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by: Theresa Flaherty - Thursday, July 2, 2020

I couldn’t have timed it more perfectly if I were starring in a sitcom. Just ahead of our scheduled podcast recording on Wednesday afternoon, I tucked myself away in my quiet bedroom, phone, laptop with script, and headphones at hand.

Ahead of calling our special guest (in this case Apria’s Bill Guidetti), Liz and I always connect on the phone to make sure everything is copacetic.

And it was, until it wasn’t. At that very moment, my fire alarms went off. All of them.

“Ohmigodohmigodohmigod” may have been uttered by me a few times before, thankfully, the alarms shut off.

At which point, my computer with the podcast script I needed outlining my preplanned, insightful questions, froze up.

I could go on, but you get the gist. It’s all in a day’s work from home. We managed to pull it together in the end (we always do).

As we slog our way through month five of this dystopian experiment known as COVID-19, we all continue to make adjustments, in how we work, think and do things.

One big change has been the switch to virtual events. In the past few weeks, I have listened in on a few Heartland at Home sessions, and while I missed the hog roast and getting reacquainted with folks in person, the sessions were well done and well attended.

Our HME Business Summit, scheduled for Sept. 15-17, has also moved online. The programming has just been finalized and it looks top-notch, as always.

I was talking to Gary Sheehan, who has participated in numerous Summit panels over the years and he’s gung-ho about online events.

“This should be the best HME Summit ever,” he told me. “There’s the ability to attract really premier leaders that you’ve not been able to because of the need for travel and multiple days out of the office.”

That, dear readers, is music to our ears.

 

 

by: Theresa Flaherty - Monday, June 1, 2020

Today was a unicorn day.

What do I mean by that? In diabetes parlance, a unicorn is a blood sugar reading of 100. No scientific reasoning that I’m aware, it’s just a nice, round number, generating excitement not unlike that of aperfect score on a school test.

One thing I’ve learned over the past 11 weeks or so of working from home is that you can’t anticipate all the little technological snafus that never happened in the office.

Case in point: Although I like the little scanner that comes with the Freestyle Libre just fine, I had finally switched to using my iPhone instead (it seems to be an either/or proposition, you can't use both).

The biggest benefit: it regularly and automatically uploads to the doctor’s office—a big help during my very first telehealth appointment back in April. The nurse already had my graphs—no extra effort needed on my part.

Downfall: Working from home, I have to use my own phone to make work calls. While using the phone, I can’t scan my blood sugar if I suddenly feel a possible low coming on. The most recent time this happened, I managed to power through, but it’s not, shall we say, ideal.

Technology, as I am so often rudely reminded, does not always get a perfect score.

Technology was at the forefront of last week’s big announcement in which AdaptHealth announced it was acquiring Solara Medical Supplies. Solara is a big player these days in the CGM and insulin pump space.

Not only do company execs expect to see growth of 20% annually for the next few years, they are looking ahead to all the possibilities of connected care in the home.

As the current pandemic has shown, it’s coming. The question is, who will be ready to jump on it?

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by: Theresa Flaherty - Monday, April 20, 2020

Appropriate to my current WFH status, I also had my first ever telehealth appointment last week, with Sarah the CDE. It was simply a three-month check-in to see how I was doing with diabetes management, including what patterns have been cropping up in my blood sugar numbers, and where I could make changes to fine-tune things.

On the plus side, I’ve been getting in more exercise because I force myself out for walks whenever the weather is agreeable (so, about half as often as I—or Sarah—would like). I am sticking to mostly my regular eating patterns and am happy to report working from home makes me less likely to stress snack mid-afternoon (see walks. See also, water plants or toss in a load of laundry).

On the minus side: Where are all these lows coming from?

Eh, it’s all a day in the life when it comes to diabetes.

Like so many around the world these days, I am all about flattening the curve to slow and ultimately stop the spread of COVID-19.

In the diabetes world, we have something a wee bit similar, called “time in range.” That’s the amount of time your sugars stay in range—a better indicator of control than the peaks and valleys of highs and lows. Even if you run a bit high or bit low, a steady, straight line means you’re on the right track.

