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by: Theresa Flaherty - Monday, September 24, 2018

As I was sitting down at my desk one recent morning my coworker, Cath, came to me and said, “Theresa, I guess I need to ask you about diabetes.”

Being short on coffee and a bit long on self-centeredness, I blinked in confusion, thinking she meant MY diabetes. But, since I’ve worked with her for years and already demoed my new-ish Freestyle Libre to the office (and my mom, my friends and my doctor), this made no sense.

She was actually trying to drum up the contact list for our November feature on diabetes, an assignment I find more challenging every year. The space has changed so much, especially in terms of reimbursement (dismal) and technology (amazing).

I have found myself doing more articles on diabetes technology, talking to companies like One Drop and Ascensia about patient self-management tools.

Technology like the aforementioned Libre, which I started using this spring—readers, it’s life-changing. After nearly 20 years of finger sticks, to wave a device at a sensor and get a number? Amazeballs. Sometimes I just keep scanning it, unlike with those precious test strips I daren’t waste.

The Libre also allows me to note if I am trending up or down (uh, my blood glucose, not my Twitter feed). It allows me to see patterns I never would have caught with traditional (less frequent) finger sticks.

But let me tell you, with technology advances, as with so much else in our on-demand society, users can be quite demanding and have very high expectations that it works conveniently and consistently (not me of course, I am as sweet as a sugar-free pie). Hopefully, that demand will push innovation further down the road.

As to the diabetes feature for November? If you get an email from me seeking product listings, please, send them along. If you get an email from our contributing editor, John Andrews, please weigh in for our story.

by: Theresa Flaherty - Tuesday, September 4, 2018

Every year around this time, HME News usually gets a small flurry of press releases from HME providers who have landed on Inc. Magazine’s annual 5000 list of the fastest growing privately held companies in the U.S.

This year: crickets. A quick, highly unscientific perusal of the 375 healthcare companies on this year’s list confirmed the notable absence of several past winners.

Where, we wondered, were such list stalwarts as Cape Medical Supply, Carolina’s Home Medical Equipment, Aeroflow Healthcare and Home Oxygen Company? Had growth leveled off? Has the list lost its luster?

Both, it turns out.

Home Oxygen Company hasn’t submitted for the last two years, says Todd Usher, co-founder of the Modesto, Calif.-based provider.

“We were in fact flat or a little behind because of the rural rollout,” he said. “This year, we are growing however, we are having trouble seeing the value in such a list to our company.”

The rural rollout also whacked reimbursement hard for Carolina’s HME, says Andrew Trammell, president of the Charlotte, N.C.-based provider.

“Inc. looks at revenue numbers over a three-year period,” he said. “We are selling a lot more but at significantly lower reimbursement. Therefore the unit growth is somewhat meaningless to Inc. so I did not even submit numbers.”  

Cape Medical Supply, in Sandwich, Mass., has made a hard turn away from Medicare in recent years, but that hasn’t stopped the competitive bidding program from having an impact on revenues, despite an increase in business, says CEO Gary Sheehan.

“We didn't submit to Inc., he said. “For us, it was Medicare rates washing across other payers—growth on patient volume remains enormous, but that just keeps revenues flatish.”

So, were there any HME providers on this year’s list?

Yes, at least one: Charlotte, N.C.-based Portable Oxygen Solutions, at No. 1055. The online provider of POCs, which launched in 2013, had revenues of $3.2 million in 2017; its three-year growth rate was 467%.

by: Theresa Flaherty - Tuesday, July 24, 2018

When provider David Chase first submitted bids for the competitive bidding program, his team of seven armed themselves with pencils, calculators and coffee, working every night for three weeks to understand their costs and come up with—what he thought—were sensible bids.

“We did not win a single bid—not one,” said Chase.“We’re in the metro New York area, so we could easily bid on six or seven MSAs and we lost every single one.”

The second time around, they tossed aside their calculators and ended up winning most categories in most MSAs in which they bid.

“When I say, ‘winning,’ it’s in quotes,” he said.

Like other providers I spoke with in the wake of CMS’s announcement that it was hitting the reset button on the program, Chase was heartened to hear that at least someone at the agency might finally be waking up to the problems.

“Nobody wants to admit they implemented a program that was not well-thought out and had so many flaws,” he said “It will be interesting to see what they are going to propose on a permanent basis.”

