In brief: MA payments, tech stage, device risk, Cardinal acquisition

WASHINGTON – CMS has released a Calendar Year 2025 Advance Notice for the Medicare Advantage and Medicare Part D Prescription Drug Programs that would pave the way for payments to MA plans to increase on average by 3.7%, or more than $16 billion, from 2024 to 2025. 

“CMS continues to ensure that Medicare Advantage and Part D prescription drug plans remain strong, stable and affordable offerings,” said CMS Administrator Chiquita Brooks-LaSure. “The Advance Notice upholds robust and stable options for people with Medicare while strengthening payment accuracy so that taxpayer dollars are appropriately spent. The Advance Notice also continues our effective implementation of the Inflation Reduction Act on schedule, including capping out-of-pocket costs at $2,000 for people with Medicare Part D prescription drug plans in 2025. This out-of-pocket cap will be truly life-changing for millions of people.” 

The Advance Notice complements a proposed rule, also for CY 2025, that CMS released in November 2023 that the agency says would, if finalized, strengthen protections for the millions of people who rely on MA and Medicare Part D prescription drug coverage. 

The Advance Notice proposes annual updates to MA payment growth rates and changes to the MA and Part D payment methodologies to improve payment accuracy. Last year, CMS finalized CY 2024 technical and clinical updates to the MA risk adjustment model to keep it up-to-date and improve payment accuracy, as well as updates to the calculation of growth rates to better account for medical education costs. For 2024, MA offerings for people with Medicare remained stable—including premiums, supplemental benefits, and choice. 

The CY 2025 Advance Notice includes the continued phase-in of the updated MA risk adjustment model and updates to the calculation of growth rates related to medical education costs, and other technical improvements. 

“These updates not only ensure payment is higher for enrollees with the most complex needs, they also make Medicare Advantage less susceptible to gaming and protect the long-term stability of the Medicare program,” said CMS Deputy Administrator and Director of the Center for Medicare Meena Seshamani, MD, Ph.D. “We are also releasing guidance on implementation of vital parts of the president’s drug law, including the $2,000 out-of-pocket cap for 2025, which will provide needed relief for millions of Americans who rely on prescription drugs to stay healthy.” 

CMS will accept comments on the Advance Notice through 6:00 PM ET March 1, 2024. The CY 2025 Rate Announcement and the CY 2025 Part D Redesign Program Instructions will be published no later than April 1, 2024. 

The CY 2025 Advance Notice may be viewed by going here and selecting “2025 Advance Notice.” 

A fact sheet discussing the provisions of the CY 2025 Advance Notice, as well as frequently asked questions, can be viewed here. 

Medtrade launches Technology Stage 

DALLAS – Medtrade is introducing a new Technology Stage on the expo floor, which will feature 30-minute interactive presentations to provide attendees with a comprehensive overview of various tech solutions from exhibitors.  

“These presentations are outside of the educational session tracks,” said Chris Kinard, chief operations officer, Valere Health, who worked with the show’s Associate Director Kerry Tyler on the concept. “They were able to carve out space on the expo floor. It’s an actual stage with seating for about 50 people. We went through the list of exhibitors and extended invitations for technology vendors to come and participate.” 

Topics include enterprise resource planning; revenue cycle management - accounts receivable; patient collections; patient management - population health; sleep tech; prescribing; inventory management; and document management. 

So far, two exhibitors have signed up to present: Atlas Technology (1:50-2:20 on Wednesday, March 27); and HME360 (2:40-3:10 on Wednesday, March 27). 

Exhibitors interested in securing one of the remaining time slots may contact Kerry Tyler at kerry.tyler@emeraldx.com. 

Report: Home medical devices pose risk 

PLYMOUTH MEETING, Pa. – One of the nation’s largest nonprofit patient safety organizations has named challenges for patients and caregivers using medical devices at home as the most pressing health technology safety hazard for 2024.  

In a new report, ECRI, an independent, nonprofit organization improving the safety, quality, and cost-effectiveness of care across all health care settings worldwide, says that medical devices used in the home, such as infusion pumps and ventilators, may be too complex for lay people to use safely and effectively. 

“Severe harm can result from the misuse or malfunction of medical devices in the home,” said Marcus Schabacker, MD, PhD, president and CEO of ECRI. “Patients and caregivers who misinterpret device readings may feel a false sense of security. Errors may go undetected or unreported, making it difficult to identify problematic trends.” 

Among the examples of patient harm: Medication errors when changing infusion pumps; skin injuries from incorrectly applied electrodes from a cardiac monitor; and fatalities if a home ventilator alarm fails to activate or goes unheard. 

“When a medical device is designed, it’s critical that human factors and the end user be considered,” said Schabacker. “As more patients receive medical care outside hospitals and nursing homes, the reality of modern care settings should influence the design of devices and other supplies we need to keep patients healthy.” 

