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On the Editor's Desk

by: Liz Beaulieu - Tuesday, July 18, 2017

In these challenging days of national competitive bidding pricing and widespread auditing, HME businesses can be, understandably, an insular bunch.

But there are problems in any market. And the severity of those problems typically ebb and flow, with periods of decline and regrowth.

At this year’s HME News Business Summit, we’re here to focus on the latter: regrowth.

To regrow, a business must take action. It can’t wait for it to happen. It must make it happen.

Sometimes taking action means throwing your playbook out the window. Never think you’d outsource your billing operations to another country? Never think you’d drop-ship sleep therapy equipment and service patients remotely? For speakers Todd Usher and Joseph LaPorta, two providers, it not only made sense, it has worked.

Even pre-eminent health systems are under pressure to take action. As health care transitions from a fee-for-service to value-based model, keynote speaker Don Carroll is reshaping Cleveland Clinic’s home and transitional care services to become not only a provider of specialty referral-based services, but also a manager of population health. He’s writing a new playbook for connected care.

There are very few more action-oriented entities than private equity firms, and we’ll have three of them represented on a panel to talk about how they’re taking HME-related businesses to the next level. Less burdened by the industry’s past successes and failures, these firms have no playbooks. Almost anything is fair game.

To use a lofty quote from Gandhi: “Action expresses priorities.” What actions are you taking? And what does that say about your priorities?

Come to the Summit and find out.

by: Liz Beaulieu - Wednesday, July 5, 2017

When it comes to the HME industry, data can be hard to come by.

Almost all HME companies (on the provider side, anyway) are private now, so there’s no more gleaning, say, revenue per employee for Apria Healthcare and using that as a benchmark (in context, of course) for your revenue per employee. This reminds me, we had a session at our HME News Business Summit a number of years back, during which Don Davis analyzed the financials of some of the national HME companies, which were still public at the time—let’s just say you didn’t need toothpicks to keep everyone’s eyes open for that hour.

That’s why in the past five years or so, there’s been a big effort to fill in this void in a number of different ways. AAHomecare launched a data gathering initiative related to audits. The VGM Group launched an impact survey to collect data on the impact of competitive bidding on HME companies and their patients. The overarching goal of these surveys: using data to influence policy change.

But going back 12 years now, the Financial Benchmarking Survey conducted by HME News and Steven Richards and Associates has been consistently buzzing in the background, providing useful data to help owners drive their HME companies to succeed on a day-to-day basis.

Data points include:

  • Revenue / revenue growth
  • Revenue by payer / by employee / by payer type
  • Profitability / profit as a percentage of revenues
  • Gross profit / expenses / EBITDA
  • DSO
  • Fastest growing product lines
  • Acquisition cost trends
  • Expense benchmarks

It goes on and on. For a presentation that Rick Glass gives each year at the Summit, during which he analyzes the results of the survey, there are no fewer than 40 slides chockfull with data.

Each year, however, it gets harder and harder to draw a large enough sample to make the survey results useful to HME companies—and representative of the industry.

We know the survey is slightly time consuming. We struggle to balance making the survey easy to complete with making it meaningful—not to mention keeping the data points consistent from year to year, so there’s a historical perspective. We now have a PDF of all the survey questions, so that you can prepare your answers in advance, and then hop online to plug and play.

But, ultimately, we need your help. Help us help you, and complete the survey today. The deadline is Thursday, July 13.

by: Liz Beaulieu - Friday, June 16, 2017

With the better part of half a year now behind us (where did it go???), I thought I’d dig into Google Analytics and see what the most read stories have been so far this year.

It’s not the first time we do these lists. We do them on a yearly basis for sure, but often I’ll make lists bi-annually or even quarterly to take the temperature of what’s most important to the HME industry.

Obviously, competitive bidding has been a recurring topic in the most read stories for years. So is what the larger providers are up to.

And it’s no different this year, with this list, which covers Jan. 1 through June 15. Eight of the top 10 stories deal with competitive bidding, and the other two deal with larger providers.

What is different: The higher-than-ever level of frustration and anxiety, and the higher-than-ever level of action.