Provider Andrew Trammell says the proposed changes, like using lead item pricing, will right some of the wrongs wrought by bidding.

“It’s certainly going to fix some of the very odd pricing fee schedules we’ve had,” he said. “For example, old manual crank beds are paid more than the newer, semi-electric beds—odd things from gaming the system.”

Still, while the proposed changes are a step in the right direction, the proposed timeline of 18 to 24 months is not. While CMS figures out how to retool the program, providers need a more immediate fix.

“There’s an easy fix and that is to acknowledge that the market clearing price is an appropriate price setting mechanism,” said provider Gary Sheehan. “They can go back to the 2016 auction, use the market clearing price and have that be the reimbursement reset for Jan. 1, 2019. I don’t think there’s any excuse for them do anything short of that, at the minimum.”

by: Theresa Flaherty - Tuesday, June 19, 2018

As I trudged from the Ramada Inn over the humid skywalk to the Sullivan Brothers Convention Center I swore, I could smell the bacon.

I was, after all, a weary traveller, in search of sustenance (and bacon) after a late check-in and a drive through the dark (very, very dark) Iowan countryside and some impressive rain to get HERE, the 2018 Heartland Conference.

We missed the hog roast, something we seem to manage every other trip.

However, once we get here, after all the sputtering and swearing and cursing (cussing, not actual, like, black magic hexes) we remember why we came.

We love the Heartland Conference. We can’t put a collective finger (all three of us from HME News) on why, but we do.

And I think the other attendees do, too. We met a newbie provider from the Chicago area over breakfast (and bacon) who drove fours hours through torrential downpours for her first Heartland. She’s so new to the industry she (gasp!) had no idea what HME News was. No offense to our friendly rival papers, but I quickly assured her we were THE HME industry publication, handed her a copy and told her where to sign up.

But, I think she, like the other attendees feel this show is as relevant as ever in these changing times.

This year's event kicked off with keynote speaker Jared Johnson who told the audience, “Thank you for showing up and making your community, company and the lives around you better.”

I attended sessions on telemedicine (and telehealth and telemonitoring) and CPAP resupply, broke bread at lunch with some other midwestern providers and hoisted a margarita with the folks from Contour Products at this evening’s community dinner (I got lumped into the marketing group dinner at a Mexican place—a sign if there ever was one).

The offer of a ride to the airport stands.

Tomorrow (or today, if you reading this on Wednesday), it’s a Washington update and a panel discussion with the SBA and CMS, serious stuff. And, I am not sure what else, but it will be good. 

I also hope there's bacon.

by: Theresa Flaherty - Wednesday, May 16, 2018

Like so many others in the HME industry, HME News has downsized a bit. By that, I mean our parent company decided to give up one wing of our office space and move those people (who happened to be primarily HME News staffers) into the other half of the office where admittedly there was a lot of wasted space. Although, not quite enough space.

Administration referred to this as The Consolidation. Having gone from my own spacious cube with a window to a…corner I prefer to think of it as The Big Squeeze. Or, The Sardine Project.

As part of the move, I had to clear out quite a bit of stuff accumulated over the 10 years I spent in that cube. That included every single conference dog tag since I started in 2005. Postcards from those same locations I had the privilege of visiting (after all, it’s not everyone who gets the privilege of going to a hog roast in the middle of Iowa). Every issue of HME News since I began, including the first one I was part of, a Medtrade show issue that clocked in at about 110 pages.

In those days, I couldn't tell a power chair from a rollator.

If I had taken the time to flip through some of those 156 or so front covers, I’d see some long-forgotten names, companies that no longer exist and a reminder that the more things change, the more they stay the same.

We are now on the 10-year-anniversary of what I have long thought of as one of the most momentous years in HME history. We had Sen. John McCain on the cover in January as a homecare champion. We had stories about home sleep testing and CPAP regulations and complex rehab cuts.

And the bidding headlines! “This is flawed in so many ways’'; “Bidding blunders”; “CMS barrels ahead”; and finally, “Industry wins big” about the 18 to 24-month delay.

Well, we see how that’s turned out. And continues to evolve (devolve?).

