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by: Liz Beaulieu - Thursday, July 9, 2015

If it’s summer in Maine, it means I’m in the throes of requesting, collecting and analyzing Medicare data sets for two upcoming projects: the annual update of our HME Databank (it happens Oct. 1!) and the publication of the State of the Industry Report (it will be an insert in the December issue).

Both will feature 2014 data.

To put 2014 in perspective, let’s consider that pricing for the Round 1 re-compete went into effect Jan. 1, 2014, and six months before that, pricing for the Round 2 re-compete went into effect July 1, 2013.

I pulled Medicare’s allowed charges for some of the more popular DMEPOS codes, like:

E1390: $1,186,187,433 (vs. $1,403,398,730 in 2013)

E1392: $30,644,855 (vs. $29,359,144 in 2013)

No drastic changes there. How about:

E0601: $181,689,399 (vs. $228,523,480 in 2013)

That’s a change.

How about:

A4253: $317,741,495 (vs. $753,293,520 in 2013)

Yikes. The Round 2 re-compete that went into effect July 1 included a national mail-order program for diabetes supplies that reduced reimbursement by 72%.

For you mobility folks, how about:

K0823: $55,990,584 (vs. $133,239,857 in 2013).

Yikes again. As you know, in addition to competitive bidding, this product has been subject to prior authorization approval in a number of states.

Well, there’s more where this came from.

Stay tuned.

by: Liz Beaulieu - Monday, June 29, 2015

I’m working on a story about oxygen transfilling technology.

I’m working on a story about oxygen transfilling technology because Invacare has reported, for the past few quarters, the loss of a significant order of HomeFills by a national account.

I thought it was a good time to check in on this technology.

I’m still in the middle of interviewing sources, but in trying to determine whether this was a one-off or a trend, I first looked at some data.

In our HME Databank, we track total Medicare reimbursement by code, including K0738, E1392 and E1390. The most current year for which we have data: 2013. That’s before Invacare’s loss, but there’s no denying in looking at total Medicare reimbursement for these three codes from 2009-2013 that portable oxygen concentrators have been the big gainers.





























We also track the top providers by code, including K0738. It turns out Apria is not only the No. 1 provider of this technology (again, as of 2013, before Invacare’s loss) but also the only national provider until Lincare makes an appearance at No. 36. I suppose this is harder to discern than at first glance, however, because some of the providers listed may be owned by Lincare or another national provider. Still, with Apria by far the leader of this product category it’s likely the national account Invacare speaks of.



Will sources in the field support the data: That POCs are enjoying a greater adoption rate than transfilling devices?

More to come.

by: Liz Beaulieu - Wednesday, June 24, 2015

It’s easy to feel, in this small world that is the HME industry, that you’re the only ones going through so much change.

You might ask yourself, is any other industry part of such a seismic shift in the way goods and services are delivered? Is any other industry, as part of that shift, seeing its revenues cut nearly in half?

Of course, the HME industry is not the only industry going through so much change.

This hit me in the side of the head yesterday on my commute home.

I was listening to a story on NPR about a makeover at food giant General Mills. You probably heard the company’s announcement this week that it is removing artificial colors and flavors from its cereal line. (This is good news for a semi-rehabilitated Lucky Charms fan like myself.)

But there’s more to the story, as NPR found out.

General Mills is in the midst of overhauling a number of its food lines, including the iconic Green Giant, which sells some 140 different kinds of vegetable products.

For some perspective, picture the Green Giant and a Golden Commode. They’re both throwbacks to an era gone by.

You see, canned and frozen vegetables don’t have the same appeal they once had. With farm shares, farm-to-table restaurants and farm stands inside grocery stores, consumers expect, and increasingly get, fresh vegetables.

“I think there’s been a pretty dramatic shift across the grocery aisle in the last five years,” Justin Massa, founder of the research firm Food Genius, told NPR. “There’s kind of very few sacred cows in the grocery store.”

Kind of like there are very few sacred products in the HME industry?

Faced with this shift in consumer tastes and the subsequent slowdown in growth, General Mills has two choices, Massa says: It can cut costs by merging (a la Heinz and Kraft); or it can try to increase revenues with products that are more in line with consumer demands.