In ranked order, ECRI's top 10 health technology hazards for 2024 are: 

• 1.     Usability challenges with medical devices in the home 
• 2.     Insufficient cleaning instructions for medical devices 
• 3.     Drug compounding without technology safeguards 
• 4.     Environmental harm from patient care 
• 5.     Insufficient governance of AI in medical technologies 
• 6.     Ransomware as a critical threat to the healthcare sector 
• 7.     Burns from single-foil electrosurgical electrodes 
• 8.     Damaged infusion pumps risk medication errors 
• 9.     Defects in implantable orthopedic products 
• 10.   Web analytics software and the misuse of patient data 

Cardinal Health to acquire Specialty Networks 

DUBLIN, Ohio – Cardinal Health has entered into an agreement to acquire Specialty Networks, a technology-enabled, multi-specialty group purchasing and practice enhancement organization, for $1.2 billion in cash. The acquisition demonstrates Cardinal Health's strategic prioritization of investing to accelerate growth in its Specialty business and provide leading-edge technologies, capabilities and talent that address critical business and customer needs. It also complements Cardinal Health's offering in key therapeutic areas by enhancing the company's downstream provider-focused analytics capabilities and service offerings and accelerating its upstream data and research opportunities with biopharma manufacturers. "Expanding in specialty is a top priority for us and we have been investing to expand our offering," said Jason Hollar, CEO Cardinal Health. "The acquisition of Specialty Networks enhances our specialty strategy by providing new capabilities that strengthen the link between our downstream and upstream services, enabling us to create value for customers, manufacturer partners and patients." Specialty Networks creates clinical and economic value for independent specialty providers and partners across multiple specialty GPOs: UroGPO, Gastrologix and GastroGPO, and United Rheumatology. 

MK Battery, Rolko North America partner 

ANAHEIM, Calif., and BLOOMFIELD, Iowa – MK Battery and Rolko North America, a subsidiary of Rolko Kohlgruber GmbH, a manufacturer and supplier of components and accessories for the mobility market, have inked a comprehensive agreement for MK to provide warehousing, logistics, distribution and route delivery services to support Rolko’s line of components for wheelchairs and rehabilitation equipment. Under this arrangement, MK Battery will stock Rolko products and make them available via their nationwide order processing and route delivery system. “Our route delivery fleet is already servicing HME providers throughout the country, and this addition of complementary, high-quality products will provide our customers with the same level of service on wheelchair parts and accessories that they have come to expect when purchasing our batteries,” said Wayne Merdinger, president, MK Battery. MK customers will also be able to add accessories such as wheels, tires, seatbelts and armrests onto their battery orders. 

BOC taps Jason Morin for board 

OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) board of directors has appointed Jason R. Morin as a public member. Morin, currently senior manager of payer relations for Coloplast, is an executive leader with more than 20 years of experience in optimizing reimbursement operations and third-party payer relationships in the home medical equipment sector. “We are pleased to welcome Jason to the board,” says BOC Board Chair Cameron Stewart, BOCO, BOCP. “His proven leadership skills and extensive knowledge of payor relationships will undoubtedly contribute to the continued success of BOC, and we look forward to leveraging his many insights to further the organization’s mission.” Morin’s previous work experience includes serving as president and CEO of Home Medical Equipment & Services of New England (HOMES), as well as vice president of reimbursement and payer relations for Home Care Specialists, Inc. He has received two HOMES acknowledgments: the Christopher J. Denmark Commitment to Excellence Award in 2017 and the Outstanding Volunteer Award in 2016. In addition to his BOC service, Morin is chair of the Massachusetts Board of Respiratory Care and a member of the Northern Essex Community College respiratory program advisory board. 

ADS adds Libre 2 Plus sensor 

CARLSBAD, Calif. — Advanced Diabetes Supply (ADS), a national distributor of diabetes devices under the ADS and US MED brands, is now carrying the new FreeStyle Libre 2 Plus sensor, the first DME provider in the country to offer consumers the 15-day sensor. “The FreeStyle Libre 2 Plus is an exciting advancement in diabetes health technology and is the only 15-day non-implantable continuous glucose monitoring (CGM) sensor in the U.S.,” said Bill Mixon, CEO of ADS. “As leading distributors of FreeStyle Libre, we are pleased to be the first to add this valuable tool to our product offerings as we continue to seek new and innovative ways to support the diabetic community.” The FreeStyle Libre 2 Plus sensor, developed by Abbott, currently integrates with the Tandem t:slim X2 insulin pump with Control-IQ technology, the No. 1 rated automated insulin delivery system. It is approved for use in patients as young as 2 years old and offers users improved accuracy, particularly in the low glucose range. The FreeStyle Libre 2 Plus is expected to integrate with other automated insulin delivery devices, such as the Omnipod Dash, in the future. ADS and US MED were part of the beta testing for the new sensor, reflecting the longstanding commitment by the industries to support technologies that advance care and support the needs of the diabetic community.