Will frustration/anxiety + action = change? It will be interesting to see what the next six months of top stories have in store.

One thing that surprises me about this list, by the way: There aren’t any stories that deal with audits. If competitive bidding is enemy No. 1, audits are enemy No. 2. But with pricing spreading nationwide last year, I think competitive bidding—and the industry—has come to a head.

Top 10 most read stories (Jan. 1 through June 15)

Tougher times ahead: Impact of rate cuts pile up

CMS adds teeth to bid program

HME infrastructure crumbles

‘Right this wrong,’ providers tell CMS

CMS does ‘whatever it wants,’ say frustrated stakeholders

Stakeholders stand ready to change bid program, with Price’s help

Pacific Pulmonary settles for $11.4M

Uncertainty kills Teijin’s bid for US HME market

Caught on tape: Criticism of bid program mixed in with criticism of Obamacare

Bid relief needs adjustment, stakeholders say

by: Liz Beaulieu - Thursday, June 1, 2017

It’s always a pleasure to speak with Weesie Walker, the executive director of NRRTS and before that a long-time clinician with National Seating and Mobility. Here’s the thing about Walker: She may be one of the most unassuming people you know, but she’s also one of the smartest.

Being as steeped in the complex rehab world as she is, naturally we talked about the urgent need for legislators (or CMS itself, for that matter) to permanently protect accessories for complex power wheelchairs from being influenced by competitive bidding pricing. As it stands, CMS will transition to bid related pricing for these accessories on July 1, a move that will result in cuts of 25% or more according to estimates and threaten the ability of clinicians to continue providing them.

The word that Walker uses most frequently to describe the possibility of this happening: scary.

“What do you do?” she wondered. “When you’re the clinician, how do you approach this with the consumer and explain to them that these cuts are preventing them from getting these accessories. And we hate that word—accessories.”

Walker hates the word because, when we’re talking about complex power wheelchairs, these accessories aren’t really accessories, or “things that can be added to something else to make it more useful, versatile or attractive.” They’re really necessities: indispensible.

Walker says the current situation reminds her of a story her husband likes to tell about a nail and a horse and a lost war. When we got off the phone, I literally googled “nail, horse, lost war.”

It turns out, Walker’s referring to a proverb called “For Want of a Nail,” which has many variations, including one that goes like this:

For want of a nail a horseshoe was lost,

For want of a horseshoe a horse went lame

For want of a horse a rider never got through

For want of a rider a message never arrived

For want of a message an army was never sent

For want of an army a battle was lost

For want of a battle a war was lost

For want of a war a kingdom fell

Long story short: The lack of a nail…caused a kingdom to fall.

In Walker’s mind, without accessories, a wheelchair will fail.

“If you don’t have, say, a head rest, it negates the function of the whole  system,” she said.

Leave it to Walker to put it so simply, yet so impressively.

by: Liz Beaulieu - Friday, May 12, 2017

Publisher Rick Rector told me recently, I get comments all the time about how a lot of the news we run is negative.

Really?

Then I got an email from Jeff Baird this week commenting on Monday’s HME Newswire, saying it was “informative, but sobering.” The two top stories in that Wire: “CMS ‘does whatever it wants,’ say frustrated stakeholders,” and “HME infrastructure crumbles.”

Hmmm.

My knee-jerk reaction was to question myself and our coverage, but now that I’ve thought about it, I guess I’d rather be called a Negative Nancy than Polly Positive, at least when it comes to what the HME industry has had to endure in the past 10 years. The list is long: competitive bidding, of course, but also audits, surety bond requirements, payment delays, it goes on and on and on.

I wrote back to Jeff: “Yes, some call HME News too negative. I like to call it realistic.”

Is there a moniker for realistic? Realistic Rebecca? How about Rachel Realistic? I digress.

There is much good going on in the industry—mainly the superhero jobs providers are doing taking care of their patients—and that bears reporting, too, but these are, to use Jeff’s word, sobering times for the HME industry, the most sobering in its history, I would argue.