So, cut costs and shift product mix. Sound familiar?

General Mills is trying to do both. To make its products more in line with consumer demands, for example, it will launch a new line of frozen vegetables this summer—think Brussells sprouts with lentils—that are meant to be sautéed quickly, rather than microwaved, improving their taste and texture.

HME and food are apples and oranges, so to speak, but the themes here are similar.

Only, where the HME industry is dealing with fickle payers like Medicare, General Mills is dealing with fickle consumers.

I’m not sure which is more of a challenge.

by: Liz Beaulieu - Friday, June 19, 2015

I love how The Braff Group thinks.

It noticed last June a particularly low deal count for the HME industry in the first quarter of 2015. But it also noticed a low deal count for the other healthcare sectors it tracks.

So it asked itself, how much of the fourth quarter to first quarter decline was a lull in dealmaking as the New Year kicked off?

I’ll let The Braff Group explain:

“To answer this, we first added up all the deals completed in a particular quarter since 2001. Then, to adjust for the possibility that a surge of volume in a particular quarter in a particular year might distort these figures, we simply ranked each quarter for each year based on the number of deals completed. This way, it doesn’t matter how many more deals were completed in one period vs. another, just now each period compared to another.”

The results:

What does The Braff Group make of all this?

“Clearly, the second half of the year produces more deals than the first, but not by much,” it says. “That means that, while some of the quarter to quarter fall-off in HME dealmaking may be due to natural rhythms in M&A, there’s more at work here than the calendar.”

The $64-million question: What’s at work here?

See the full analysis in The Braff Group M&A Insider on page 23 of the July issue of HME News.

by: Liz Beaulieu - Wednesday, June 10, 2015

While trying to parse together the news last Friday that CMS was dropping non-invasive vents from Round 1 2017, Managing Editor Theresa and I came to the conclusion that the agency figured out it needed to work out some kinks with this product category before putting it out to bid.

“How refreshing” was, I think, Theresa’s reaction.


This is not to say, of course, that non-invasive vents won’t be included in a future round of competitive bidding, but it’s evidence, nonetheless, that there is some sense of reason at CMS.

Theresa will be calling the usual suspects this week to get further intel on CMS’s decision to drop non-invasive vents from competitive bidding and overhaul the product category.

Why is the agency dropping five existing codes and replacing them with two new codes? Why does it believe this will help to prevent the codes from being used to bill for pressure support vents that are used as positive airway pressure devices for treating OSA rather than respiratory failure?

Something that would help to restore reason to this product category: local coverage determinations with specific criteria for vents. Will this be part of CMS’s overhaul? One can hope.

Reason and CMS came to mind this week, too, when I read the results of a study concluding that Medicare beneficiaries in the initial nine test markets for competitive bidding are receiving only a portion of the diabetes supplies they need. As a result, there was a higher number of deaths and hospitalizations in these markets in 2011, according to the study’s backers, the National Minority Quorum.

The forum argues that CMS needs to be held to the same standards as other clinical trials involving humans.

“A clinical trial’s safety review board looking at these findings would stop a trial out of an abundance of caution for patients,” said the forum’s president and CEO, Gary Puckrein.

How’s that for reason?

by: Liz Beaulieu - Tuesday, June 2, 2015

No sooner had I heard that CMS had sent out letters to providers asking them to review their bids as part of the Round 2 re-compete had I started hearing of issues.

The letters prompt providers to verify with the applicable organizations that they have met requirements required for submitting bids. The reaction started on twitter.

One provider tweeted me, “My analysis shows a BIG disconnect between CBIC/NSC and accrediting bodies.” His emphasis, not mine. A few tweets back and forth and the provider tweeted me again, “As we speak (tweet), the CBIC sent out a notice to disregard our prelim report as it was in error.”

The next day, another tweet: “Looks like new preliminary reports are out. On a Saturday no less. Just got the email.” Any difference between this report and the first report? Not as far as this provider can tell. “The accrediting organization info seems to be ignored.”

