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by: Theresa Flaherty - Friday, January 31, 2014

It’s official. The winter doldrums have set in. The anticipation of the holidays has been replaced by blackened snow and brown and tattered wreaths hanging neglected.

I can’t get out of my own way to do much of anything. Did I pack my motivation away with the Christmas decorations?

I can’t help but worry that a similar fatigue has set in for HME providers. That’s because the deadline to register for the Office of Medicare Hearings and Appeals forum got extended (it ends today). That made me wonder if they weren’t seeing the sign-ups they expected.

And, Carolyn Cole from VGM this afternoon emailed me a press release touting the importance of participating.

“The forum will be loaded with hospital and pharmacy representation. We want to make sure we’re there too, to represent DME as an important part of the audit discussions,” said John Gallagher in the release.

To be sure, VGM is doing its darndest to get people fired up to attend the forum and also hit the hill next day to talk to lawmakers. I am quite confident that a dedicated few will indeed, make the effort.

That’s not to say that the vast majority of providers don’t care, but simply don’t have the time, the inclination or the resources.

But with audits eclipsing competitive bidding as the issue du jour, I hope a few more people get out there and speak up.

The iron is hot.

by: Theresa Flaherty - Friday, January 24, 2014

I handed back the CGM yesterday and asked "where do I sign up?" to get one of my own. That's because, while I wouldn't want to be tethered to it constantly, the peace of mind—and the guts to more aggressively manage my diabetes—that little black device offers would be worth it. Totally. Turns out lots of people use it during certain times, such as when their numbers aren't making sense, overnight, or maybe during a long hike.

After going over the downloaded graphs, as well as my log book, Erica (the nurse, not our HR manager) and I made some changes to my dosing, as well as to my routine, to see if that fixed a few, shall we say, less than optimal patterns. I can report that after one day, I can already see major improvement in sugar trends.

I filled out the paperwork to get the process rolling and to see what my insurance will cover and what my out-of-pocket would be. Looking online, they seem to run about $1,200, not including the sensors. And it comes in pink or blue, in addition to black. I'll keep you posted. I can't wipe out my entire HSA on this but I think I can swing it.

Meanwhile, one technology trend I am not sure of: Google's blood sugar detecting contact lenses, which has received quite a bit of press in the last week or so. I know from social media that many patients say they'd only consider the lenses if they already needed contacts, which makes a certain sense, I guess. I just find it hard to believe technology is anywhere close to being able to track blood glucose levels without actually sampling blood.

Theresa Flaherty
Type 1

by: Theresa Flaherty - Monday, January 20, 2014

I woke up Sunday morning around 5 am thanks to the guys clearing the latest snowfall from the neighbors. At which point I wondered, why hasn't the CGM beeped at me all night?

Cause it needed to be charged, which doesn't take long, but since it has to stay within 5 feet of me, it was kind of a pain at that hour(old house, not a lot of conveniently placed outlets.) However, while killing the 20 minutes or so I needed to recharge, I found the logbook they gave me at the doc's office on Wednesday and which I had promptly misplaced. So, part of Sunday afternoon was spent backfilling it, with sugars, carb counts and insulin doses, as well as what I ate and when, and exercise, illness, stress and what color pajamas I wear.

Just kidding on that last one.

I can think of no greater nightmare of a patient population than those with diabetes for the HME suppliers. Cause let me tell you, I hate keeping logs (although I love having them when at an appt) and we all know what happens if Medicare wants to see those logs and they, frankly, don't exist for suppliers to collect. (I will try and be more diligent by the time I reach Medicare age, but I am making no promises, suppliers. Sorry!).

I've been talking to providers today and last week, and last month, about audits (otherwise known as "nightmare," "ridiculous" and "frickin' ridiculous") and it's clear, even without the infamous ALJ memo, that the problem is getting worse.

"I think she did that to raise a red flag," John Gallagher told me today, about the memo.

Here's hoping that, between the ALJs themselves complaining, and other provider groups up in arms, that there's strength in numbers.

Speaking of numbers, this morning's (4 am!) low of 43 only points to why I am using this CGM. Come to think of it, last Monday I also had an ungodly early low.


Theresa Flaherty

by: Theresa Flaherty - Friday, January 17, 2014

In diabetes we have a rule: the rule of 15. What this means is, if you have a low blood sugar, you should consume 15 grams of carb, wait 15 minutes then test again. It's a good rule and it can work pretty well if you can stick with it.

I woke up this morning around 4 and according to the CGM, my blood sugar was an excellent 98, which I confirmed with my meter. However, since I was planning to roll over and go back to sleep for another 3.5 hours I decided to have a swig of OJ in case my numbers were trending down. I have noticed in recent months (years??) that I do not need 15 grams of juice. This was never more clear than this morning. I had some juice (maybe an ounce—3 carbs—at the most). I'd like go on the record here as saying that even at that dark hour, I used a glass, no carton chugging for me.

