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by: Theresa Flaherty - Monday, January 25, 2010

This statement caught my eye:

I supported national health insurance until I became Medicare-eligible this year.

After chuckling at that statement, I read on. It's always interesting to get a patient's perspective on the industry—its rules, its regs, its technology. In this case, the writer is a new CPAP patient. Turns out, she doesn't like having Medicare monitor how often she uses the therapy.

Medicare monitored my usage during the first month and threatened to cut me off because I wasn't using the machine enough. Ever try getting used to sleeping with a helmet at night? Not easy is putting it mildly.

Now, while most (actually all) providers would agree with her that it's a tricky therapy, they mostly tell me the policy, despite all the extra work it requires, is good medicine. They also mostly agree that if the patient isn't adhering to the therapy, taxpayers shouldn't be footing the bill.

The writer goes on to complain about the face-to-face follow-up visit.

Then, after a series of difficult procedures, tests and surgeries, Medicare threatened to cut me off again because I couldn't see my pulmonologist within a very rigid time frame. I was just too sick.

Maybe she was too sick. Maybe the policy needs a little more flexibility. Maybe she just likes to moan. I'm just glad she now has Medicare and not some government-controlled health insurance plan (insert sarcasm here).

Finally, our cranky, possibly sleep deprived beneficiary writes:

Who needs Big Brother watching my every move? Sarah Palin's "death panel" may not be as farfetched as I once believed.

Theresa Flaherty

by: Theresa Flaherty - Thursday, January 21, 2010

I just came across yet another article on Medicare fraud. The story lead off with—wait for it—a fake DME provider in Miami.

An article by Mark Potter on MSNBC.com reads:

"After knocking on the door, calling the office number and peering through the mail slot, they found no one inside the 250-square-foot facility, which had only a desk and a few medical supplies on shelves along the wall. "The equipment on the wall certainly wouldn't justify one percent of what's billed to Medicare," said FBI Agent Brian Waterman."

Hmmm. Was there a framed accreditation certificate hanging on the wall? A copy of the company's surety bond on file so that it could bill Medicare for more than $1 million in fake claims?

Why are legitimate providers doing all that again? To prevent fraud, supposedly.

Even better, Medicare often pays dead docs for services rendered. But, if you are a legitimate provider with an order in hand from a long-time trusted referral source, you'd better not contact the patient for whom it was prescribed. At least, that's what the OIG says.


Theresa Flaherty

#HME News

by: Theresa Flaherty - Wednesday, January 20, 2010

Well now I'm thoroughly confused. I just read an article about how a new program at Walgreens that would offer face-to-face consulting services for Type 2 diabetes patients is being panned. By the medical profession.

Now, I realize there is no love lost among independent pharmacies for Walgreens. But, at the heart of the issue, isn't this sort of service supposed to  help the patients—and save the health care system money? Isn't this sort of service what's supposed to separate the good from the bad and the just plain ugly in customer service?

In fact, there has been a push in the industry for pharmacists to offer more one-on-one help, or disease state management, with the patients they see regularly. Diabetes is a natural fit. A story I wrote in August about a new program garnered several calls from providers wanting more information.

It seems the docs are afraid it will "blur the lines" of care. It doesn't sound like Walgreens or any other pharmacy would ever seek to replace a doctor's care, but rather augment, to help the patient. Let's face it: It can take months to get into see the doctor, it's more expensive and it's less convenient.

This doesn't mean I think Walgreens is being altruistic, They, like everyone else, seek to grow revenues.

With reactions like this from the medical community, I fear meaningful health care reform is a long way off.

by: Theresa Flaherty - Tuesday, January 19, 2010

Last Friday I texted my $10 donation to the Red Cross to help victims of last week's earthquake in Haiti. But, aside from the overarching needs of food/water/shelter there are bound to be large numbers of Haitians who need more specific help, including medical care and medicines for specific health conditions, like, say diabetes.

dLife, a multimedia organization geared toward people with diabetes, posted a few options for those of you who would like to donate for more specific needs. Here are two:

dLife Foundation: Supports individuals in need of diabetes supplies and education, and funds diabetes organizations with similar goals. Now through March 31, all donations to the foundation will go directly to medical relief organizations assisting Haiti.

Insulin for Life: Tax-exempt, Australia-based organization collects insulin, syringes, test strips and other supplies to people in urgent need.

And of course, there are many other groups, including Doctors without Borders, UNICEF and AmeriCares. Just make sure you know who you are donating to and that the group is reputable.

Theresa Flaherty

by: Theresa Flaherty - Wednesday, January 13, 2010

I was just reading my co-worker's 'Wheels in Motion' blog about clearing the sidewalks with wheelchair users in mind—after all it's not just the able-bodied who need to traverse them safely.