Still, when Theresa and I met on Wednesday afternoon to come up with an idea for the cartoon for the June issue, we set aside the idea of providers literally running away from Medicare (playing off of AAHomecare’s recent data analysis that more than 40% of providers have dropped that business) or of a large building representing the HME industry literally crumbing (also a play off of that data).

Instead, we went with what we think is a pretty funny visual of travel CPAPs making their way through an airport security checkpoint unencumbered, as opposed to their regular CPAP counterparts. This plays off the news this month that both ResMed and Philips have launched mini-CPAP devices better suited for traveling. See cartoon below.

That’s a bit of positive news for you: manufacturers in the industry developing technology that improves not only convenience but also compliance to therapy and, therefore, overall health.

Of course, about everything else related to that news, however—like how manufacturers are forced to market travel CPAPs as retail items due to the restrictive reimbursement environment—I choose to be realistic.

by: Liz Beaulieu - Monday, April 24, 2017

Earlier this year, we wrote about ResMed teaming up with Dr. Mehmet Oz to launch SleepScore Labs, a new company focused on helping people understand and improve their sleep. One of the company’s first goals: compile and analyze consumer sleep data, starting with its national sleep study at sleepscore.com, and license SleepScore by ResMed technology for other consumer sleep devices.

This morning, I got an email from Ascensia Diabetes Care, announcing a partnership with, you guessed it, the Dr. Oz Show to launch a 60-day “Take Charge” Diabetes Challenge. As part of the challenge, participants will use: Ascensia’s ContourNext One blood glucose monitoring system to monitor their blood glucose; and higi’s health-screening stations and online community platform, which is linked to more than 80 health devices, trackers and apps, to monitor their weight and body mass index. The goal: raise awareness of the importance of testing blood glucose levels regularly and maintaining a healthy diet.

Starting to see where I’m going?

Also today, twitter alerted me to a story about Apple being “fairly advanced” in the development of a continuous noninvasive blood glucose monitor—the Holy Grail of diabetes management. Managing Editor Theresa, Type 1, will believe it when she sees it, but she says, “If anyone can do it, it’s apple.”

The race to not only raise awareness of chronic conditions like obstructive sleep apnea and diabetes but also better manage them is now regularly drawing attention from big names like Dr. Oz and Apple. Say what you will about Dr. Oz (“Half of Dr. Oz’s medical advice is baseless or wrong,” screams one headline from the Washington Post)—and Apple for that matter (any Samsung users out there?)—that’s powerful stuff. The Dr. Oz Show averaged 1.8 million viewers for the season that ended in May 2015; Apple had more than 98 million iPhones in use in the U.S. at the end of March 2015.

Also powerful: the technology that’s fueling increased awareness and better management. Data collection and analysis around chronic conditions has never been higher thanks to connected devices and accompanying apps and software. And although we don’t know much about what Apple is up to, I’d bet the tech giant’s monitor will come with bells and whistles that advance existing use into another stratosphere.

It’s feeling like prime time for chronic conditions, and it’s about time.

by: Liz Beaulieu - Wednesday, March 29, 2017

HME stakeholders have always had a dual strategy: regulatory and legislative.

But with industry champion Tom Price as the new secretary of Health and Human Services, their regulatory strategy has taken on a new sense of urgency.

Stakeholders haven’t wasted time calling on Price, who came onboard in February, to take swift action on a number of issues, most of them competitive bidding-related. In March, both AAHomecare and The VGM Group wrote him letters, detailing their wish lists.

Also in March, I saw this info in the most recent bulletin from the Midwest Association for Medical Equipment Services: “On the advice of congressional committees of jurisdiction (House Ways and Means, Energy and Commerce, Finance), AAH is working regulatory routes to determine if there needs to be a legislative route.”

Again, stakeholders have always had a dual strategy, but it appears they—and their champions in Congress—feel that’s more than going through the motions, now that Price is CMS’s boss.

It’s still early, but there does seem to be a new air of cooperation at CMS. I listened to two Special Open Door Forums on the agency’s new prior authorization process for two complex rehab codes, and for the most part, all of the questions that providers had were answered. There was less of the standard, “Email us and we’ll get your question to the right person” response that has been typical during past forums. What’s more: Things that providers asked for during the first call (concrete examples of accessories that would be considered part of the process, for example) were delivered during the second call.

