In brief: CRT bill heads to governor’s desk, Roche sues pharmacy network

 - 
Friday, March 22, 2019

NASHVILLE, Tenn. – The Tennessee State Legislature has enacted legislation to create a “separate benefit” category for complex rehab technology.

HB 647, which is headed to Gov. Bill Lee to sign, will ensure that CRT products receive separate consideration when state Medicaid authorities propose adjustments to reimbursement rates or other regulatory changes.

“CRT products are designed to meet the unique needs of individuals with disabilities and profound healthcare challenges, supporting positive health outcomes and providing the independence and self sufficiency that would otherwise be challenging or impossible,” said Bill Mixon, CEO of National Seating & Mobility, in a bulletin from AAHomecare. “Thanks to this legislation, the individuals and caregivers who depend on CRT can be assured that any budgetary or reimbursement changes covering these essential products will get the special deliberation they deserve.”

The legislation was affirmed by a 30-0 margin in the Senate; and a 94-0 vote in the House.

Six states have recognized CRT as a separate benefit and efforts are currently underway in in New York. Those efforts got a boost recently when AAHomecare retained Bridge Public Affairs to support efforts.

With a growing number of individuals served by Medicaid programs nationwide, it is increasingly important for the CRT community to work with state legislators and healthcare agencies to ensure sustainable reimbursement rates and sound regulatory policies,” remarked Tom Ryan, AAHomecare president & CEO. “We need to make sure that state policymakers everywhere understand that CRT improves quality of life and clinical outcomes for Medicaid patients, while also saving money by reducing costly hospitalizations, as well as lessening the need for nursing home care and other inpatient stays.”

Roche sues pharmacy network

NEW YORK – Roche Diagnostics has filed a lawsuit against the former executives of a Utah-based company, alleging nationwide fraud involving test strips.

According to the lawsuit, filed March 19 in United States District Court in New Jersey, Alliance Medical Holdings and its former officers and directors conspired to obtain Roche’s not-for-retail test strip brands meant for the mail-order market and dispense them to the retail market.

Alliance then allegedly billed the insurance companies for retail strips, exploiting the substantial difference between the wholesale list price and the retail reimbursement rate.

“Because of the significant differences in how retail strips and NFR strips are sold and paid for, it is crucial for fairness and functioning of the marketplace that the test strips be sold only within their intended channels,” the court filing states. “Diversion of NFR strips to retail channels not only deprives Roche of retail sales, it also causes an out-of-pocket loss on each vial of NFR strips that is paid for through a pharmacy benefit.”

The alleged fraud took place from 2011-2017, when Alliance Medical filed for bankruptcy protection, and caused Roche more than $87 million in damages, according to the court filing.

The lawsuit names the former CEO of Alliance, and more than a dozen other defendants, including former executives, a national banking association, and investment firms.

Roche has filed similar lawsuits in other states. In September, it sued Priority Healthcare Corporation, a network of pharmacies in Alabama, Mississippi and Arkansas, saying it paid $37.5 million in “unwarranted” rebates to insurance companies for claims where not-for-retail strips were billed as retail.

Study: US oxygen fatalities far outnumber those in England

LONDON – Home oxygen fatalities in the US are nearly twenty times than in England, according to new research from BPR, a medical gas specialist.

BPR used data from local health service organizations (clinical commissioning groups) in England to compare how many incidents and fatalities were recorded in that country between 2013 and 2017 to that same time period in the US.

Among the 73% of English CCGs that responded, one fatality and 63 non-fatal incidents were recorded. When the results are extrapolated to cover the full home oxygen patient population in England and Wales (81,000), the results would be 89 incidents and 1.4 deaths—a significantly lower rate than any previous study in the UK or elsewhere.

During the same five-year period in the US, the number of fatalities involving home oxygen fires was approximately 500, with an estimated 5,950 burn incidents recorded at emergency rooms. When adjusted to reflect the equivalent patient population in England, the number of deaths over five years is 27—almost twenty times more.