Then I got an email from a provider saying CMS wasn’t showing that he was licensed and that he needed to check with the NSC. Before doing that, the provider checked PECOS and sure enough it showed he was licensed. So he called the CBIC and they still told him to call the NSC. So he called the NSC and they told him his licensure is valid and current, and it was valid and current prior to March 26 when the CBIC pulled the info. They told him to call the CBIC.

You can probably guess where this is going. I’ll let the provider explain:

“I just spoke to the CBIC and they told me that if the NSC says it is there than it is OK. However, she couldn’t confirm anything on the CBIC side and she told me to only go by what the NSC told me. I asked how this could have even not showed in there in the first place and she just said that PECOS was back logged and it might not have been in there when it was pulled on March 26. The call ended with me just saying, ‘It is really hard for me to trust what I’m being told since everything was in there before and you didn’t show it so now my company and livelihood is at the hands of something that didn’t work in the first place.’ All she said was she was sorry and that if the NSC stated it was on there, then I was OK.”

The provider's email ended with: “Ughhh.”

I realize that running a program as large and complicated as competitive bidding is probably no easy task but, since we’re talking about the Round 2 re-compete, this isn’t CMS’s first rodeo.

With the added emphasis on meeting licensure requirements thanks to a provision in the recently passed “doc fix” bill, CMS has every incentive to get it right. Everyone's watching this time.

by: Liz Beaulieu - Friday, May 29, 2015

Health care is becoming less siloed.

In my eyes, one of the larger goals of healthcare reform is to break down the barriers between different healthcare providers. A hospital can no longer operate in a silo. Because of the pressures to reduce readmission rates, it has to make it its business to know what patients are doing when they’re outside of its four walls. To do that, it needs help from other healthcare providers. Skilled nursing facilities. Home medical equipment providers.

The increasing interconnectedness among healthcare providers has been a focus of the HME News Business Summit for a number of years. This year is no different, with North Highland Company’s Fletcher Lance, who has worked with the likes of Cigna and the Hospital Corporation of America, set to talk about how healthcare reform is reshaping the delivery models that payers and providers use to provide care.

While providing this big picture perspective is a hallmark of the Summit, for attendees, we target providers from within the HME industry. The crème of the crop, we like to call them. The innovators and disrupters.

There’s a definite need to rub elbows with your own kind. Who better than other HME providers to share experiences with and bounce ideas off of?

But in another event, in another place, what if you could also rub elbows with other healthcare providers. Say, case managers and discharge planners.

Would this be valuable? How would you want to interact with other healthcare providers in a conference setting? What type of education would appeal to this different, but connected, group of providers?

We’re doing some research on how to make this happen. We’d love to hear your thoughts.

by: Liz Beaulieu - Wednesday, May 20, 2015

Here are a few quotables and tidbits from my first day at the AAHomecare Washington Legislative Conference.

You’ll end up in cuffs, sir

Outgoing AAHomecare Chairman Robert Steedley started everyone off this morning with a funny anecdote about Jay Witter, the association’s senior vice president of public policy. It turns out Steedley has a thing for cuff links and when Witter was preparing him for this week’s testimony before the House Ways and Means Committee Health Subcommittee, Steedley said something to the effect of, What if I get so worked up under questioning that I slam the mic down on the table? Witter replied, “Well, you’ll end up in cuffs, sir.” This is why, Steedley explained, he thinks everyone should call Jay Witter, Jay Witty.

Hey, you’re not Sean Cavanaugh

The conference’s keynote speaker, Sean Cavanaugh, deputy administrator & director of the Center for Medicaid, couldn’t make it. His replacement: Rahul Rajkumar, deputy director for the Center for Medicare and Medicaid Innovation. Rajkumar explained why he was happy to be before a crowd of HME providers. You see, Cavanaugh came up to him and said one of them had to testify at a congressional hearing. Cavanaugh told him: You have a choice, you can testify or you can speak to this group. “This is why I’m incredibly happy to be here today,” Rajkumar joked.

The way we pay for health care matters

Rajkumar, from India, shared a story about visiting New Dehli and witnessing a relative have an acute stroke. He and his uncle got him into a car and raced him to the hospital, where a neurosurgeon agreed that he was having a stroke and needed TPA, a protein that helps breakdown blood clots. But before the neurologist could administer the TPA, the father needed a CAT scan, and before the father could have a CAT scan, Rajkumar needed to go pay for it in advance. “The neurologist had a look of anguish on his face when he told me that,” he said. “The way we pay for health care matters because it says what matters.”

