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On the Editor's Desk

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.

by: Liz Beaulieu - Friday, May 8, 2015

If you’re like me and you’re in Maine, you look out your window these days and feel rejuvenated. The sun is out more, the air is warmer, the grass is greener and there are small signs that the plants that have been blanketed in snow for months are, indeed, alive.


It’s also around this time of year that my email inbox is over-flowing, my day planner is full of chicken scratch, my desk is buried in paper and my to-do list looks like I haven’t done a thing in three weeks because there’s so much to do it can’t all possibly get done.


Because we’re hustling to get applications for our annual HME Excellence Awards and we’re hustling to get participants for our annual Financial Benchmark Survey, and we’re finalizing the educational program for our HME News Business Summit. This, amidst the usual responsibilities of issues and HME Newswires and webcasts.

Yes, it’s that time of year when I use this blog as a public service announcement.

So please apply for an HME Excellence Award—it’s a great way to take stock of where your company has been and where it’s headed.

Please participate in our Financial Benchmark Survey—with all the talk of the importance of data in every part of health care, here’s your chance to get it specifically for your line of business.

And please check out the educational program for this year’s HME News Business Summit, which will be posted to next week—where else are you going to get education on healthcare delivery models, connected health, disrupters and more.

With this blog scratched off my to-do list, I’m going out to enjoy some of that sun.

by: Liz Beaulieu - Thursday, April 30, 2015

A few weeks ago, I was in a CPAP frame of mind; this week, it’s vents.

First, CMS announced that non-invasive vents would be a new product category in Round 1 2017.

Then the agency announced in an MLN Matters article that providers who furnish vents—not only invasive vents, but also non-invasive vents—“must meet all applicable requirements for accreditation, such as ensuring that frequent and substantial servicing is provided.”

What’s the big deal? “Providers need to meet the quality standards for invasive vents, even if they’re only providing non-invasive vents,” says Wayne van Halem, president of The van Halem Group.

Products that are categorized as needing “frequent and substantial servicing” may mean visits by respiratory therapists and other high-end services, van Halem says.

In the background to all of this: a widespread prepayment review for non-invasive vents that kicked off last fall.

Because CMS usually takes actions like these when they see a spike in utilization, I leafed through the past few years of our State of the Industry reports to see how much Medicare spends on vents.

We had data on E0463, an invasive vent. Check out these numbers:

2013: $56,613,568

2012: $49,379,924

2011: $41,496,425

2010: $36,164,171

2009: $29,055,186

2008: $23,800,959

In six years, spending on E0463 has increased 138%.

Unfortunately, we don’t have data on the other codes in the vents policy group, like E0464, a non-invasive vent.

In our HME Databank, however, we have a list of the top providers for E0464, who may be most affected by all of these changes. The top 5, with the amount Medicare paid them for E0464 in 2013, are:

Ashli Healthcare, $4,505,809

Sleep Management, $4,273,506

DME Tennesse, $3,252,492

Medemporium, $3,015,729

Super Care, $2,567,222

We’re on all of this for the HME Newswire on Monday. Managing Editor Theresa will have a story about non-invasive vents being included in Round 1 2017 and I’ll have a story about the accreditation requirements for vents.

Stay tuned.

by: Liz Beaulieu - Tuesday, April 21, 2015

More than anything else, the binding bids language recently passed as part of the “doc fix” bill sends a strong message to CMS that its competitive bidding program, as currently structured, is majorly flawed.

Here’s why, unfortunately, it doesn't mean more: Per the bill, bindings bids will be applied for contracts “not earlier than Jan. 1, 2017, and not later than Jan. 1, 2019.”

As we’ve reported, this means the language has no impact on the Round 2 re-compete that’s scheduled to go into effect July 1, 2016, nor the application of bid pricing to all areas scheduled to go into effect Jan. 1, 2016.

That’s why, as AAHomecare’s Tom Ryan has said, getting binding bids language included in the “doc fix” bill was a huge victory, but not mission accomplished.

Ryan well knows, if nothing else changes, there’s a lot of pain, both for HME providers and Medicare beneficiaries, that’s going to happen before Jan. 1, 2017.

I don’t know the politics of why that date was chosen (it’s likely that modifying the Round 2 re-compete, a wheel already in motion, would have been too costly to pass muster with Congress), but it’s the reality of the situation.

There’s another reality, though: That CMS, which has had the luxury of largely ignoring the industry’s concerns, now has some explaining to do.

Namely: Why did the agency think it was OK to steamroll through two Round 1s, almost two Round 2s and a soon-to-be national roll out without binding bids, without state licensure requirements and other fixes to the program?

With binding bids language included in the “doc fix” bill, all of Congress, along with the president, are now watching.

What will CMS do next?

Will the agency work with industry stakeholders to do what’s right and implement binding bids and other fixes sooner rather than later, regardless of the dates and other specificities in the bill?

Or will it, once again, ignore the industry’s concerns until Congress, along with the president, forces its hands?

Either way, industry stakeholders are prepared. You see, they’ve learned a thing or two in the 10 or more years they’ve been battling competitive bidding.

