Subscribe to E–SP RSS Feed


by: Theresa Flaherty - Thursday, November 19, 2009

Few people know about senseless government waste more than HME providers. But it seems beneficiaries might be taking notice as well.

A recent opinion piece on the asks "What is wrong with Medicare"? Written by a man name Joe, who turned 65 this year, it outlines his introduction to Medicare rules and regs regarding CPAP machines and supplies. Joe was diagnosed with a sleep study in 2006 and has been using CPAP ever since.

My sleep study was conducted at a sleep lab chosen by my insurance company, and the exam determined that I indeed suffered from sleep apnea after only 109 minutes of testing. However, despite being officially diagnosed with sleep apnea, Medicare rules require a sleep study lasting at least 120 minutes. Therefore, since I was 11 minutes short of their requirement, I must undergo another sleep study exam in order to qualify for the CPAP supplies that I have been receiving regularly for the past three years. The exam costs over $1,000, but I was told that I would not be billed for the sleep study because Medicare will incur all charges.

So, while Joe, the new Medicare beneficiary, has successfully gotten himself diagnosed and treated for three years, your government would like to shell out another $1,000 for him to retake the sleep study to recoup that extra 11 minutes. Meanwhile, we hear daily about soaring health care costs, soaring Medicare costs and millions of uninsured Americans. Undeterred, Joe attempted to reason with Medicare.

I called Medicare directly to advise them of this absurdity and spoke to two different customer service representatives in the hopes of convincing them that this was a unique situation that warranted an exception to the rule. However, I was told was that I needed to retake the sleep study or they would deny any CPAP supply claims.

The problem, of course, is that a bureaucracy offers no flexibility. It isn't, shall we say, nimble. Which should scare the beejesus out of everyone as all these unwieldy trillion dollar health care reform plans (although I haven't seen too much actual reform included) wend their way through Congress.

Why are Medicare costs so out of control? I think the problem starts with Medicare itself.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, November 17, 2009

It isn't enough that a lot of Americans are overweight. Now, our pets are, too, apparently, a hefty 50% of them (disclaimer, I live with a rather large black cat, Bruce, but he came that way and is on a diet).

But, I digress. As I may have mentioned, November is National Diabetes Awareness month. It came to my attention this morning that it is also National Pet Diabetes Awareness Month.

Note: Not all overweight people develop type 2 diabetes, not all people with diabetes are overweight and I believe the same applies to pets.

Still, with 24 million people in this country with the disease, can I just say it is ridiculous that we now have to devote time and attention to the same common sense care and feeding of animals we should be taking with ourselves, and our (well, your) children?

Theresa Flaherty

by: Theresa Flaherty - Friday, November 13, 2009

Tomorrow is World Diabetes Day.  Have you ever heard of it? It started in 1991 as a way to,  you guessed it, raise awareness about diabetes. The date, Nov. 14, was chosen because it is the birth date of Sir Frederick Banting, who discovered insulin, which I personally think is one of the greatest discoveries of the 20th century.

The International Diabetes Federation, which created World Diabetes Day, issued a Blue Monument Challenge this year. More than 800 monuments will light up in blue. The monuments include: The Empire State Building, Niagara Falls, the London Eye in the United Kingdom, the Sydney Opera House in Australia, Place de la Concorde in France and Tokyo Tower in Japan, as well as monuments in South Africa, the United Arab Emirates and Germany.

According to the IDF, there are 285 million people with diabetes world wide.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, November 3, 2009

This morning, the executive editor forwarded me a press release on American Diabetes Month and suggested I poke around and see what providers are doing to incorporate this national campaign into their marketing etc this month.

He does this every year.

It's not an unreasonable suggestion for a story but it's not one I am able to write because, well, most providers don't do anything special. I don't know why. The ones I talk to genuinely care about their diabetes patients but November just doesn't bring out the promotions the way that October does with National Breast Cancer Awareness Month.

Maybe they've tried in the past and haven't gotten much traction for their efforts. Maybe its because diabetes is kind of boring. Still, I would think any opportunity to position oneself in front of the community would be jumped at.

I was talking to provider Laurie Schneider of Great Lakes Home Healthcare last week. That company does specials each month, often tied into a bigger theme. This month, it's 10% off diabetes accessories like socks. Great Lakes customers, she says, are now quite accustomed to asking what the monthly special is.

"We always have a huge month when we offer discounts," she told me.

With so many people out of work or uninsured, what about offering free blood sugar checks? Sure, it will cost you a little out of pocket and yes, if these folks do in fact, have diabetes but no money or insurance, they aren't exactly going to look like a cash cow. But, they might remember you down the road. And really, customer loyalty is kind of priceless.

Theresa Flaherty

by: Theresa Flaherty - Friday, October 30, 2009

candy-cornWell, once again it's Halloween and I am trying to decide whether to give out candy (good candy, like Reese's or M&Ms as opposed to say, Bit o' Honey). Maybe a less, shall we say, sugar-chocked item would suffice?
It's not just because, as a person with Type 1 diabetes, I rarely eat the stuff any more and prefer to avoid the temptation (and calories). It's also because I see your kids out there and, well, they don't look like they need it. They're getting bigger everyday. And, before you parents of "husky" kids scream defensively "He's just big-boned!" let me just assure you, it's your fat kid that always gets greedy, groveling and grasping for two or three candy bars (Get those pudgy fingers away from me).
Coincidence? Not!
Do I sound like the Wicked Witch? Believe me, it's not the first time comparisons have been made.
But let's face it: People who don't take care of themselves wind up costing the health care system money. Lots of it. The younger they start, the more they cost. The fatter they are, the more they cost. The greater the co-morbidities, the more they cost. This is where I would normally insert rising rates of obesity and type 2 diabetes, but we've all see the statistics.