At HME News we are on week five ( or is it six?) of working from home. I remain optimistic that we will see the pandemic curve flatten soon and I can get back into the office and the hum of a working newsroom (though I plan to WFH a bit more often).

I am also optimistic that my next check-in with Sarah will be face to face (there are limitations to telehealth) and that I'll have some curveless graphs for her to parse.

Stay safe, stay healthy and stay home!

by: Theresa Flaherty - Tuesday, April 7, 2020

I had no sooner positioned my phone on the dining room table, speaker phone engaged and introduced myself to Dr. Sohail Masood of KabaFusion when the lawn guys showed up in all their noisy, machine-wielding glory.

I tried moving phone, laptop and Dr. Masood away from the racket—first to the living room couch, then, when that didn’t help, to the bedroom.

“I’m sorry, I can’t hear you!” I apologized, more than once. I then had to interrupt him again to pop in earbuds while frantically typing notes into my laptop (which I am not good at in the best of circumstances). All while nervously monitoring the rising buzzsaw of lawn equipment as the lawn guys kept moving around my first-floor abode.

Then. A hammering on the front door, which I ignored, and then hammering again. The phone, the laptop, the earbuds and Dr. Masood accompanied me to the front door because the UPS guy insisted in getting my last name, despite my wild gesticulations through the glass door which clearly announced: “I’M ON A CALL!”

Fortunately, Dr. Masood (and I) had a sense of humor about the whole thing. Working at home presents challenges in the best of circumstances and the circumstances we currently find ourselves in are far from the best.

I’m fortunate I can work from home and I’m interested to see how working from home works out for companies that have either been reluctant to allow it, or have never implemented it so quickly or on such a large scale.

One provider who saw the writing on the wall is Gary Sheehan of Cape Medical Supply, which quickly ramped up WFH for 90% of its workforce. Technology-wise, the company had many of the components, such as online meeting software and chat functions, already in place. Employees scooped up desktop machines and monitors and set up remotely.

One key to success: Flexibility and trust, especially during a crisis, said Sheehan.

“We’re not auditing keystrokes or monitoring call queues,” he said. “I understand people have lives and there’s a lot going on.”

A lot, indeed.

Anticipating that HME providers may implement more WFH when things return to “normal,” we’ve enlisted Acu-Serve’s John Stalnaker to write a batch of Smart Talk columns on the topic. Look for it starting with the June edition.

In the meantime, stay safe, stay healthy and stay home if you can!

by: Theresa Flaherty - Wednesday, April 1, 2020

My most important task as a reporter when it comes to any crisis happening in the world at large is talking to HME providers to find out what’s happening on the front lines. What are you seeing? What’s been the impact? What are you doing? What do you need everyone (especially policymakers) to know?

We do this fairly frequently (hurricanes. competitive bidding. locusts). In-house, we refer to it as the disaster beat. However, nothing could have prepared us for the disaster unfolding in real time. The coronavirus pandemic has been unlike anything else I’ve covered in nearly 15 years at HME News. Providers are well and truly in the thick of a healthcare disaster that changes daily and they (and we) are doing our best to keep up.

I’ve been lucky to talk to quite a few of you, in quick snatches of phone calls taken at my dining room table, shouting into a speaker phone and praying the noise from the kitchen isn't too loud.

PPE? NOPE.

PPE remains the No. 1 concern for most of the providers I talk to. Brad Heath laughed out loud when I asked him.

“We have some distilleries making sanitizer for us,” he said. “We have been able to get some gowns. We started using shower caps as shoe covers at one point. As far N95 masks, we have a massive amount of orders and we can’t get those.”

KEEP YOUR DISTANCE

Like the rest of us, HME providers are also concerned about contracting Covid-19, but unlike many of us, lots of those positions can’t be done from home. At Bedard Pharmacy, they are doing their best on social distancing, says Sean Andrews.

“We have space to segregate each department,” he said. “They each have their own break rooms, bathrooms and they can’t go into anyone else’s.”

DOCUMENT, DOCUMENT

Tyler Riddle has been keeping an ongoing log of the situation as it unfolded in his corner of Georgia. He’s got an eye to the future.

