micciche, who plans to include the bill on the agenda for the upcoming January session. “Before, in our state, you couldn’t reuse durable medical equipment. If you had a very high-priced wheelchair and the person didn’t need it anymore, they would have to purchase a new one for that client.” A House version of the bill passed in May.

Griffin Home Health goes state-of-the-art

CHARLOTTE – Griffin Home Health Care is relocating to a new state-of-the-art showroom in the Greylyn Office Park, four miles from its current location. The provider’s office and warehouse will also be located there. “(The new location) will provide support for all branch locations to better serve patients and customers,” Griffin Home Health stated in a press release. A full-line provider of HME founded in 1983, Griffin Home Health serves the 16-county region in and around the Charlotte metro area. It also has a location in Gastonia.

Short takes: Lincare, Golden Technologies, Medtrade, AOPA

Lincare is once again a member of AAHomecare after failing to renew its membership in 2008…Golden Technologies has named Carrie Ernest as its new marketing manager. Previously, she worked in communications for several high-level government agencies, including Veterans Affairs, where she worked as the director of communications for the Wounded Warrior Project…Medtrade Spring attendees who register by midnight on Friday, Dec. 18, can save up to $75 on the expo, and more than $200 on a conference pass. The conference is slated for Feb 29-March 2, at the Mandalay Bay Convention Center in Las Vegas…The American Orthotic & Prosthetic Association has named Jeff Lewis of Mesa, Ariz., the winner of the Mobility Saves Testimonial Contest. Lewis won the grand prize of $500 for his video describing his active life as a quadruple amputee.