In brief: Tricare will make payment adjustments; Hospital HME, DASCO form partnership

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Friday, July 14, 2017

WASHINGTON – Tricare, the healthcare program for uniformed services members and their families, will also adjust payments from June through December 2016 per a provision in the 21st Century Cures Act, according to AAHomecare.

The provision in the Cures Act requires Medicare to retroactively delay a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017, allowing providers to recoup a portion of six months worth of payments.

In a letter responding to HME providers who inquired about whether Tricare, which bases its payments on Medicare’s payments, would also make adjustments, Tricare stated: “You are correct TRICARE uses Medicare’s DMEPOS fee schedule, Medicare reduced their rates in the second half of 2016, and a subsequent resolution (the 21st Century Cures Act) delayed that reduction, and retained the original, higher rates for claims with dates of service between July 1 and December 31, 2016.  TRICARE followed suit and we suggest you resubmit any claims adjudicated under the reduced rates to the Managed Care Support Contractor (MCSC) in your region for reprocessing.”

In response to the news, Laura Williard, vice president of payer relations for AAHomecare, advises providers to submit a small batch of claims to ensure they are processed correctly before submitting all claims.

Williard also advises providers who have not already done so to submit similar letters inquiring about the adjustments in case they are questioned by the contractors administering Tricare contracts.

The news culminates six months of work by Williard and AAHomecare on this issue. They reached out to Tricare and its contractors, marshaled providers to pressure the program, and even secured legal opinions confirming that Tricare was obligated to follow the Cures provision.

Hospital HME, DASCO form partnership

POINT PLEASANT, Ohio – Pleasant Valley Hospital’s HME division has entered into a joint venture with DASCO Home Medical Equipment, the Gallipolis Daily Tribune reports. It will now do business as DASCO-Pleasant Valley Home Medical Equipment and will be jointly owned by the two organizations, the newspaper says. “This partnership will allow DASCO to provide increased access to highly specialized respiratory equipment like home oxygen, non-invasive vent systems and CPAP equipment, while continuing to provide specialty care medical products and equipment to the families in this community,” Rachel Mazur, DASCO CEO, told the newspaper. The staffs of the two organizations are working together to install state-of-the-art business and communication technology to identify and serve the needs of customers. They are also working to further identify, define and implement best practices for clinical and business operations to allow for improved patient outcomes, the newspaper reports. DASCO’s home office is in Westerville, Ohio; it has several branches throughout the state, as well as West Virginia, Kentucky and Indiana.

SleepQuest buys Grove Medical

SAN CARLOS, Calif. – SleepQuest, a national provider of care management services for obstructive sleep apnea, has acquired Grove Medical Equipment in Anaheim, Calif. SleepQuest closed on the transaction on June 30 and began serving Grove Medical’s customers on July 1. The acquisition expands SleepQuest’s service base in the Oakland and East Bay areas, and gives OSA patients there access to telehealth- and on-site based services. “This business fits well with our business model and information technology platform,” said Robert Koenigsberg, founder and CEO of SleepQuest. In addition to its main location here, SleepQuest has patient service centers in San Francisco, San Jose and Fresno.

Lifeway Mobility buys Total Access of New England

HARTFORD, Conn. – Lifeway Mobility, an accessibility solutions company based here, has acquired Total Access of New England. Total Access will operate as Lifeway Mobility from a new office near Westborough, Mass., and continue to serve the Greater Boston area. Dan Martin, owner of Total Access, will join Lifeway as vice president and will be responsible for the Massachusetts operation. Martin, a certified aging in place specialist, founded Total Access seven years ago in response to requests for access solutions for homes and businesses. Lifeway Mobility serves Connecticut, Massachusetts and Rhode Island. It was formed by Paul Bergantino, formerly of Numotion.

Aeroflow Breastpumps launches insurance-friendly site

ASHEVILLE, N.C. – Aeroflow Breastpumps has launched a new website that combines ecommerce with insurance processing, the company said in a press release. Users must fill out a “Qualify through Insurance Form” before being eligible to shop for breast pumps that are covered by their specific insurance plan.The site features breast pumps from top brands like Medela, Spectra, Lansinoh and Evenflo, and offers instructional videos and other resources. “Aeroflow is dedicated to making the transition into motherhood as enjoyable and stress-free as possible for women across the country,” said Jennifer Jordan, Aeroflow’s director of Mom and Baby. “Our new website’s simplified and intuitive design makes shopping for a breast pump easier than ever, without compromising on what we at Aeroflow Breastpumps do best: getting moms access to the medical products they need, both easily and at no extra charge.”