“At the end of this, we are using all of this information to strengthen our narrative so when we go back to Congress we can say, ‘Hey, competitive bidding is egregious, this is what we do on the front line,” he said. “Or when UnitedHealthcare tries to cut reimbursement in three to six months. When a third-party says they are going to go back and audit all these claims we have a strong record of everything we did.”

by: Theresa Flaherty - Wednesday, March 4, 2020

We’re back in Las Vegas, complete with hand sanitizer stations in the lobby of Mandalay Bay and conspicuously thinner crowds in the restaurants and at the blackjack tables in the casino, what with the unfortunate confluence of coronavirus panic and Medtrade Spring. I’ve shaken plenty of hands. I’ve also done some no-contact hand waves and one elbow bump. Hey, whatever works!

Medtrade SXSW

Show Director Mark Lind is definitely shaking hands. He’s also working the show floor, moving from booth to booth to check in with exhibitors.

He asked us if we’d heard anything from providers about the big move next year to Phoenix.

Truthfully, everyone’s been asking ME what I think and, personally, I say, why the hell not? I love coming to Vegas but I can see where a change of scenery might be a good thing. It’s less expensive and surely, there’s less smoking everywhere.

Still, if you aren’t happy, Lind, who’s begun putting his stamp on the HME industry’s signature event, wants to know about it.

“Send them to me,” he said. “I won’t hide from it. I’m easy to find. I’m the guy with the bow tie.”

Gallagher Power

There’s another conference here, something about Gallagher Power. (They're in insurance, the guy in the elevator told me.) Signs extorting "Gallagher Power" abound and there are thousands of people moving en masse, adorned with bright Gallagher lanyards around their necks. So far, the HME industry’s own version of Gallagher Power, VGM’s John Gallagher, doesn’t seem to have let this newfound power go to his head.

Pretty sure he's loving it, though. I know the rest of us are.

Merv Griffin, who?

One of the most immediate changes upon Lind’s tenure is the AAHomecare Update, which has been rejiggered—possibly reimagined—as the Merv Griffin Show. Lots of attendees (yours truly included) got the joke.

Not so for provider Josh Marx, which he freely admitted.

“I don’t know who Merv Griffin is,” said he, as he took the mic during the update.

That admission also garnered plenty of chuckles. But his, uh, shorter cultural reference timeframe, is also a good thing. It shows that yes, there is still new blood getting in to the industry. And the industry needs that new blood to drag the industry kicking and screaming into a new era, one it needs to adapt to.

That’s true of the need to consider how you sell, what you sell, and who pays for it. (Hint, not necessarily Medicare.)

Stay tuned.

by: Theresa Flaherty - Wednesday, February 19, 2020

HME News World HQ is located in a tiny little dip where the land meets the sea. There are three roads out, all uphill. In yesterday’s snowstorm, which wasn’t markedly different than any other snowstorm, I found myself unable to coax my car up the steep hill to Main Street. Literally halfway up, it refused to budge and I found myself reversing direction back down the hill to relative safety.

The whole scene called to mind the often Sisyphean tasks providers contend with, namely fixing the competitive bidding program. For example, they get a bill introduced, they start pushing it up the hill, and then the clock runs out. Or they get CRT accessories excluded, only for vents to be added.

Often, it simply starts to feel like such a long slog: for me to write about, certainly, but also for our famous “stakeholders,” tasked with the endless cycle of calls and meetings and lawmaker visits.

Speaking of stakeholders, this week’s MAMES member bulletin highlights this beautifully. The top story: “Legislative Update: No change from last week.”

That's what we in the biz call a slow news week!

Fortunately, the bill IS picking up cosponsors, most recently Rep. Morgan, R-Va. on Feb. 6. With the impeachment boondoggle behind us, perhaps lawmakers can now turn to other matters, but time will tell.

As for me, I headed in a different direction and eventually made it home, no worse of the wear.

by: Theresa Flaherty - Thursday, January 23, 2020

I’m not a big app user, but I recently downloaded, after years of hearing about it, the myfitnesspal app. It lets you log pretty much all the food (including your recipes! You can scan labels!), and calculates nutrition and macros and all that.

OMG, I love it. I’m not only seeing how many more calories I’m consuming then I was telling myself (but that those snug jeans were screaming about loud and clear), but it’s so much easier to track my carbs—critical for an *insulin user.

