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by: Theresa Flaherty - Wednesday, May 7, 2014

The Omni Shoreham has hosted Frank Sinatra, U.S. presidents and other heads of state and, in 1964, The Beatles.

This year, it's HME providers with a lengthy to-do list.

In years past the focus has been on competitive bidding, but this year, while that's still on the menu, audits are in the spotlight. Rep. Renee Ellmers, R-N.C., has promised to sponsor audit legislation and providers here are tasked with asking their own reps to be an original co-sponsor.

I think lawmakers will be primed to hear that message. Kim Brandt told attendees that important reports on audits from the Senate Finance Committee and the Government Accountability Office (GAO) are the works, as is a possible hearing on the issue after July 4. AAHomecare is working on it, too. Officials have a meeting scheduled with Chief ALJ Nancy Griswold in June to discuss the two-year delay at the third level of appeals.

AAHomecare cookie tin

The first speaker today was none other than CMS's Laurence Wilson. The session was closed to the press (there's that CMS transparency again), but since it was held over the chicken and asparagus lunch, I was allowed in so long as I kept my reporter's notebook in my pocket and didn't live tweet. Still, I don't think I'll get anyone in trouble when I say that Wilson recounted a meeting with AAHomecare's Tom Ryan, saying that it had been awhile since he'd been visited by the association, which always brought him cookies.

As Ryan said, and others, too, providers and CMS ultimately have the same goal: to help the patient. The problem is that the agency goes at it at in different ways. Ryan told me he's determined to open dialogue with Wilson's office and, while Wilson's speech didn't break new ground, attendees were optimistic there is some sort of detente in the future.

Finally, there is renewed focus on the patient and how they are impacted by everything.

"The focus has been on the billing, on the rules, on the costs, the procedures, the audits," Dr. Elizabeth Vliet told attendees. "Bring the focus back to patient care. The patient is the ony person I have ever answered to."

Theresa Flaherty





by: Theresa Flaherty - Friday, May 2, 2014

My pharmacy robo-called my voicemail the other day to let me know that a prescription was ready. My voicemail has a voice-to-text feature that seems to work well, but like all technology (and human beings, for that matter), it has its limitations.

“Theresa Clarity, press 1 to continue,” it read.

Now, to be crystal clear, I am impressed as hell that the robot got the basic pronunciation correct, (except for that pesky first letter). You see, I find that many good folks west of the Mississippi—and quite a few to the east—cannot pronounce Irish names. (Common mangle: flagerty.)

I should interject here that I’ll likely get no sympathy from editor Liz Beaulieu. (Common mangle: beluga.)

People, please, if you are gonna pass around the Gs like candy, we’ll take it in crisp bills.

Clarity is the quality or condition of being clear, something I strive to do with every story I write. That’s easier said then done, some days. Take yesterday, when a legal story dropped into my lap. We always rely on attorneys to explain to us what we think we are reading, often with copius examples, and yesterday was no exception.

Also yesterday, in a moment of decided fog-headedness, I completely goofed on the time for a call I had set up with a provider. It’s in my book, and in my email correctly but I came to work with a different time in my head. Luckily, the provider took pity and carved out some time for me today.

If only achieving complete and utter clarity every day was as easy as pressing a button.

by: Theresa Flaherty - Friday, April 25, 2014

An ounce of prevention is worth a pound of cure, or so the old saying goes. Unfortunately, when it comes to healthcare dollars, money often gets spent on the more-costly cure. 

That needs to change, says Brian Pavlin.

“I think that the way that health care moves forward, we are going to want to prevent readmissions,” he said. “We need to focus on things that cause readmissions, whether it’s drug interactions or something else.”

HME providers are uniquely placed to help patients before something goes wrong—even in nursing homes.

“Some of the homes I go into, I can show you five patients ready to fall out of their chairs,” said Pavlin. “There’s nothing that allows for proper positioning so they are on the edge of the chair. We can prevent that through less expensive products.”

Less expensive is key thanks to ever-shrinking reimbursement.

“We used to get $10 to $15 dollars a day for a $1,200 air mattress,” said Pavlin. “That was great money. Now we are getting $3 or $4.”

by: Theresa Flaherty - Wednesday, April 16, 2014

On Saturday, I cracked open a window, cleaned out my car and stowed my winter boots in the closet. 

This morning, I donned mittens while I chipped snow and ice off of my car (in Maine, we keep the ice scrapers at hand year round).

Ahh … spring.

Last week, the industry got whacked with its own wet blanket: Two reports issued by the OIG and the GAO on the competitive bidding program.

The first found that CMS generally complied with its own bidding rules and said that CMS should continue to follow its own rules.