Since 2006 England and Wales have adopted a number of processes to improve home oxygen safety, including patient education and risk assessments. At the same time firebreaks, also known as thermal fuses or fire stop valves, which stop the flow of oxygen in the event of a fire in the tube, became mandatory across the entire home oxygen patient population.

“This study shows that adopting a program of best practice to tackle the issue of home oxygen fire safety, including the universal use of thermal fuses among all home oxygen patients, can have a dramatic impact on patient safety,” said Richard Radford, managing director at BPR Medical, in a press release.

Download the report.

NSM acquires Access Quip, LiveWell Medical

NASHVILLE, Tenn. – National Seating & Mobility has acquired Access Quip, a home accessibility company in Toledo, Ohio. Access Quip has specialized in home and commercial accessibility options for more than 15 years. Owners Chris Ray and Troy Nungester will stay on with NSM, according to a press release. NSM has also acquired LiveWell Medical Corporation with locations in Charlotte, N.C., and Greenville, S.C., bringing NSM’s total number of locations in the Carolinas to nine, according to a press release. LiveWell owner Scott Staley will stay on as branch manager of the Charlotte location. Earlier this week, NSM announced it has acquired Toledo, Ohio-based Access Quip.

VGM launches bid bond

WATERLOO, Iowa – VGM Insurance Services has developed a new Competitive Bid Bond for HME providers who plan to bid in the next round of the bid program. CMS requires all bidders to obtain bid surety bonds from an authorized surety in the amount of $50,000 for each area in which they submit a bid. “The DMEPOS competitive bidding program is expected to open as early as June 2019 so providers should begin their preparations now if they intend to consider placing a bid in one or more of the 130 competitive bid areas (CBAs),” said Mark Higley, vice president of regulatory affairs at VGM in a press release. “As in all previous rounds, VGM stands ready to assist in all facets of the program, including providing those impacted with education, tips and tools, as well as easily accessible surety bonds for those intending to participate before the bid window closes.” VGM Insurance has partnered with Lexon Insurance Company since 2009.

VirtuOx offers cardiac diagnostic service

SAN FRANCISCO – VirtuOx has launched CardioCHECK, a new way to diagnose patients with cardiac arrhythmias by using mobile cardiac telemetry in the patient’s home. The CardioCHECK program allow prescribers to order MCT at the same time as other VirtuOx services like overnight pulse oximetry for nocturnal hypoxemia or home sleep testing for obstructive sleep apnea, according to a press release. “Research has shown arrhythmias are common with patients who have comorbid conditions like sleep apnea and hypoxemia so now offering mobile cardiac telemetry was a natural progression for VirtuOx,” said Kyle Miko, founder and CMO in the release.

MK Battery supports power soccer

ANAHEIM, Calif. – MK Battery, a longtime supporter of the United States Power Soccer Association, is encouraging the HME industry to support this life-changing, adaptive sport program. “MK Battery is soon to enter its seventh year as the primary HME Industry sponsor of the United States Power Soccer Association and it continues to be a most fulfilling experience for our entire organization,” said Wayne Merdinger, president. “We’ve gotten to know many of the players and their families which has truly personalized our relationship with our ultimate mobility customers. “Seeing how our products, in concert with this amazing sport, have genuinely changed lives is something that resonates throughout our company, and knowing that our financial support helps make that possible is most gratifying.” Financial contributions help defray costs for the athletes and their families. At the local level, mobility providers can spread the word among their customers or sponsor local teams. For more information: Jim Labas, president, USPSA, jim.labas@powersoccerusa.org or visit www.powersoccerusa.org.

Sunrise puts learning in 'motion'

FRESNO, Calif. – Sunrise Medical has launched Education in Motion, a new integrated learning resource for clinicians to share industry insights, discuss new advancements in technology and share knowledge. The site is free to access and features downloadable resources, blogs, webinars and education and will be updated regularly.