Fast forward some time (maybe an hour? I was too groggy to care) and the CGM woke up me to tell me my sugar had soared to at least 240. Could be overnight hormones, could have had a rebound from a low after all (I really don't think so), could have been the juice. But it was interesting all the same, and will be something I ask Erica about when I see her. That's the whole point of the device, to track trends, but also anomolies.

I think the rule of 15 could apply to a lot in life. Take this morning when I discovered that someone had burnt toast badly enough to scorch my brand new stainless steel toaster. It's less than a month old and it has a big black mark. Did I immediately text the likely suspects? Leave a passive-aggressive note? Nope, I waited a few minutes and the urge passed. I'm still ticked, but I am sure the offender will do their best to clean it up. It wasn't intentional, after all.

Theresa Flaherty


by: Theresa Flaherty - Thursday, January 16, 2014

I've been chipped and calibrated and am once again using a dexcom continuous glucose monitor (CGM). I think this is a newer model. It seems smaller and lighter and has a few more data input options. I still have to keep it within reach at all times and have quickly adjusted to picking it up every time I walk away from my desk.

Now, ordinarily, when I am tracking my numbers in this kind of detail (and with a nurse figuratively looking over my shoulder) I am on my best little person with diabetes behavior.

But last night felt like a tequila kinda Wednesday so I went out for margaritas as planned. I like 'em with rocks and salt. Lots of salt. Tequila of choice was Hornitos for those of you keeping track. Now, it's not that I think a margarita is good for my blood sugar, but watching the trend rise quickly and steadily upward was quite the eye-opener. Not only that, my numbers stayed consistently high all night. Too high. In other words, while it's OK to indulge in a rare treat, it's simply not worth it on a regular basis. Especially since I'll have to fess up that I drank two margaritas and they are loaded with sugary sour mix.

The meter only woke me once last night (well, this morning) to remind me my numbers were too high. Which is unfortunate, because the whole point of the great CGM experiment, 2.0, is to see if I am going low too often. Yesterday, I woke with a 60. Monday morning about 4 a.m. it was all the way down to 43! And yes, the lower it gets, the worse it feels and the more it just takes out of you. I was nearly an hour late for work because I needed to sleep in a bit longer to recover.

I also like to give credit where it's due: I arrived for my appt to get the CGM a full 24 hours early! Fortunately, the staff at Maine Medical Endocrinology and Diabetes managed to squeeze me in (thanks, Erica!). 

Stay tuned.

Theresa Flaherty

by: Theresa Flaherty - Monday, January 13, 2014

This week marks the 95th anniversary of the Boston Molasses Disaster. That's when a storage tank exploded sending a wave of the sticky stuff, sometimes reaching 25 feet in height, at 35 mph through the North End. Buildings were knocked off their foundations and crushed.

An excerpt from a Boston Post story at the time reads "Molasses, waist deep, covered the street and swirled and bubbled about the wreckage ... Here and there struggled a form—whether it was animal or human being was impossible to tell. Only an upheaval, a thrashing about in the sticky mass, showed where any life was ... Horses died like so many flies on sticky fly-paper. The more they struggled, the deeper in the mess they were ensnared. Human beings—men and women—suffered likewise."

OK, so the news story is a bit overwrought but doesn't all this make you think of competitive bidding and audits? Ensnaring HME providers in their evil wake? Knocking decades old businesses—indeed the very foundations of the industry—off its collective foundation?

This week we will start on the March issue. The first story I am tackling is the backlog of ALJ appeals (speaking of molasses). No fewer then three people so far have alerted us to a memo from the Office of Medicare Hearings and Appeals.

According to the memo, in January 2012, the OMHA central office received about 1,250 appeals each week. In December 2013, that number was—wait for it—15,000 per week. 15,000! The OMHA has a backlog of 357,000 claims and 65 ALJ judges. (I should note, these aren't just HME appeals). That's nearly 30,000 cases per judge. I guess we can all see why they have suspended assigning new hearing requests. 

I can think of one way to catch up on this backlog: suspend the damn audits. I mean, the fact that there are so many appeals only underscores that the auditors are denying claims based on, as one provider put it to me, being submitted on the wrong color paper. This comes as no surprise to the industry which has all along said that the practice of paying auditors for finding mistakes would create a bounty system in which they get their sticky little fingers into everybody's files. The system is broken and, to add insult to injury, people are being denied due process. I mean, last I checked, this is America, no?

Back to the owners of that exploding molasses tank. They blamed it on anarchists (a claim never borne out).

Audits? Anarchy? You be the judge.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, December 31, 2013

People the world over are counting down the minutes and hours until the New Year arrives. Except perhaps for Jo in the next cube. She's singing "White Christmas."

I am personally counting the minutes until I get sprung from this joint today. No special reason, I just have holiday brain.

So let's talk resolutions. I make a few soft ones every year and don't beat myself up when they (inevitably) fall by the wayside. This year's have to do with fitness, both physical and fiscal.