I am not so sure the industry would wholeheartedly agree with that, particularly with regard to little things like financial transparency.

“There are bankrupt companies who have won bids,” AAHomecare’s Tom Ryan pointed out.

The GAO report on the program’s impact on providers and beneficiaries was even more disconcerting. The GAO is supposed to function as the eyes and ears of Congress. Unfortunately, it looks as though the GAO looked through a pair of rose colored glasses supplied by—CMS.

“It was junk in, junk out,” said VGM’s John Gallagher. 

For an industry hoping the reports would back up their concerns, it was a double disappointment.

“This doesn’t give me a distinct 'gotcha!' to take to the Hill," said Ryan.

I’ll be attending the AAHomecare Legislative Conference in May and it should interesting to see what sort of conversations will take place in those hallowed halls on the Hill.

By the way, this is my 6th year attending the event—an HME News record, I think.

by: Theresa Flaherty - Thursday, April 3, 2014

“Hi, this is Theresa calling from HME News. How are you?”

“Oh, Theresa, I am living the dream,” was the reply.

It’s a refrain I am hearing more often these days from weary providers. I sympathize with them and, on more than a few occasions I’ve been told they feel like they are talking to a therapist as I gently probe for what’s troubling them.

Let me tell you, I feel like a therapist some days.

But despite it all, there are always providers trying new ideas, thinking outside of the box. Those stories always brighten my day.

At the start of this week, I was feeling decidedly pessimistic because, with a Friday deadline looming, I was having trouble tracking down people to talk to, as well as drum up fresh content for the May issue. And did I mention we woke to snow, sleet and freezing rain that day?

“Theresa, you have to be creative, think outside the box,” editor Liz told me.

We are wrapping up writing tomorrow and, looking through the stories that have already been filed, I think we have a nice variety of stories, from a group of CRT companies that have formed a strategic alliance, to an unusual partnership between a pharmacy and an HMEs. I’ll sleep better tonight thinking of the joy providers will experience upon getting their issue.

It doesn’t hurt that the sun has been shining for 3 whole days.

by: Theresa Flaherty - Monday, March 17, 2014

Well, I am sorry to say today’s the day I finally pulled the plug on my plans to get a Dexcom CGM (color: pink). The reason: I can’t afford it.

The problem is the cost of the sensors, which are good for about a week to 10 days (my personal experience says one week). A three-month supply runs $1,356 until I meet my deductible. So, rather than spend a lot of money (mine and the insurer's to just have the device sit around unused) I decided to wait for the time being.

I was explaining my dilemma (and shock and awe at the cost) to Lisa Feierstein of Active Healthcare. Turns out her company also offers Dexcom and she too, couldn’t believe the price (to be fair, she’s the boss so wasn’t as intricately familiar with the pricing as I’ll bet her staff is).

Although she was able to give me better pricing if I didn’t go through insurance, it was still quite high. The problem, as Lisa told me after doing some research, is that the sensors fall under the DME benefit rather than the prescription drug benefit.

“Welcome to our world,” she told me.

I suddenly have a lot more sympathy for all those seniors complaining about how they can’t afford their equipment. Well, except for the ones who can, they just don’t want to.

It’s probably for the best. I having been having a spectacularly bad run of luck with devices lately. In November, my cell phone finally gave up the ghost, followed in December by my laptop. Last week, on the heels of springing the clocks forward, my watch slowly ticked to a halt (between the two events, I may not be on time for work until we set the clocks back in the fall).

Fortunately, unlike the aforementioned, I am not yet giving up the ghost, or the hopes that perhaps next year, I can get the CGM.

Theresa Flaherty

by: Theresa Flaherty - Thursday, March 13, 2014

This blog headline caught the attention of my Google alerts: Why Medicare's Attitude Toward Diabetes Could Kill Senior Citizens.

The blogger has Type 1 diabetes and, judging by her picture, is nowhere near Medicare age. She is, however, concerned about the national mail-order program which she believes will reduce access to high-quality supplies.

To be sure, the blog, which I wound up skimming because it's rather legnthy, hits on some critical points, including the AADE survey of contract suppliers which I wrote about in February and problem with FDA standards for meters (which aren't reassuring).

That second item is relevant to the bidding problem, but also presents a much larger issue, which then circles back to potential problems with bidding. If a meter isn't accurate, what's the point? It's hard enought to keep those sugars steady without the meter throwing a monkey into the works. 

The blog includes a link to a recent US News and World Report article. Did you know that 98,000 (!) seniors over the age of 80 wind up in the ER every year because of insulin-related hypoglycemia? That sounds like a lot. If meters aren't providing accurate enough info to calculate an insulin dose, that's a serious issue, for both the FDA, which really needs to tighten its standards, and CMS which is paying, if not for the actual meters, for the related supplies and, when necessary, ER visits.