At any rate, all any of us can do is go along to get along, like shouldering additional duties. Did I mention that my corner is also the first desk that the delivery folk see? I’ve become the de facto receptionist and go-to person for signatures.

Editor Liz overheard me this morning cheerfully chatting with the FedEx guy as I signed for who-knows-what. (Warning to my coworkers: I will sign for anything and everything without checking it so if you're ducking a subpoena or something, prepare to get served).

“You’re the receptionist extraordinaire,” she said. (She likes to show off her French language skills to me).

“Liz, I’ve decided to just roll with it,” was my reply. (I like to quote song lyrics back at her).

If you need me, I’ll be removing the extra thumbtacks from my bulletin board so I have more room to squeeze by.

by: Theresa Flaherty - Thursday, March 29, 2018

As a reporter, I’m the one used to asking the questions. At this year’s Medtrade Spring show I found myself on the receiving end many times.

Several people asked what product I’d seen I liked the best. Since I am not about to go on the record and play favorites, my answer instead was about the overall of trend of sleeker—and dare I say it, sexier—products coming to market.

Although I did look longingly at the sleek and steamy humidifiers at the booth across from us. I have a lingering cough that is worsened by convention center air. And hotel air. And airplane air.

The other question that came up with some frequency today: What’s your favorite thing about coming to the show?

That’s easy. I love talking face to face with everyone, putting faces to the names and voices who contribute to HME News in their own way, namely by…answering my questions.

Blast from the past

I (mostly) don’t take it personally when people don’t take or return my calls, even if they used to speak with me regularly and willingly. On Wednesday, I met Tim Cady of Advanced Diabetes Supply who I spoke with many times in the distant past, but haven’t heard from in years.

“Tim Cady! Where have you been?”

We chatted about the changes in diabetes care since we last spoke, like CGMs and the Freestyle Libre. It’s good to know they are still out there and going strong.

At the AAHomecare reception that night, I found myself speaking with someone about pharmacy. I hadn’t caught his name due to the din coming from the bar, but when he hauled out his nametag—“Oh, Dave Kroll! We’ve spoken many times in the past.”

You may or may not remember, but Kroll’s was one of the original winners of a mail-order diabetes contract. He reminisced about folks offering him big bucks for that contract. How times have changed.

That’s a wrap

The show is over, seemingly before it’s begun and I hope you all had fun. For those in the new, I’ve sampled margaritas each day I’ve been in Las Vegas (not while working), and there’s another in my evening plans. My hands down favorite: This one from the Chandelier Bar at the Cosmopolitan. 

Like good writing, it doesn’t go for a lot of filler.

Keep it simple out there everyone!

by: Theresa Flaherty - Wednesday, March 28, 2018

Tom Ryan has a chip on his shoulder. Ryan, as many of you know, was a DME owner before taking the reins at AAHomecare. Before competitive bidding killed a solid, independent business of 20 years.

“I’m still that disgruntled DME owner, “ he told attendees at this morning’s Washington Update. “I still have that chip.”

He’s in good company here at Medtrade Spring. Not that the show floor was flooded with outwardly disgruntled providers today, but they are all here looking for a different slice of the pie—preferably as far away from Medicare reimbursement as possible.

As Seth Johnson told me before the first educational session he attended this week on retail: “There’s a lot of buzz around retail.”

Jeff Baird agrees. As one of the 78 million baby boomers planning to continue attending Rolling Stones concerts and participating in strenuous sounding sports, he’s willing to pay cash when he inevitably needs one of your products to help him do this.

“The retail market is wide open,” he said.

I hung at the booth quite a bit today and spoke with a variety of folks, reassuring them that yes, HME News really is located in Maine and we really do live there (we know, we’re lucky). We've long promised the aforementioned Jeff Baird lobster if he ever makes the trek.

I love meeting providers. My apologies to Johnny (I’ll withhold your last name) for putting you on the spot for a quote when you were innocently trying to introduce yourself after several years of communicating via email.

And finally, speaking of names, for those of you wondering who the mysterious @lisawe is—and wondering whether you should follow her—that I included in a tweet after meeting Sara Struwe of the Spina Bifida Association, it was merely a failed attempt at tagging Lisa Wells, who introduced us.