One Drop partners with Amazon’s Choice brand

NEW YORK – One Drop, a provider of digital therapeutic solutions for people with diabetes, will partner with Choice, Amazon’s health brand, to bring digital health management solutions to Amazon Choice customers living with diabetes and hypertension. “Choice and One Drop have partnered to eliminate barriers to disease management by giving Choice customers access to holistic, hyper-personalized digital care through the One Drop platform," said Jeff Dachis, CEO and founder of One Drop in a release. Choice customers will have access to One Drop’s diabetes, blood pressure and weight management capabilities. Amazon launched its exclusive Choice brand, offering glucose and blood pressure monitors, in 2018.

Prochant launches metrics white paper

CHARLOTTE, N.C. – Prochant, a provider of HME billing and outsourcing services, has released a white paper, “Are You Tracking the Right Metrics?” to help providers track metrics that are critical to success. The paper suggests using industry-standard key performance indicators (KPIs) such as days sales outstanding, 90+ A/R, payment rate, and write-off rate allows providers to measure and track what is most relevant to their decision-making process. “The KPIs shared in our new white paper are critical to moving your company in the right direction because they offer a deeper understanding of your business and allow you to course-correct when you encounter red flags” says Joey Graham, executive vice president and general manager in a press release. “Over the past two decades, Prochant has tracked these KPIs as part of our front- and back-office billing processes to help providers become more profitable.” Download the free white paper.

New Option Care study shows benefit of clinical interventions

PHOENIX – Patients with short bowel system receiving parenteral nutrition can avoid hospital readmissions when clinical interventions are provided by a nutrition support team, according to a new study from Option Care. According to the study, SBS patients receiving home PN intravenously (IV), dehydration is a common cause of hospital readmission, with an average three-day length of stay. In the study, the nutrition support team—including a dietitian, nurse and pharmacist—made recommendations (interventions) to adjust the home PN volume based on the weekly monitoring of patients’ hydration status through reviewing laboratory values and conducting nutrition assessments.  “Every intervention decreases the likelihood of the patient being readmitted to the hospital and this study highlights the value of a nutrition team in providing clinical monitoring and nutrition support, which leads to improved patient care and significant cost savings.” The study is being presented at the American Society for Parenteral and Enteral Nutrition (ASPEN) 2019 Nutrition Science & Practice Conference.

Mass: Medicaid to audit providers

BOSTON – MassHealth, the Massachusetts Medicaid program, has begun auditing HME providers. The audits, which are being conducted by Optum and the MassHealth Office of Long Term Support and Services, are in response to an April 2017 report that found $206,000 in improper payments were made to suppliers on a variety of claims. MassHealth anticipates conducing two audits per month until all suppliers have been audited, according to a blog from the van Halem Group. Suppliers should expect to have 100 patient claims reviewed; and be able to produce appropriate licenses and employee records. Documentation not available at the time of the audit can be submitted at a later date.

MAMES seeks board members

STILLWATER, Minn. – MAMES is accepting nominations for its board of directors for three-year terms. The MAMES executive committee is looking to fill the following seats: Minnesota: 1 director; Missouri: 2 directors (1 seat open to fill ASAP); Nebraska: 1 director; South Dakota: 1 director; Wisconsin: 1 director; and associate board position: Associate director: 1 director. Interested applicants can apply here.

RAC to audit OTS knee orthotics

WASHINGTON – Performant Recovery, the Medicare RAC auditor, has been approved to add off-the-shelf knee orthoses (L1812, L1820, L1830, L1831, L1833, L1836, L1848, L1850, L1851 and L1852) to its audit list. The RAC will perform complex reviews to determine if the orthosis is reasonable and necessary based on documentation in the medical record. The RAC had previously added the codes to its proposed topics list, along with codes for glucose test strips (A4253). Those codes have not yet been approved for audit, according to a blog post from the van Halem Group.

AOPA and COPA to hold joint meeting

WASHINGTON – The American Orthotic & Prosthetic Association has partnered with the California Orthotic and Prosthetic Association to hold a combined annual meeting in 2019. AOPA is set to hold its 102 Annual National Assembly at the San Diego Convention Center in San Diego, Calif., Sept. 25-28.