HME Woman of the Year committee named

WATERLOO, Iowa – VGM Group has announced the five members of its 2017 HME Woman of the Year Honorary Selection Committee. They are Dr. Kristen Davin, the inaugural HME Woman of the Year, and president and owner of Precision Seating Solutions; Rose Schafhauser, president and owner of Association Management and executive director of MAMES and SWMESA; Quinton Hart, mayor of Waterloo, Iowa; Rick Rector, executive vice president of United Publications, Inc., and publisher of HME News and Home Health Technology News; and Joan Eliasek, president of Extended Care Sales at McKesson Medical-Surgical. The selection committee will review all of the nominations and each submit three semifinalists. Upon reviewing the semifinalists, VGM will select three finalists to attend the awards ceremony on October 24 at Medtrade, where the 2017 HME Woman of the Year will be announced. Nominations are due Aug. 14. www.vgm.com/hmewomanoftheyear.

AAHomecare, VGM want your data

The next submission round for AAHomecare’s HME Audit Key opens July 17. Even if you haven't previously participated or have skipped rounds, you can still take part in this round, says the association. The latest results, running through the first quarter of 2017, showed overturn rates of 68% of repository products; 77% for ostomy, urological, wound care and diabetes supplies; and 81% for NPWT devices and supplies. “Please help fight back against a broken audit and appeal system,” says AAHomecare. Registration and participation is free and open to all suppliers at hmeauditkey.org…With HME providers starting to receive Cures payment adjustments from both Noridian and CGS, VGM is asking them to share any issues, including issues with posting in their billing software. FMI: Ronda Buhrmester, ronda.buhrmester@vgm.com, Dan Fedor, dan.fedor@vgm.com.

Home infusion: Studies highlight benefit of education, inotropic therapy

Patients have better outcomes when they receive home infusion education before they are discharged from the hospital, according to Option Care data. These patients were less likely to experience disruptions in therapy, go to the emergency room or be readmitted to the hospital, according to a presented by the company at the National Home Infusion Association Annual Conference & Exposition in May. The study compared outcomes of 60 patients who received pre-discharge education vs. 37 patients who did not and found outcomes improved by 20% for the first group. Education included proper handwashing, appropriate care of medication, and how to monitor for signs of infection…Advanced heart failure patients who received home infusion of inotropic therapy have a better quality of life, according to another study from Option Care and presented at the NHIA conference. The study included 88 adult heart failure patients who filled out the Minnesota Living with Heart Failure Questionnaire (MLHFQ) before the start of inotropic infusion and three months after therapy. There was an 8.65% improvement among all patients. Additionally, there were improvements in shortness of breath (17.13%), hospital stays (17.65%) and medical care costs (20.78%).

US power soccer team takes second place in World Cup

KISSIMEE, Fla. – Team USA has taken second place in the 2017 Fédération Internationale of Powerchair Football Association (FIPFA) World Cup in Kissimee, Fla. Team USA was going for its third consecutive World Cup win. “It was a thriller of a game, with the score tied 2-2 until France broke away in the final minutes,” said Wayne Merdinger, executive vice president and general manager of MK Battery, the primary sponsor and official battery of the US Power Soccer Association and TEAM USA. England took third place, defeating Australia. Medtrade attendees had the opportunity to see Team USA in action at last year’s show. “When we saw the team last year at Medtrade 2016, it was obvious that they were an incredibly skilled group,” says Kevin Gaffney, group show director, Medtrade. “We at Medtrade are thrilled that Team USA has once again done so well in the World Cup. We offer our sincere congratulations.” 

CPAP helps keep COPD patients out of hospitals, study shows

TUCSON, Ariz. – Although PAP therapy is associated with a reduction in hospitalization for COPD patients, more than 92% of patients are not receiving the therapy, according to a recently published study funded by Royal Philips. The retrospective study, led by Dr. Sairam Parthasarathy, professor of medicine and interim chief of Division of Pulmonary, Allergy, Critical Care and Sleep Medicine at the University of Arizona College of Medicine, revealed that only 7.5% of the more than 1.8 million COPD patients analyzed were receiving any form of PAP therapy. Data from the reviewed administrative claims suggest that individuals receiving either BiPAP, CPAP or non-invasive positive pressure ventilation therapy experienced lower hospitalization risk than before therapy initiation, as well as lower hospital risk than those who did not receive any positive airway pressure therapy at all. “Frequent readmissions of COPD patients not only disrupt their quality of life, but are costing our health systems billions,” says Parthasarathy. “This analysis revealed that there is a solution already accessible within our toolbox that can keep patients out of the hospital, but it is significantly underutilized. With improved awareness and implementation of PAP therapy as a treatment for COPD, we can lower the cost burden for health systems while allowing patients to recover in the comfort of their own homes.”