My biggest regret right now is that myfitnesspal doesn’t integrate (sync?) with my FreeStyle Libre app to also pull in blood sugar data and, when I can be bothered to enter it, insulin doses. Maybe down the road, eh?

Last week, I listened to the latest Special Open Door Forum on the documentation lookup service. It sounds like it’s moving along swimmingly, but unsurprisingly, there’s a roadblock: Not everyone is using electronic health records, or they are not using the same EHRs as others or they are not using the same version.

This is also borne out in a recent story by Liz Beaulieu on e-prescribing, in which AAHomecare’s Kim Brummett summed it nicely:

“It’s really up to the ordering physician or hospital: Do they want to do it, and what platform do they want to use. If I’m a provider, I can choose to use this platform, but that doesn’t mean my referral sources will.”

That all adds up to a whole lot of inability to fully integrate and communicate across the healthcare continuum, despite that being exactly where healthcare needs to go. And where it is going. In many cases, the patients are already there, waiting for the system to catch up.

*Fun fact: While there is some disagreement, this day in 1922 is widely credited with being the date of the first successful insulin injection.

 

by: Theresa Flaherty - Thursday, December 5, 2019

“How ‘bout those CGMs?"

I was at the doctor’s office today—not the endo’s—and the nurse was double-checking I still used the Freestyle Libre.

Turns out, she has a Dexcom. I’ve said it before in this forum: the advances in diabetes tech are game changers. They have forever changed the way diabetes is managed. End game: more time in range (this is a fairly new concept), better AICs.

I discussed this recently with several diabetes providers for a recent story on Walgreens entering the market. They love this stuff.

But for all this technology, nothing is perfect. Take the Dexcom outage last weekend.

I don’t know the details, except that users were not receiving alerts that their numbers were high or low. This was especially frightening for parents who use Dexcom to keep track of their young, sugar-free children.

It’s at times like this I hope everyone has a backup meter and a paper logbook, but then, I am an anachronism.

Earlier this week, I actually did have an appointment at the endo’s office, with the CDE. I checked in 15 minutes early for my appointment. Some sort of glitch (human? computer?) failed to register me. Looking up from the computer screen to see me not-so-patiently waiting in the nearly empty waiting room where I was trying to avoid making eye contact with an annoying person from another life might have solved this, but I digress.

Anywho, it turns out my chagrin over, uh, bouncy numbers Thanksgiving week were for naught. I very recently switched from using my Libre reader to scanning the sensor with my iPhone. That means, instead of uploading my numbers directly to the computer, it had to be sent, as if by magic (and electronic invitation), to some server or some such. Alas, the mobile dead spot I was in meant I couldn’t get past step No. 2 (accepting the terms, for those of you keeping track.) to get all set up.

Yep, waited 35 minutes to be seen only to have no data to look at.

by: Theresa Flaherty - Friday, August 23, 2019

I believe there's a saying that 5% of the people do 95% of the work.

It's a comment that's been made to me many times over the years on the HME legislative beat and one that was certainly born out by our September Newspoll in which 62% of respondents say they hadn’t set up a meeting with lawmakers or their staff in their district offices; 77% said they didn’t plan to host lawmakers at their location.

But, it's the all-important August recess!

“I’m just burnt out on trying to get the industry’s point across to anyone in Congress,” said one respondent. “I feel like I am shouting into a void.”

In other instances, the lack of scheduled meetings is not due to a lack of trying, providers say.

“I’ve asked my closest (geographically) Congresswoman for years to meet with me,” wrote on respondent. “She recently announced she is not seeking re-election, so it will never happen.”

I don't totally understand folks who do nothing but I certainly can't fault providers for being burned out by the whole prospect of advocacy. I hear ya! Confession time: There are days when the prospect of writing yet another story about competitive bidding makes me want to scream. But I refrain. Not only would it not solve anything, editor Liz would tell me "tough luck."

But all that burnout is balanced by the news in today's email inbox recounting visits that have taken place in the past week, including visits in Wisconsin, North Carolina, New York and New Mexico. Upcoming visits will span New England, thanks to the hardworking folks at HOMES.

Next weekend is Labor day and the unofficial end of summer. I'm kind of looking forward to getting back to work with a renewed focus and energy.

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