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by: Theresa Flaherty - Monday, April 19, 2010

Despite cloudy skies over Jacksonville, the providers attending this year's MED Group National Respiratory Conference seem to have a somewhat sunny disposition. They are interested in what's going on and what they can do to stay viable.

Today's speakers included Phil Porte and Patrick Dunne, both of whom I am sure you've heard of.

Both made some interesting observations/comments today that got me thinking.

Phil compared the 36 month cap on oxygen to the Medicare Part D donut hole and, you know, he's right. It is a big gap for patients (and providers) to fall into after that 36 months is up, but before they hit that five-year mark.

He also had some straight talk for providers about health care reform. It's here to stay. For those of you lollygagging around and saying, "Maybe it'll get repealed," it's time to face the music.  It won't.

So yes, certain aspects of the new health care reform law are in play at this year's event, as well as discussions on the latest CPAP guidance and other common concerns of the respiratory provider.

As part of health care reform law, hospitals apparently have to reduce hospital readmissions, and Patrick talked about how providers can position themselves to help hospitals do just that. There's too much to get into right now, but HME News will take a closer look at this topic. Meanwhile, I leave you with this comment of Patrick's which seems to sum it all up nicely:

"If it looks like a barrel of lemons to you, get some sugar and learn to make lemonade."

Theresa Flaherty

by: Theresa Flaherty - Friday, April 16, 2010

Here's a shout out to a blog I stumbled across this morning. It's called a sweet life and it's about diabetes. It caught my eye because a recent posting contained a fascinating history lesson.

After wondering how people with Type 1 diabetes managed to survive the Holocaust, the blogger dug up a story about Eva Saxl, who, along with her husband, fled Nazi-occupied Prague for a Jewish ghetto in Shanghai, which was Japanese occupied at the time. The Japanese began shutting down pharmacies and insulin was impossible to get, except through the black market.

Eva and her husband, Victor, with the aid of a medical textbook, created their own insulin by, get this, extracting it from the pancreases of water buffaloes. Keep in mind that they also had to keep the insulin bacteria-free as well as at proper potency level and you start to realize just how crazy—and brave—this was.

But, it not only worked, Eva and Victor were able to make enough insulin for other diabetics living in the ghetto.

The Saxls eventually landed in the United States, where Eva became a spokeswoman for the American Diabetes Association at a time when most people with diabetes kept it hidden.

I guess I shouldn't complain about those expensive vials of insulin I get from CVS.

Theresa Flaherty

by: Theresa Flaherty - Thursday, April 15, 2010

Could this be competition for the negative pressure folks? An MIT doctoral student has invented a hand-powered suction healing system.

The kicker here: It costs about $3, a far cry from the $3,604 providers pay for new pumps.

According to an article in Fast Company Magazine:

The device, which has been field-tested in Haiti, is composed of an airtight wound dressing, connected by a plastic tube to a cylinder with accordion-like folds. Squeezing it creates the suction, which lasts as long as there's no air leak. What's more, where regular dressings need to be replaced up to three times a day--a painful ordeal--the new cuff can be left on for several days.

I realize I am comparing apples to oranges here folks, but still, you gotta admit, it's an interesting concept, not to mention an improvement over the leech treatments of yore.

Theresa Flaherty

by: Theresa Flaherty - Thursday, April 1, 2010

Unless you've been living under a rock (and I know some of you out there have), you probably know that the health care reform bill expanded Round 2 of competitive bidding to an additional 21 MSAs. There is no official list, but AAHomecare (if you haven't joined, you really should) has put together an unofficial list of potential areas. But, the bigger picture is, even if you are not in Round 1 or 2 of the dreaded program, competitive bidding is going to affect you.

I repeat, this is not an unofficial list.

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD
Washington-Arlington-Alexandria, DC-VA-MD-WV
Boston-Cambridge-Quincy, MA-NH
Phoenix-Mesa-Scottsdale, AZ
Seattle-Tacoma-Bellevue, WA
St. Louis, MO-IL
Baltimore, MD
Portland-Vancouver-Beaverton, OR
Providence-New Bedford-Fall River, RI-MA
Buffalo-Niagara Falls, NY
Rochester, NY
Tucson, AZ
Honolulu, HI
Albany-Schenectady-Troy, NY
Oxnard-Thousand Oaks-Ventura, CA
Worcester, MA
Springfield, MA
Sarasota-Bradenton-Venice, FL
Stockton, CA
Poughkeepsie-Newburgh-Middletown, NY
Boise City, ID

Also, here are the next three beyond the 21-MSA cutoff:

Madison, WI
Des Moines-West Des Moines, IA
Harrisburg-Carlisle, PA

by: Theresa Flaherty - Wednesday, March 31, 2010

The call came in around 3 this afternoon.