Wipe out

After Sen. John Hoeven, D-N.D., spoke, an attendee stood up to say that if competitive bidding were expanded nationwide he would have to close his business of six stores and 66 employees. Hoeven had this advice for providers as they set out on their Capitol Hill visits tomorrow morning: “Emphasize the small business impact. This will wipe out small businesses in this industry.”

Have you heard from Boehner?

AAHomecare’s reception to honor Invacare’s Mal Mixon with a lifetime achievement award featured a video from House Speaker John Boehner. It also featured a presentation by Rep. Pat Tiberi, R-Ohio. Also there to honor Mal: new President and CEO Matthew Monaghan and former Executive Vice President and Chief Product Officer Lou Slangen. After receiving the award, Mixon spoke of the importance of engaging lawmakers in the industry’s issues. “We’re not selling pots and pans,” he said. “What we do is real worthwhile to society.”

by: Liz Beaulieu - Monday, May 18, 2015

It sounds obvious, and it is. The future is coming.

But while it sounds obvious, the future is not simple to predict and it’s certainly not easy to navigate. And yet, it’s coming, always coming.

The future is what buzzes in the back of my mind when I look at the slate of sessions for this year’s HME News Business Summit.

The future is a panel of “disrupters” who are redefining what they do, and in the process, redefining the HME industry.

It’s an approach to sleep therapy that emphasizes smart machines and apps that better connect healthcare providers and patients and increase data collection, and as a result, improve adherence.

It’s an HME industry where providers are valued for all that they do, not what payers think they do.

The future is a payment model that’s long-sighted not short-sighted, one that supports technology that allows seniors to stay in their homes safely.

The future is unknown, of course, but what you’ll learn during these and other sessions at this year’s HME News Business Summit is that the future is something you should always be speculating about. It’s something that should empower you to explore different avenues, to take risks.

Because the future is coming, and we want you want to be ready.

See you in Nashville.

by: Liz Beaulieu - Wednesday, May 13, 2015

If you follow Theresa’s and Tracy’s blogs or twitter feeds, you already know they’ve been competing to see who can take the most steps in a day.

Managing Editor Theresa has her pedometer, and I’ve spied her up from her desk more often during the day, using her feet instead of the phone for inter-office communication. Am I right, Theresa, that you’ve also been drinking more water? (Her preferred drink of choice: coffee, coffee, coffee.)

Associate Editor Tracy has her Fitbit, and I spied her yesterday returning to the office after taking a walk outside over lunch. Though I’m unsure of her water intake (she drinks soda…in the morning!?!?), I know she usually eats a nice salad for lunch (with avocado or cheese, but never both). We won’t talk about what she eats for breakfast, though (Tracy, your secret is safe with me).

Jo-Ellen Reed, our account manager, has a pedometer, too, and as Theresa mentioned in her blog, she logged more than 8,000 steps the other day while traipsing through New York City. (Which got me to thinking, could it be that city slickers actually take more steps than those of in the wild?)

I don’t know if Rick Rector, our publisher, has a pedometer or Fitbit, but I do know that he meets with a trainer on a regular basis and recently started using a device on his desk that allows him to work on his laptop in a seated or standing position. Cool, huh?

Then there’s me. A year ago, I could have won this how-many-steps-in-a-day contest easily with five-mile runs every morning and half-hour walks during lunch. I don’t know if it all would have added up to the targeted 10,000 steps, but I bet it would have been close.

These days, I’m trying to get in my steps by proofing while walking during the day (it sounds dangerous, but it isn’t) and taking half-hour walks with a baby after dinner.

Thankfully, Theresa and Tracy have excused me from their competition due to the aforementioned baby, but I can use her as an excuse for only so long.

In fact, I can use her as an excuse only for the rest of today, because when I get home, there will be a new jogging stroller on my porch.

My next purchase: a pedometer or Fitbit.

Watch out, Theresa and Tracy.