One idea I got, just today, from the Internet. It's called "plank a day" and every day you do a plank, starting at 20 seconds and aiming just a little higher each day. Just a year ago, I couldn't have even considered this due to my shoulder problems but I have come a long way and while there are residual problems, I am grateful to be on the mend. The projected rock-hard abs will simply be a bonus ; )

This relates to my second resolution: pilates, where I believe they love the plank. I have been wanting to take a class for ages but they are hard to come by around these parts and when you do, they are expensive, the hours are sporadic and the hours are also geared toward folks that don't seem to have to work for a living (which cycles us back to expensive). My gym offers yoga—for free—but it doesn't appeal to me. Other excuses have included that if I am gonna do it, it should be twice a week, or, I'd like the class to be right after work. No more. I found a beginner's class, once a week, near my house at 6:30 in the evening. It's $15 bucks a class (ouch!) but it's time to reallocate funds (wine budget) and make the effort.

Speaking of $15 classes, the other Internet resolution I liked and plan to attempt was a 52 week savings challenge. You save $1 the first week, $2 the second week, $3 the third week and so on. If you keep it up, you have $1,378 by the end of the year.

Check back for updates and Happy New Year!

Theresa Flaherty

by: Theresa Flaherty - Friday, December 20, 2013

I can't be the only person in the industry who doesn't feel like doing any more work this afternoon. HME News will be closed until Dec. 26 and I don't plan on returning until Dec. 30 so really, I am in (festive) vacation mode at this hour.

I've been making cold calls this week (very cold calls, we had a couple of days of fffffrigid temps and nearly 20 inches of snow).

What can I report? Well, despite audits and competitive bidding (the Round 1 recompete is mere days away), there are still providers out there staying positive and staying strong. They are trying to add new products and services and opening new retail locations.

They are also, always, giving back to their communities. Whether it's continuing to supply them with enteral nutrition despite not being paid because it's the right thing to do or whether they are donating wheelchairs to veterans taking part in honor flights, they don't hesitate to lend a hand.

We had our company Christmas party last night. As part of it, we make a donation to the local food bank, because, while there are a million worthy endeavors to support, there is nothing so egregious as neighbors going hungry. I am proud to report that we raised what I believe is a record high $1,000, despite the pinch we have all felt from the economy.

Merry Christmas!

by: Theresa Flaherty - Friday, December 13, 2013

"What's the plural of armadillo?"

That's not typically a question I ask myself when proofing pages for HME News. But I am trying to write a snappier headline for one of associate editor Elizabeth Deprey's stories on mobility providers rethinking their business models as they run screaming from the Medicare program.

But it does kind of point to the larger trend we are seeing of providers doing what they can to diversify and move forward, while CMS and its auditing henchman continue to peck, peck, peck at providers for their perceived peccadillos (did you hear the one about the provider who was denied a claim for a wheelchair for a quadriplegic vent patient because the physician did not initial a date change? You will, it's in the January editorial pages of HME News).

But I digress. For all the horror stories we continue to hear—and I am sure I'll be hearing plenty more next week as I make a new round of cold calls (please, answer the phone, with the holidays we are pressed for story gathering time)—I still manage to speak with people who are trying new things and looking forward to the future. I talk to providers launching ad campaigns, ecommerce sites and new retail locations. They are trying new products and new markets.

As we stumble headlong into the New Year, I hope to hear more of these stories and perhaps, some better news on the bidding and auditing and fronts, as well.

As to the plural of armadillo? Just add an "s."

Theresa Flaherty

by: Theresa Flaherty - Tuesday, November 26, 2013

We've written stories in the past about how home medical equipment allows people to travel to visit friends and relatives for the holidays.

This year, I spoke with the folks at Pediatric Home Service about a photo contest they are holding that shows how vents and other HME allows medically fragile children to do just that. It was a nice contrast to the usual stuff about seniors and oxygen tanks (not that there's anything wrong with that). This allows the provider to not only highlight the services it provides but also showcases the advances that have been made in technology (lighter weight, longer battery).

I am so lucky all I have to do is haul along my glucometer (and strips, insulin, syringe and, if I am really on the ball, fast-acting glucose tabs). And maybe a bottle of wine.

Maybe the first or second year after I was diagnosed, I wound up eating by myself, simply because I was starving, my sugar was bottoming out and it seemed silly to eat extra food that I didn't want or need merely to prolong the turkey. Fortunately, experience has taught me how to better plan around unusual meal times. And carbs. And relatives in general.

Speaking of carbs—and prolonging dinner—have I ever introduced you to my brother and his deep fryer? (We are a little different from one another in all things food, needless to say).

Well, he got the bright idea to deep fry the damn bird (it was all the rage that year). Dinner was a little late. And later. Needless to say, as Russ futzed about with the turkey behind the garage (that's where the fryer was, he wasn't trying to catch the bird), the rest of us chatted, snacked, poured more wine.

Finally, it was time:

"Folks," said bro, "dinner's ready. And there's no turkey."

Did we really just hear that right?

Yes, yes we did. Apparently, he could never get the oil hot enough, so the bird never really cooked but it did get a good soaking in oil.

At least we had room for lots of side dishes and pie, needless to say.

Happy Thanksgiving and safe travels to you and yours.