See you all at AAHomecare in 14 minutes.

by: Theresa Flaherty - Wednesday, March 21, 2018

Like many of you, I am gearing up for Medtrade Spring next week. My get-ready checklist looks something like this:

Identify educational sessions to attend.

Schedule face time with fellow attendees who are usually just voices on the phone.

Bug HME Christina for all relevant travel confirmations and assorted paperwork.

Verify that my “conference pants” still fit.

Pack lots of reading material for the plane (there’s no quick way from Maine to…anywhere).

One item on my reading list: Arianna Huffington’s Sleep Revolution, which I recently picked up at the bookstore. Arianna is all about prioritizing sleep, which I wholeheartedly agree with it, even though I don’t always succeed. I mean, I’m no Warren Zevon, but sleep doesn’t come easily to many of us.

Amid all this pre-show activity, an article titled “Beverages to avoid to sleep soundly while traveling” caught my eye.

Gasp! The three categories are caffeine (coffee), alcohol and soda.

Uh, what else is there?! I love a cold glass of milk like no one’s business, but caffeine is what will keep me going during the show. And who among us doesn’t remember my fervent (and fevered) pleas at last year’s show for Diet Coke in that Pepsi-centric town? (Thank you, Kevin Gaffney!).

Plus, I have a post-show margarita with my name on it waiting for me.

Hopefully, I’ll see you at the show, but if not, stay safe, sleep well and cheers!

by: Theresa Flaherty - Thursday, March 8, 2018

I am home today on the couch with my latest mystery novel enjoying yet another snow day (at least, until it’s time to venture out and shovel out). While I often tease Editor Liz Beaulieu, the resident HMeteorologist, for always managing to dredge up the most extreme weather forecasts, this time she was bang on.

We are now three months into the new year, and after several months of a seeming status quo, I hope our recent list of the five most-read stories for February isn’t a forecast of things to come in 2018.

That short list of headlines contained the words “aghast,” “upends” and “unfeasible.”

I pointed this out to Liz, who commented that it was a sad state of affairs. To me, it’s also evidence that the more things change, the more they stay the same.

In particular, that word aghast, which describes Tom Ryan’s reaction to an out-of-the-blue proposal to expand competitive bidding to rural areas.

Pardon my French, but WTF?

Which I am pretty sure is what Tom and Jay and many others really said when they first learned of this bizarre proposal.

It’s as if the past 10 years of fighting back against the bidding program never happened. Has the industry been shouting into a void?

I’d like to think not—that this idea will be beaten back quickly. HME providers have proven time and again to be a resilient bunch, though there are a lot fewer of them these days.

Like the arrival of spring, I guess we shall have to wait and see.

by: Theresa Flaherty - Thursday, February 22, 2018

Having worked at HME News now for longer than I care to admit (but, it’s been 12 years), I often find myself viewing the world through the lens of home medical equipment.

For example, a headline on oxygen will lead me to a story on winemaking. Or the answer to a Jeopardy question about lox has me shouting at the TV, “What is liquid oxygen, Alex?” rather than, “What is bagel topping, Alex?”

Even when I’m not misreading something, I still wonder things that the average person wouldn’t. Take this letter to workplace advice blog askamanager.org, titled: “my employee uses a wheelchair…but I found out he doesn’t really need one.”

It reads, in part:

I’m a manager in charge of a division at my company. “Drew,” one of the people I manage, uses a wheelchair. When first hired, Drew was told to ask if any accommodation was needed. He has never asked for any. Our area is on the first floor of our building. Our building has elevators and all the doorways are wide enough for his wheelchair. When Drew first began working here, he used public transit. There is a bus stop a few feet outside our front door.

Now Drew has a car with hand controls and no one else parks in the space closest to the door. The space has been reserved for him.

The letter writer goes on to describe how she inadvertently came across an online film, featuring Drew, about people who believe they are disabled but are actually not.

While blog commenters had varying degrees of huh? How dare he? And WTF? I wondered, What kind of chair is it? Power? Manual? Does he like Invacare vs. Drive? Where did he get it? Was he properly fitted for it?

Also, How did he pay for it? (Well, out-of-pocket, obvi, but geez, how many people can’t afford wheelchairs and modified vehicles that actually need it?)

The biggest question: Which one of our readers sold this guy a wheelchair?

Needless to say, I don’t think this will turn into a new market for providers looking to diversify their markets.

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