To get back to our weird little niche, if 98,000 people are having issues with just insulin, what are the long-term ramifications of less obvious problems associated with the bidding program? Here, I am not talking specifically about faulty meters, but bennies who become less compliant because they get a new meter they don't like, for example.

Slowly, insidiously, the blood sugars creep up, causing a host of very expensive complications (heart and kidney failure, anyone?). And we're not talking just the over-80 crowd. We're talking anyone of Medicare age, including those who are still working because they are, well, able. What's the cost to Medicare here?

It's heartening to note, at least, that the (sort of) broaders public is indeed, well aware of the problems and dangers of short-sighted cost-cutting measures like competitive bidding.

Theresa Flaherty



by: Theresa Flaherty - Friday, February 21, 2014

As winter drags on it may seem like efforts to repeal Medicare’s competitive bidding program move at a glacial pace, but they are moving.

“The conversation is alive and CMS is on the defensive,” Cara Bachenheimer told me yesterday.

As proof of that: On Feb. 12, Rep. Renee Ellmers, R-N.C., published an op-ed in The Hill, calling for a reform of the bidding process. On Feb. 5, CMS officials were called up to brief members of the House Ways & Means Committee.

“CMS said everything is great, but several members voiced opinions about problems,” said Bachenheimer.

Meanwhile, stakeholders’ eyes remain firmly fixed on the “doc fix,” a potential vehicle for key points of the market-pricing program. Alas, rumors persist that some lawmakers think bid rates should be applied to Medicaid to pay for the fix.

“It’s difficult to know what’s going to happen and everybody on the Hill denies there’s a list,” said Bachenheimer. “We are doing what we can to make sure we stay out of the pay-for package.”

Theresa Flaherty

by: Theresa Flaherty - Friday, February 14, 2014

Yesterday, while taking a snow afternoon, I finally managed to connect with Neighborhood Diabetes (who I have actually talked to in the past for stories—kind of cool) that I was referred to by the diabetes center to get the CGM.

The good

The insurer, as expected, gave the OK.

The bad

Also as expected, I would have to pay for the $1,100 device out of pocket because I have not yet met my deductible ($2,500). I never meet the deductible (see previous parentheses).

The OMG!

A three-month supply of the sensors (figuring 1 per week): A whopping $1,356! First, I thought I heard wrong. Then, I actually said, “Oh wait, is that the combined cost of the CGM and the sensors?” Nope. Just the sensors. That too would be applied to the deductible.

Hey, I’d finally meet the deductible. Too bad I'll wipe out my HSA for the year.

Needless to say, I told her to call me back on Tuesday so I could do some number crunching (and research and price shopping). She has to call me back because I couldn’t get through to them for three days (a whole different concern).

On a funny note, in order to get the prior authorization, I need to supply three weeks of logs to document that I am testing at least 6x per day. Which I do. Unfortunately, if I don’t remember to press save on my meter, it doesn’t record the test. Which means I am going to get delayed in the getting the device. It's not that I disagree with the need to supply the logs, but who the heck shells out this kind of money if they aren't serious about managing their diabetes??

I am still leaning toward the CGM, and a blood sugar of 48 this morning about 30 minutes after I got to work (well, I did have to dig out of nearly a foot of heavy, wet snow) is pushing me further down that road.

I am off to test and to make sure I log it. Stay tuned.

Theresa Flaherty

Type 1

by: Theresa Flaherty - Monday, February 10, 2014

When I saw this abbreviated headline, “This student is on death bed, but his family still has to prove…” I immediately jumped to the conclusion the family was trying to prove some sort of medical necessity or lack of mobility or some such nonsense that we hear about every day here in HME land.

What the family actually had to prove is that Ethan, an 11-year old born with cerebral palsy (who died mere days after this article was written) can’t take a standardized test. (Sample Q: What does a peach taste like? A: He was tube fed).

It’s all so different and yet so eerily (and frustratingly familiar). It brings to mind the instances where paraplegics (or, I guess, their wheelchair provider) need to prove medical necessity, or amputees need to prove they don’t…have a leg?

Yes, yes, yes, fraud needs to be prevented and I don’t know a single provider I talk to who would disagree.

But, it would appear that the education bureaucracy is as rigid and unflexible (and robotic) as any other. Policy is policy and there’s no coloring outside the lines.

Common sense be damned!

I would suggest that now that the child has died, perhaps these people can be left in peace.

Although, if this was an HME issue, the auditors would likely be bending over the tombstone with a clipboard in five years.

Theresa Flaherty