"Theresa, do you remember me?" asked the caller. "I just got my billing number reinstated, but only to March 27. What about all those other months of rental on my equipment?"

That provider's lawmaker had written a letter on his behalf and within two weeks he had his number back, although he is still seeking to bill retroactively the date he relinquished it.

Meanwhile, the volume of calls to the National Supplier Clearinghouse Advisory Committee has dwindled, said Rose Schafhauser, operations administration for the committee.

"Hopefully--hopefully--the worst is over," she said. "I think the backlog was so large and you had so many people that were voluntarily suspending their number (they couldn't keep up)."

Well....the NSC should have planned better. I can imagine what would happen if I took five  months to write a story. Or pay a bill.

Needless to say, but I'll say it anyway, the whole experience has left a bitter taste in providers' mouths.

"Eth," who got her (his?) number today reinstated today, posted this comment to a blog I wrote in February.

"For the first five months, our application was in the mail room in a pile. In January, it was changed to a pile on someone's desk. Unbelievable! Sixty days as advertised turned into eight months--wish my creditors had the same timeline."

Congrats to these to providers on their perseverance. Shame on CMS and the NSC.

Theresa Flaherty

by: Theresa Flaherty - Monday, March 29, 2010

I was reading the latest issue of Newsweek yesterday and one article caught my eye. It had to do with how far, and not so far, women have come in the workplace over the last 40 years.

In 1970, 46 female employees ("dollies," they were called) sued Newsweek for gender discrimination. Fast-forward to 2010: Much has changed, says the article, titled "Are we there yet?" but sadly, women (everywhere, not just at the magazine) have not totally caught up. In 2010, women still earn only 77 cents on the dollar to men. In 2010, women who hold MBAs earn $4,600 less per year in their first job out of B-school then their male counterparts. In 2010, 43% of all women are employed as secretaries, nurses, teachers and cashiers, very little change from 1960. You get my drift.

Coincidentally, at HME News last week, we were trying to think of a few strong women leaders in the industry. We know you're out there. But, it is far easier to list a bunch of strong and, frankly, not-so-strong male executives in the HME world. And, I know from the many Medtrade shows I've attended, pen and notebook in hand, that I often have to seek out women when looking for a balanced variety of quotes. Why is that?

What is the make up of your company? Are there women in the upper ranks or are they answering phones and doing the billing? Whatever their job description, are their salaries on par with male colleagues doing the same work?

Theresa Flaherty

by: Theresa Flaherty - Tuesday, March 23, 2010

OK. I think a new food/obesity study making the rounds today is trying to compare, well, apples to oranges.

Brian Wasnik, a Cornell University food behavior scientist, and a team of researchers, used a computer to compare the size of the food depicted in 52 paintings of The Last Supper, including Da Vinci's famous rendering.

The size of the main dish grew 69 percent; the size of the plate, 66 percent, and the bread, 23 percent, between the years 1000 and 2000.

"I think people assume that increased serving sizes, or 'portion distortion,' is a recent phenomenon," said Brian Wansink, director of the Cornell University Food and Brand Lab and author of "Mindless Eating: Why We Eat More Than We Think." "But this research indicates that it's a general trend for at least the last millennium."

It's a painting. Paintings have as many meanings and interpretations as there are artists to paint them. Deconstructing a painting, as any art history student could tell you, is not about taking it literally and applying a modern context to it. In this case, I would wager  the large portions are meant simply to reflect bounty or abundance, not actual serving sizes. And yes, as people became more innovative, and wealthier, they had more food. Besides, who wants to look at a painting of the Last Supper and see bread and water (or, in this case, wine).

Still, I suppose it's a fun study, if not pure science. Here's an article for further reading, from the Los Angeles Times.

