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by: Mike Moran - Wednesday, November 12, 2008

When Sen. Barack Obama got elected president, industry stakeholders began wondering: How quickly will he and a Democrat-lead Congress try to address healthcare issues, and what impact will the changes have on the home medical equipment industry? It looks like we have the answer to the first question. Sen. Max Baucus, D-Mont., unveiled today a "detailed blueprint" to guarantee health insurance for all Americans, according to an article Postal hd in The New York Times. The word on the street is that he and Sen. Ted Kennedy, D-Mont., were tripping over themselves trying to introduce a plan first.

Additionally, four leading advocacy groups, including the AARP, have started a campaign to press Obama to enact comprehensive healthcare reform in his first 100 days in office , according to an article

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in The Los Angeles Times.

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How this all affects the HME industry is still unknown. Baucus' plan is a mixed bag for the HME industry, according to AAHomecare. It proposes healthcare policies that "shift the focus from institutional care to services provided in the home and community," but it also hails competitive bidding as an anti-fraud program and a sound payment methodology for HME and services. Sounds contradictory to me.

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by: Mike Moran - Tuesday, November 4, 2008

An interesting excerpt from a Time article posted today:

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In one unscheduled stop of the day, less than an hour after (the death of his grandmother Madelyn Dunham), Obama popped into his campaign office in Charlotte and made a few phone calls to uncommitted voters. He did not mention his grandmother to the campaign volunteers there, who were stunned and thrilled at his arrival. But his upbeat mood suddenly changed in the middle of one of the telephone calls, when the voter to whom he was talking brought up the subject of home heath care for the elderly.

"This is happening in my own family, and in addition to Social Security and Medicare, one of the things that I think is really important is (utilizing) home care a lot more," Obama said, suddenly looking sad and tired. "My grandmother was able to stay (at) home all the way until recently."

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Click here

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to read the whole article.

by: Mike Moran - Monday, November 3, 2008

If you weren't at Medtrade last week, here's a recap of the show's top stories:

*The HME industry may have numerous cuts and fraud charges to do deal with, but challenges create opportunities, said five industry panelists during a jam-packed keynote address.

*When it comes to preparing for upcoming changes in the industry—national competitive bidding, the oxygen cap and the 9.5% nationwide reimbursement cut—it wouldn't hurt for providers to do a little role playing, said an industry consultant.

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*Respironics and Philips Electronics plan to take advantage of their synergies to drive up revenues for home healthcare to 1 billion to 1.5 billion euros.

*ResMed has introduced a new CPAP mask designed specifically for women.

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*Shoprider enters lift chair business.

*Traffic at Accreditation Central was brisk.

*Several state associations shared a common booth at Medtrade. Their goal: Take advantage of a growing interest in membership.

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*For providers, launching a lobbying or public relations campaign may seem like a luxury they can't afford, but AAHomecare says that doesn't have to be the case.

*SeQual demos repair software.

For these stories and more, read Show Daily #2 and Show Daily #3.

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by: Mike Moran - Thursday, October 16, 2008

CMS last week announced plans to roll out a bunch of anti-fraud measures. There were quite a few familiar measures: conducting more stringent reviews of new applications, including background checks; and making unannounced site visits. But there was one measure that caught me off guard:

"CMS is also shifting its traditional approach to fighting fraud by working directly with beneficiaries by ensuring they received the durable medical equipment or home health services for which Medicare was billed and that the items or services were medically necessary," stated the agency's press release.

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This is an interesting approach, one that I've never heard discussed before.

I can see how this would work. Picture this: A fraudulent provider has used a beneficiary's Medicare number without his consent to bill for a piece of DME the beneficiary never needed or received. When CMS calls the beneficiary, he says, "What DME?" Or a fraudulent provider has billed Medicare for a more expensive power wheelchair but delivers to the beneficiary a less expensive scooter. When CMS calls the beneficiary, he says, "What power wheelchair? I have a scooter."

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But I also see how this could blow up in CMS's face. Picture this: CMS calls a beneficiary and asks him whether his power wheelchair is medically necessary. More specifically, CMS asks him whether he uses his power wheelchair outside the home, and he says, "Yes." What then? CMS sends a recovery unit to the beneficiary's house to pick up the medically unnecessary wheelchair?

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If this type of situation unfolds, it might actually work in the industry's favor. Beneficiaries will start associating CMS, not providers, with bad policy.

by: Mike Moran - Wednesday, October 8, 2008

UPDATE: The Senate passed the bill 74-25. The House of Representatives is back in session tomorrow.

As I write this blog on Wednesday, the Senate is debating whether to pass its version of a financial markets bill (At the moment, Sen. Bernie Sanders, I-Vt., is pontificating in front of a large poster of Treasury Secretary Henry Paulson; he's detailing the millions in compensation Paulson has made in the past five years). A vote is expected tonight.

We sent a NewsPoll to readers this morning, asking them whether they agree with the government’s plan to spend $700 billion in taxpayer money to bail out the financial market. In less than 24 hours, more than 200 readers have responded. A large majority of readers say, "No." They also say the crisis has not affected their ability to borrow money and they don't think the bail out will help.