Then this morning, I saw a Change Request in which CMS instructs the contractors to accept timely orders and medical documentation whether they come from a beneficiary’s treating physician or a transferring HME provider. That’s a big deal for providers in competitive bidding areas, where transfers of beneficiaries from non-contract to contract providers are common.

While these are positive signs, the big questions remain: Will Price pull-through where it matters most, and lead CMS in overhauling the competitive bidding program?

We’ll soon find out.

by: Liz Beaulieu - Friday, March 10, 2017

The best part of my twitter feed is a handful of HME providers who are fairly active on the social media tool. Sure, they’re not always on topic (for some of them, it is a personal account, not a professional account), so there are posts about the Patriots, the new Nintendo Switch and whether or not coleslaw should have a mayo- or vinegar-based dressing (mayo, all the way).

But this week, their posts were the perfect blend of both—personal and professional.

It would be funny, if it weren’t so sad. Providers like Gary Sheehan (@gmsheehan) and Tyler Riddle (@ThomasTRiddle) took to twitter to rant—their word, not mine—about just how dysfunctional and unsustainable the DME benefit for Medicare has become.

Now Gary and Tyler are both funny, but they’re also serious businessmen. Both have been heavily involved in their state associations, as past or current presidents of their board of directors.

Gary started off with this tweet, which was re-tweeted six times and liked nine times:

Just off phone w pt in rural community who cannot find oxygen for his wife. This happens all day. All across America. Shame on you Medicare.

He then proceeded to post tweets of his and the patient’s husband’s correspondence with members of Congress:

Here is topical section of the note I received. This stuff is heartbreaking. Quit your dithering Medicare/Congress and get something done!

He ended the series with:

This is where we are. America's seniors desperately calling Congress to receive oxygen that a year ago was readily available & accessible

Then there’s Tyler. If you want a detailed account of what it’s like to be a provider of sleep therapy products, search no more. In a “epic” stream of more than 50 tweets, he gives you the ins and outs—from how providers are held responsible for patient compliance with CPAP devices (can you imagine a pharmacy being held responsible and essentially having their reimbursement held hostage based on a person taking their meds, he asks) to how Medicare and its policies and regulations may be inadvertently encouraging non-compliance.

After seeing all these tweets, I tweeted Gary and Tyler, noting that they were pretty chippy and asking if it was a full moon or if they had just had enough.

It was the latter.

Which prompted MAMES (@mameshme) to respond, summing it all up:

Happy Friday!

by: Liz Beaulieu - Friday, February 10, 2017

Because I start planning the educational program for the HME News Business Summit in January or February, I often equate the event with winter. 

As I look out at a fresh foot of snow (and think about the two feet of additional snow we could get through Monday), my mind is on what’s top of mind for the C-level execs in the HME industry, and how to turn that into informative and impactful sessions for the Summit.

I’m a bit behind the ball this year (see above: snow means treacherous driving conditions, preventing you from driving to work and day care, which means, not working from home, but hanging out with a two year old).

But don’t worry: I have a few ideas that appear to be gelling together.

Because the Summit is in Cleveland this year (at the Ritz-Carlton, as a matter of fact), I know I’d like someone from the Cleveland Clinic, one of the pre-eminent hospitals in the country, to address our crowd. It looks like our man might be Don Carroll, who heads up the clinic’s Center for Connected Care, which houses all of its home and transitional care services. He’s been charged with finding out how the clinic should respond to increasing pressure to “control” lives outside of its four walls. Carroll has already built out a specialty pharmacy division for the Cleveland Clinic and managed a 19-store pharmacy chain for the hospital. He will talk about how he plans to reshape how the Cleveland Clinic is tackling one of its biggest challenges yet: becoming not just a provider of specialty referral-based services, but also a manager of population health.

I also know I want to address M&A and investments in the HME industry. This is a recurring topic at the Summit, but I feel like 2016 was an especially interesting year for M&A and investments, and I’d like to approach the topic more from the buyer’s perspective, whether it’s an HME company buying another HME company or a private equity firm investing in an HME company. Why are they so bullish on the market?

