In brief: Scooter Store layoffs, Price reception

NEW BRAUNFELS, Texas - It's going from bad to worse at The Scooter Store, which plans to lay off 220 employees, according to San Antonio Express-News. The layoffs, which will occur across all divisions, represent less than 10% of the company's workforce, according to the newspaper. Company spokesman Tim Zipp blamed the layoffs on reimbursement reductions; changes in claims-processing procedures; and a drop in unit sales. Founder and CEO Doug Harrison resigned in March, followed by several other top-level executives. New CEO Marty Landon, formerly of Kinetic Concepts, has been leading the company since July. Industry watchers have speculated that many of the changes may have to do with Sun Capital Partners, which invested $25 million in The Scooter Store in 2011.

AAHomecare pushes strategic plan

WASHINGTON - The AAHomecare board of directors met recently to review progress and advance a long-term strategic plan. The association is focused on gaining broad acceptance for the value of home medical equipment; fostering effective communication with Congress, CMS, patients, private payers and other stakeholders; and offering consultative services directly or in conjunction with an outside network of experts. AAHomecare's medical supplies council formed two working groups—an ostomy group and a fistula group—to address policies in these areas. The council is also monitoring implementation of accountable care organizations (ACOs) and changes to reimbursements in state Medicaid programs.

Rep. Tom Price to attend Medtrade

WATERLOO, Iowa - Rep. Tom Price, R-Ga., who has introduced a bill to replace competitive bidding with the market-pricing program (MPP), will attend an Oct. 16 reception at Medtrade, co-hosted by Van G. Miller, VGM CEO; Cara Bachenheimer, senior vice president of government relations for Invacare; and Philip Stoudenmire, president of the Georgia Association of Medical Equipment Services. Price, a physician, is a member of the House Ways and Means and Budget committees, and chairman of the House Republican Policy Committee. The reception for Price is scheduled from 10 a.m. to 11 a.m. in Room B 213 of the Georgia World Congress Center and costs $250 per person. To RSVP or make a donation: Diana Kincaid at 770-435-5725.

Medicare Advantage enrollment projected to increase

WASHINGTON - Enrollment in the Medicare Advantage program is projected to increase by 11% in the next year, according to an announcement today from Kathleen Sebelius, Health and Human Services Secretary. Since the Affordable Care Act was passed in 2010, premiums have fallen by 10% and enrollment has increased by 28%. “Thanks to the Affordable Care Act, the Medicare Advantage and Prescription Drug programs have been strengthened and continue to improve for beneficiaries,” Sebelius stated. “Since the law was enacted in 2010, average premiums have gone down, enrollment has gone up, and new benefits and lower drug costs continue to help millions of seniors and people with disabilities.”

The obesity numbers are in—and up

PRINCETON, N.J. - An annual report suggests that by 2030, more than half of Americans could be obese, a scenario that could push an already strapped healthcare system into deeper crisis.  The report, “F as in Fat: How Obesity Threatens America's Future," was released Sept. 18 by The Trust for America's Health and the Robert Wood Johnson Foundation. Rising obesity rates could cause a spike in diseases, including coronary heart disease, stroke, hypertension, Type 2 diabetes and arthritis, according to the report. The cost of treating these obesity-related diseases is estimated to increase from $18 billion per year in 2011 to $66 billion per year by 2030. FMI: http://www.rwjf.org/en/about-rwjf/newsroom/newsroom-content/2012/09/new-report-finds-adult-obesity-rates-could-exceed-60-percent-in-13-states-by-2030.html

Medicare pays out billions for 'upcoding'

WASHINGTON - Doctors and other medical professionals have added $11 billion or more to fees for Medicare beneficiaries over the last decade through “upcoding,” according to a new report from the Center for Public Integrity. Upcoding is the practice of charging for more costly services than are actually delivered. The report found that, between 2001 and 2010, doctors billed Medicare for longer, more complex office visits despite little hard evidence that patients required more complicated and time-consuming care. The investigation also found that more than 7,500 physicians billed the two top paying codes for three out of four office visits in 2008, and that “the most lucrative codes are billed two to three times more often in some cities than in others." FMI: http://www.publicintegrity.org/2012/09/15/10810/how-doctors-and-hospitals-have-collected-billions-questionable-medicare-fees

Audits overwhelm pharmacists

ALEXANDRIA, Va. - Audits are hammering community pharmacists and that puts patient access at risk, according to a new survey. The National Community Pharmacists Association (NCPA) asked more than 350 community pharmacists about their experiences with audits conducted by pharmacy benefit managers (PBMs) and other Medicare Part D intermediaries. The survey found: 96% of pharmacists stated that a typical PBM contract has minimal or no transparency on how generic pricing is determined or what the reimbursement rate will be; almost 50% of respondents stated that more than 10% of the time, PBMs set maximum allowable costs reimbursement for generics below the pharmacy's cost just to acquire the drug, much less dispensing and overhead costs; and about 76% say audit requirements across Medicare Part D plans are inconsistent.

Coding deadline bumped

WASHINGTON - The new effective deadline for DMEPOS products listed on the PDAC website with HCPCS code K0009 has been changed to Feb. 28, 2013. It was previously listed as Sept. 30, 2012. Manufacturers will still be required to submit a new coding verification application to the PDAC for review and assignment of the correct code for products currently coded as K0009. Products which have not received coding verification review from the PDAC must be billed with code A9270.

Short takes: Invacare, Lehan Drugs

Invacare sponsored the National Veterans Summer Sports Clinic, which took place Sept. 16-21 in San Diego...Tim and Ann Lehan, pharmacists and owners of Lehan Drugs in Dekalb, Ill., have been named the 2012 Illinois Retailers of the Year by the Illinois Retail Merchants Association.