Do you agree? Vote and submit comments at:

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by: Mike Moran - Tuesday, October 7, 2008

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Invacare received national air time last week. As part of a series called "Everyone Has a Story," the Today show featured Lance Carr, a 38-year-old with muscular dystrophy who thanked his father, his "hero," for caring for him. During the show, Carr received a new wheelchair donated by the Elyria, Ohio-based manufacturer.

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Some potentially bad news:
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McCain plans to cut Medicare and Medicaid to pay for his health plan, according to an article Hookers Inc. movie download

published today in the Wall Street Journal.

by: Mike Moran - Wednesday, September 24, 2008

Claims for glucose test strips for patients whose diagnosis codes listed them as having breathing problems, bubonic plague, leprosy and impotence?

So reads another report released today by the Senate Permanent Subcommittee on Investigations. Investigators looked at medical equipment claims submitted between 1995 and 2005 and found $4.8 billion in Medicare payments for bills submitted with codes that were invalid or blank.

Some bills featured smiley faces or exclamation points instead of proper coding. But guess what? They were still paid.

A CMS official told USA Today that the agency addressed this "vulnerability" five years ago. Investigators acknowledged that spending on claims paid with invalid codes fell dramatically after 2003. They still topped $23 million from 2004 to 2006, though.

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The report is the third in a series of reports by the subcommittee on medical equipment.

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by: Mike Moran - Friday, September 19, 2008

Feeling no need to pontificate this late on a Friday, here are a few interesting reads:

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This means providers in California who do business with Medi-Cal will start getting paid again.

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Individuals and clients in parts of Texas have been extended a number of relief measures, including "guidelines for durable medical equipment and supplies replacement will be modified to allow earlier replacement should the item be damaged, lost or destroyed."

by: Mike Moran - Wednesday, September 10, 2008
Did this pass your radar? On Sept. 8, Johns Hopkins University announced it had received a $1.7 million grant from the John A. Hartford Foundation to help primary care practices in eight states improve the quality and outcomes of health care for older adults with chronic illnesses. Twilight trailer

So what, you're asking? Well, the university's Roger C. Lipitz Center for Integrated Health Care, part of its Bloomberg School of Public Health, plans to use the money to help primary care practices to qualify and participate in CMS's three-year Medicare Medical Home Demonstration.

Medicare Medical Home Demonstration? The demo, required by the Tax Relief and Health Care Act of 2006, seeks to "redesign the health care delivery system to provide targeted, accessible, continuous and coordinated care to high-need populations and under which...incentive payments are paid to physicians participating in practices that provide as a medical home."

Elegy rip Stay with me here. Take Johns Hopkins' Guided Care model, for example. Per the model, "Specially trained nurses work closely with physicians and chronically ill patients to improve quality of life and reduce the need for expensive inpatient health services. The nurses assesses patient needs in their home, develops a care plan, monitors conditions, educate and empowers the patient, supports family caregivers, smooths transition between sites of care and works with community agencies to ensure that the patient's health care needs are met."

This is the kind of news item that crosses our desk (or really, our computer screens) and we think, "Hmmm, that's interesting," and then we continue interviewing and writing about national competitive bidding, the 36-month oxygen cap or some other more pressing, HME-related issue. We only have so big a news hole to fill, after all.

But if I were an HME provider, I'd take notice. This demo could go a long way toward educating physicians and nurses about the importance of caring for patients in their homes and the role HME providers play in helping them do that (Won't they need HME to care for many of these patients?).

I'm not telling you anything new here, but home health care is, in many cases, not only more comfortable for the patient but also more cost effective. Based on a pilot study, Johns Hopkins found that insurance costs for Guided Care patients were 23% lower over a six-month period. That's quite a savings, when you consider Medicare beneficiaries with multiple chronic conditions account for 80% of Medicare spending, which totaled $425 billion in 2007.

So what's a provider to do with this kind of information? Keep it in your back pocket and the next time you're visiting with referral sources or legislators, tell them about it. If this demo becomes the wave of the future, hopefully, they'll remember that you're part of the solution.

by: Mike Moran - Thursday, September 4, 2008

It was "hugs and kisses" all around for CMS officials during a Sept. 3 special Open Door Forum. Of course, the verbal displays of affection were from all the physicians, podiatrists, opticians and other medical professionals who discovered, much to their delight, that they are exempt from accreditation.
Needless to say, HME providers are not excused.
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The forum was held to provide guidance to all DMEPOS providers on the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA).

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A new subparagraph (F) added to MIPPA section 154(b) states that "eligible professionals and other persons are exempt from meeting the September 30, 2009 accreditation deadline until CMS determines that the quality standards are specifically designed to apply to such professionals and other persons."
CMS official Sandra Bastinelli added that CMS will also, for the time being, exempt orthotists and prosthetists from the Sept. 30, 2009 deadline but said the agency will be issuing further clarification on the quality standards for O&P "hopefully in the first six months of 2009."
That means orthotists and prosthetists may have to get accredited at some point.
Bastinelli continued her push to get HME providers rolling on accreditation, telling listeners that they need to get their applications in to their accrediting organization no later than Jan. 31, 2009 if they want to be assured of getting accredited in time.

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