While we don’t typically do regulatory and legislative updates at the Summit (AAHomecare has a great event dedicated to just this each spring), I don’t think we can ignore the topic of healthcare reform this year, not with the new administration and new secretary of health and human services. How will the Affordable Care Act and other reform efforts be impacted? I’m looking for an expert in Cleveland (an attorney from the Center for Health Law & Policy at the Cleveland-Marshall College of Law? An analyst from the Center for Health Care Research and Policy at Case Western University?) to give us the latest and greatest.

Finally, I’m rolling around ideas about how to address labor cost management, and how to continue last year’s conversation about interoperability.

But I need more ideas. If you can’t come to Maine to help me shovel (or take care of a two year old, so I can work), the least you can do is jot me a line (ebeaulieu@hmenews.com) or send me a tweet (@hmeliz) and let me know what’s top of your mind.

The Summit is just as much your event as ours.

by: Liz Beaulieu - Monday, January 23, 2017

I’ve been making a round of calls to HME industry consultants today to see what they’re working on with their provider clients. (Managing Editor Theresa likes to call the story that I write from these calls “Consultant’s corner.”) I can’t say that I’ve dug up much yet. I’ve been hearing a lot about audits, but that’s pretty much business as usual for HME providers these days.

A number of consultants I’ve spoken with have mentioned the anticipation surrounding the new administration and the possibility of Rep. Tom Price, R-Ga., a supporter of the HME industry (and vice versa), as secretary of the Department of Health and Human Services.

“Everyone’s holding their breath to see if he’ll be confirmed and to see what he’ll do,” one consultant told me.

At the top of the list of things they hope he’ll do, according to a recent HME Newspoll: repeal and replace Medicare’s competitive bidding program.

We’ll know a lot more about Price’s fate tomorrow, after his confirmation hearing before the Senate Finance Committee—they’re the ones that actually vote on his nomination. If you believe the headlines coming out of D.C., it will be a tough day for Price. “Tom Price’s divisive hearing sets stage for brutal Senate Finance battle” was a headline in Politico following Price’s hearing earlier this month before the Senate Health, Education, Labor & Pensions Committee.

I was reminded earlier this month that while the majority of our readers (or those who responded to our poll, anyway) believe Price is a good pick for HHS secretary, they don’t all think so.

“I found your coverage of…Tom Price to be alarming, disgusting and extremely false,” one reader emailed me.

While Price has made a name for himself in the HME industry for his popular stance on HME issues, including repealing and replacing the bid program, this reader pointed out that his larger goal of also repealing and replacing the Affordable Care Act could have serious consequences.

“There will be many, many people uninsured, under insured and dropped from the ‘for profit’ healthcare system, discriminated against and left for dead from politicians stuck in the early 1900s and failing to represent all Americans,” he wrote. “To pretend otherwise is an egregious error on your part and I lost any respect I had for your publication trying to stroke these awful men's egos. You are ignoring the fact that this administration does not care about all its citizens or even most of its citizens. It only cares that the rich ones continue to get richer. Our small little DME companies will disappear or be gobbled up by the large ones who suck up to Tom Price. You apparently no longer represent me.”

He has a point about the uninsured. If Obamacare is largely repealed, fewer people will have health insurance, and that’s not necessarily a good thing for HME providers—especially those who serve Medicaid recipients, because the majority of the people who gained health insurance as a result of Obamacare were added to the Medicaid rolls.

For whatever reasons, however, many of our readers also support repealing and replacing the ACA. Because of the business implications? Because they don’t do a lot of Medicaid business? Because they’re hardline Republicans? All of the above?

Me, I go back to what that consultant said. Not about whether or not Price will be confirmed (isn’t it likely in the current environment in D.C., even after a “battle”?). But about what he’ll do. We know where everyone in the HME industry falls on competitive bidding, but regardless of where you fall on the ACA, what he does or doesn’t do is going to be a big time big deal.

Only time will tell. One thing’s for sure: There are a lot of eyes watching.

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