Her blog brought to mind a little accident I had several years ago while living in Cambridge, just outside Boston. One winter night, I was walking with a friend over extremely icy, lumpy sidewalks (and for those of you in that area, you know how uneven the sidewalks are even in summer—gives whole new meaning to the child's rhyme "step on a crack"). I slipped and fell. Hard.

A woman in a wheelchair passing by stopped to make sure I was OK (my companion was laughing too hard to be of help). I assured her I was.

Now I wonder how she, and others like her, manage to get around in the winter. It's a testament, though, to how home medical equipment can help people get out and about, and yes, even help the (supposedly) able-bodied when necessary.

Stay safe out there!

Theresa Flaherty

by: Theresa Flaherty - Wednesday, January 6, 2010

There's a new show on TNT called "Men of  a Certain Age." Apparently, one of the characters, Owen, uses CPAP, or as the case may be, doesn't use it. I don't watch the show and couldn't find a link to the episode. I found a promo clip, however. Owen wakes up tired and groggy, with his unused CPAP next to him on the nightstand. His wife comes in and says "You'd sleep better if you wear your mask."own-crop-2 Echoing, I'm sure, wives everywhere in real life.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, January 5, 2010

John Coster, senior vice president of government affairs for the National Community Pharmacists Association (NCPA) addressed independent pharmacy issues in a January 4 video posted on YouTube.

The association is still working on a "permanent fix" to DME accreditation, he said.

"Many of you have become accredited, some have not," said Coster. "This permanent exemption will benefit everybody. We believe it will be enacted as part of health care reform."

In case you're one of the three people who hasn't heard: both the House and the Senate reform bills have provisions that would exempt pharmacists from mandatory accreditation. Industry stakeholders hope to see a final version of the bill in February.

Incidentally, NCPA has a couple of other videos posted to YouTube which humorously cover pharmacy-related topics outside the scope of HME News. Check them out and see for yourself.

Theresa Flaherty

by: Theresa Flaherty - Thursday, December 31, 2009

At this time of year we editors like to cull top 10 lists. On this last day of 2009 I perused our stats to see what the top story was for specialty providers. No surprise: it was a CPAP story: Providers request CPAP do-over, which first appeared back in March.

In fact, CPAP documentation requirements, which went into effect in November of 2008, were an ongoing saga this year, with providers trying to educate both physicians and patients with varying degrees of success.

This fall, providers in the first 10 MSAs then had the added joy of crafting bids that factored in the additional expenses associated with providing CPAP to Medicare beneficiaries, all the while knowing that CMS will only look at manufacturer's invoices as an indicator of cost.

But, in recent weeks, as I've talked to CPAP providers, it sounds like they are hanging in there and, in many cases, enjoying patient compliance rates of 90% or more. Still I have a feeling that as the 2010 progresses, issues will continue to challenge and vex providers.

Stay tuned for 2010 and Happy New Year!

Theresa Flaherty

by: Theresa Flaherty - Wednesday, December 30, 2009

I grew up in Maine, a gun-friendly state if there ever was one. I don't understand the desire to own a gun but ... whatever.

However.

Stupid people shouldn't be allowed to own guns (or have driver's licenses for that matter) which brings me to my point. Owing a gun, driving a car, having children all bring with them a healthy amount of personal responsibility, a notion I frequently trumpet in this space.

Police in Macon, Georgia recently cited a 55-year old diabetic man for unlawfully firing a gun after the ambulance he called when he suffered a low blood sugar didn't arrive fast enough.

Not many details were given, but I can't help but wonder why the guy didn't just drink some OJ. One does not need medical attention simply because they have a low blood sugar. If one has the cognitive ability to dial 911 (or pull the trigger) you'd think it'd be a no-brainer to help himself. By the time he should have needed an actual ambulance, he'd probably be unconscious.

Honestly.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, December 29, 2009

This one's from the kind of interesting file. The National Community Pharmacists Association (NCPA) and RxPatrol, which tracks pharmacy crimes, recently released a 10-minute training video for pharmacy staff.

Pharmacies, it appears, are subject to special pharmacy crimes. I have talked to one or two pharmacists in the past who have been robbed. Drugs exude an enticing pull after all. I suppose the "mom and pop" nature of many community pharmacies makes them seem like easy targets.

The 10-minute video outlines various scams as well as ways for pharmacies to protect themselves. To view the video or learn more about RxPatrol and its services visit www.rxpatrol.com.

Pharmacists don't have a choice about Medicare taking their money, but they can sure as heck try to avoid letting others taking what doesn't belong to them.

Theresa Flaherty

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