I just seriously hope a breakdown of body types a la Picasso isn't next.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, March 16, 2010

So Deutsche Bank is looking for some data on HME and competitive bidding. So what? Happens all the time in industries across the world. In fact, HME News, under Executive Director Mike Moran, also collects data. And from the phone calls we regularly get asking about our data, HME providers love this stuff.

But I am hardly surprised that once again HME providers are up in arms about making data available (when they even have data. Remember the October HME NewsPoll? The one in which nearly three quarters of providers couldn't put a dollar value on the services they provide Medicare beneficiaries).

When the HME industry can't cough up cold hard data about how hard Medicare is hitting them because it doesn't consider associated costs, well, then, small wonder CMS don't listen.

Mike, in his blog "Deutsch Bank's sniffing around" quotes a provider, who received the bank's survey as "asking for some very private information considering that round 2 is nearing. Needless to say, I’m not completing it.”

Let's see: It is indeed asking for your recent bid amounts. I'm sure that's closely guarded information,  It wants stuff like company location and number of patients. Etc, etc. etc. I ask these questions all the time (except for the one on bid amounts; I know better).

The National Home Infusion Association has the right idea with its new industry survey, which rolled out in January. As the association's Nancy Kramer told me: "Today we cannot answer how many patients in the United States receive home infusion therapy," she said. "We should know that answer. We should be able to leverage that when legislative and reimbursement decisions are made."

So, while the industry, and Mike, might just not like the intrusion of an outsider poking around providers, I say maybe it's time to look at the bigger culture of fear and secrecy that run rampant in the HME sector.

Want more reimbursement for your services? Show CMS and lawmakers what it costs. Transparency works both ways.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, March 2, 2010

Jonathan Blum appreciates your concerns. He really does.

But the competitive bidding program is moving forward.

A brave statement to make at a luncheon populated by about 300 HME providers with knives.

"We take PAOC very seriously and we've learned from the past," Blum, the director of Medicare Management Services told the crowd at AAHomecare's conference today. "The online bidding system is smoother, and we are not aware of any significant concerns."

That's all well and good, said providers, but you're missing the point, Mr. Blum. As PAMS' John Shirvinsky put it:  "No matter how hard you guys work, it's a fundamentally flawed program. This is going into the market, weaning the players and hoping that the chips fall where they may and everybody is served."

One thing that really seemed to irk the crowd. Blum attempted to describe a way in which the program is anti-fraud. Apparently, in CMS's mind, high prices attract interest of the not so-legal kind. So, if through competitive bidding, we "get prices right," the crooks will go find another market to swindle.

Thereby once again punishing HME providers who try to do the right thing.

But, as Walt Gorski suggested later in the day, there was some good that came out of Blum's lunchtime chat.

"That was a really motivational speech for us all (to get more sponsors to sign HR 3790)," he told attendees.

I think tomorrow, on Capitol Hill, providers plan to do just that.

Theresa Flaherty

by: Theresa Flaherty - Monday, March 1, 2010

I had a hot dog near the Lincoln monument this afternoon and discovered a new use for walking canes. A woman used hers to fend off a particularly aggressive squirrel who tried to join her for lunch today. Unlike our esteemed executive editor, she doesn't travel with a BB gun, so it was her weapon of choice. Effective, but there's probably no Medicare code for that one.

Fast forward to this evening: I was  just chatting with Clay Stribling at the welcome reception at AAHomecare's Legistlative Conference. Although I wasn't taking notes, I don't think he'll mind if I write about this.

Clay attends lots of these industry events. He usually speaks at them about the Medicare topic du jour. Clay's a little frustrated these days. Seems every time he's slated for a talk, Medicare changes its mind. To wit: In recent weeks, the consignment closet rules and the OIG telemarketing alert.

My point? The industry is constantly changing and providers who want to keep up with those changes belong to industry associations like AAHomecare. They attend these events. They even, on occasion, make some of those changes happen.

As another attendee told me tonight, and she shall remain nameless: "It's their livelihood." She was talking about how, as always, we see the same faces at these events. Where are the rest of y'all? (sorry, I come south, that is, anything below Boston on the map, I like to try out a southern accent).

She's right, you know. It's your livelihood. I hope you are one the providers here this week who feels strongly enough about that livelihood that you were compelled to come to Washington and speak up for it.

Theresa Flaherty