With all the focus on health care reform, the topic of personal responsibility comes up again and again, and rightly so.
Taken all together, stickers and pretzels are starting to look like a better alternative all of a sudden.

Theresa Flaherty

by: Theresa Flaherty - Thursday, October 29, 2009

[Posted 10/27/2009] Qualitest Pharmaceuticals and FDA notified healthcare professionals of a nationwide recall of Accusure Insulin Syringes. All syringes, regardless of lot number, are subject to this recall. These syringes were distributed between January 2002 and October 2009 to wholesale and retail pharmacies nationwide (including Puerto Rico). The syringes in these lots may have needles which detach from the syringe. If the needle becomes detached from the syringe during use, it can become stuck in the insulin vial, push back into to the syringe, or remain in the skin after injection. Consumers who have any Accusure insulin syringes should stop using them and contact Qualitest at 1-800-444-4011 for reimbursement.

by: Theresa Flaherty - Wednesday, October 28, 2009

Add prison inmates to the growing list of niche populations for sleep apnea.

Executive director Ed Grandi, executive director of the American Sleep Apnea Association, gave a talk at a conference attended by health care providers who work with incarcerated adults and adolescents.

In his talk, Grandi offered basic information on how to address this problem as well as suggestions on how to improve adherence to therapy.

I just wonder what kind of problems creep up in tiny prison cells when one inmate suffers from sleep apnea. Which is worse for his cellmate? The snoring?  A noisy CPAP machine? Can they even use CPAPs in prison?

Theresa Flaherty

by: Theresa Flaherty - Friday, October 23, 2009

A provider emailed me the other day wondering if the deadline extension for pharmacies to get accredited would include big-box stores like Walgreens.

I couldn't provide him with a detailed answer, except to say I didn't think so (hey, this stuff confuses me, too).

I do know that part of the reason for the extension was also to buy more time to get a permanent exemption from the requirement in there.

This morning, in poring over VGM's analysis on the latest version of the Senate Finance Committee's health care bill (thank you VGM!)  I came across the provision to permanently exempt "certain" pharmacies from accreditation. Here it is:

Effective January 1, 2010, the Committee Bill would make certain pharmacies eligible for an exemption from the accreditation requirements.  A pharmacy would be exempt from the accreditation requirements under the following circumstances: (1) the pharmacy submits an attestation that its total Medicare DMEPOS billings are, and continue to be, less than a rolling three year average of five percent of total pharmacy sales; (2) the pharmacy submits an attestation that it is enrolled as a provider of durable medical equipment, prosthetics, orthotics, and supplies under the Medicare program for at least 5 years and has had no adverse determination against it for the last five years due to fraud; and (3) the pharmacy is willing to submit documentation to the Secretary (based on a random sample of pharmacies) that would allow the Secretary to verify the information in (1) and (2).  The documentation submitted for (3) would be required to consist of an accountant certification or filing of tax returns by the pharmacy.

The provision would also allow the Secretary to determine accreditation standards that are more appropriate for pharmacies. The Secretary would have the authority to implement this amendment by program instruction or otherwise.

Theresa Flaherty

by: Theresa Flaherty - Thursday, October 22, 2009

images-11Provider Vicki Jones is tickled pink. She opened a branch of the Women's Health Boutique in Dallas yesterday.

"Channel 11 covered our ribbon cutting," she said. "A full minute! Wow! That was fabulous for us."

It doesn't hurt that it's National Breast Cancer Awareness month, when fall colors everywhere mingle with ubiquitous pink ribbon products.

"We wanted to play off that. The media seems more open to the stories we have to tell during October," said Jones.

Jones has been doing this for 20 years and welcomes the attention breast cancer gets these days. It wasn't always like that.

"Back then, you didn't even say the word breast cancer, no one even knew what the word mastectomy was or how to say prosthesis," she said. "Now, we have NFL football teams wearing pink ribbons during games. That's wonderful."

Theresa Flaherty

by: Theresa Flaherty - Wednesday, October 21, 2009

Undercover police in Phoenix this week busted up a diabetes test strip ring.

Yup, you read that right.
Samuel Camerano, 49, is charged with trafficking in stolen goods. He allegedly buys stolen test strips and resells them on sites such as ebay and to other distributors who then sell them back to the pharmacy.
According to an article on, police said that during the operation Camerano bought 30 boxes of test strips with a value of $2,254 for only $215 on five different occasions believing them to be stolen property. Authorities said the final sale of test strips to Camerano was on Oct. 8, and he was arrested and charged with trafficking stolen property immediately following the transaction.
Police launched their investigation when area Target stores reported an increase in test strip thievery.
In Sarasota, Fla. sheriff's deputies arrested to people, also for stealing test strips—and, randomly, cologne—from two area Target stores.
Personally, I wonder what Target is thinking? I can't even buy store brand glucose tabs without getting a pharmacy staffer to unlock the case for me (and if you've followed my CVS saga, you know how I love to interact with them).

But I digress. Once again, I must ask, why, oh why, do test strips cost so much?

Theresa Flaherty