Stakeholders are hoping to work with CMS, but because hope is not a strategy, they’re also drafting language and lining up champions to at least delay or phase-in the national roll out.

And this time, stakeholders have the momentum.

by: Liz Beaulieu - Friday, April 17, 2015

I shouldn’t have been surprised this morning, when I was watching the Today show, eating my granola (homemade) and drinking my coffee (freshly ground and French press brewed), to see a ResMed CPAP mask.

Yesterday, news of a new study saying CPAP therapy can help to ward off memory decline burned up the Interwebs (141 articles at last check)—and the Today show was on it.

All this publicity on the study got Managing Editor Theresa and I thinking: Will staving off memory decline and possibly Alzheimer’s for about 10 years be the push that shoves people who suspect they have a sleep disorder to get tested, and if they’re found to have a disorder, to commit to their CPAP therapy?

After the Today show segment, I suspect there were a lot of wives having conversations with their husbands (and vice versa, of course) and a lot of adult children having conversations with their baby boomer parents.

“You know Mike uses a CPAP device,” my dad told me this morning (he and my mom watch the kid on Fridays). “Gerry does, too.”

First it was a CPAP machine on Mike & Molly, then a CPAP mask on the Today show and now my dad talking about friends using CPAP machines—I think we’re getting somewhere.

If we’re getting somewhere with awareness, we still have a ways to go with compliance, however. About half of the providers who responded to a recent HME Newspoll reported compliance rates that fall between 51% and 75% (Read my story in the HME Newswire on Monday for the full story). That could be better, I’m sure we’d all agree.

All of this, combined with a session at the HME News Business Summit on connected health in sleep therapy, proves I’ve been in a CPAP frame of mind lately.

But don’t worry Theresa. I’m not plotting to take over your beat.

It was 20 years ago today, that Sergeant Pepper…no, that I, as a fledgling editor of an upstart publication, contacted incoming NAMES CEO Bill Coughlan about an interview for a profile in the very first issue of HME News, which was to hit the proverbial newsstand in May of 1995. I had just come back from two years in Vietnam, and I was resuming my career in newspapers, this time on a trade business newspaper in a very particular industry.

As I tried to make sense of what was happening in the HME industry in the spring of 1995, the discombobulation was great. I remember coming home from work one day and draping myself over a bed in the room my wife and I were letting, and groaning. I’m in over my head, I told her.

I wasn’t, of course. And I shouldn’t have been groaning. By sheer coincidence, I had actually worked as an HME tech driver for a spell in early 1990 in Santa Cruz, Calif., for a company called Mid Coast Medical. I had set up semi-electric and full-electric hospital beds. I’d hauled oxygen concentrators into homes, and knew my way around a Hoyer Lift. But this, writing about HME, was all new to me.

And none of it, as I read the headlines of HME News today, 10 years after I left the paper to go back to Vietnam for four more years, is new. Competitive bidding is still on its way, as it was in the spring of 1995. Shelly Prial still has some very definite opinions (My best to Thelma, Shelly). And David Miller, well, I’m guessing he doesn’t have that beard he was sporting after his retreat to Costa Rica all those years ago. (Maybe that’s why I left HME News, inspired by David’s sea change.)

I was, literally, in my 20s when I started writing for HME News. Just a kid, really, editorializing about this or that having to do with power wheelchairs and smart CPAP. And I’ve turned 50 in the same month that HME News turned 20.

There’s something to be said for longevity, and just plain staying home. Every one of you in this industry are big believers in both those concepts, yes, because they are the ways and means of your livelihood, but also because it’s still a cost-effective solution to one of the most urgent problems facing Americans today—the cost of staying alive through the sunset.

So many of us today are advocates for measures that just ain’t a public good, but in home health care–in the provision of home medical equipment, especially–you can feel good about what you do. We’re polarized on almost every last little thing in America, but there are no two sides to home health care. Everyone’s for it, and we’re all drifting toward it, whether we like it or not.

I’m making contingency plans for my own parents now, in Florida, and in a home that will enable as much equipment as we can wheel into it when the time is right. This wasn’t supposed to happen to me, in the same way I was never supposed to be a recipient of that AARP thing that came in the mail.

I’m too young to be nostalgic, but I am, and I blame the heritage that goes with my last name for that. A bunch of weepy folks, lamenting this or that.

I was calling up guys like Joe Lewarski 20 years ago, Mario LaCute and John Durkee, Jeff Baird. I always liked getting Lou Slangen on the phone; he was enthused about everything. Cara Bachenheimer always returned calls, and always seemed to be right about everything. Asela Cuervo, too.

I think of Carolyn Cole in the Heartland, and when I think of Van Miller, I think of Southern hospitality. Thing is, Van’s from Iowa. Bob Fary, if I called Bob today, the first thing I’d ask ol’ Bob is whether he’s slapped a Hilary Clinton bumper sticker on his car yet.

Tom Ryan, on 9/11, I can still hear the emotion in his voice as he talked about getting ready to do his part with all the equipment he had, but how no call had come because getting wounded on 9/11 wasn’t what really happened to New Yorkers that day; dying was.

I’m nostalgic, too, for newspapers. I still sit down to a big fat one every Sunday morning, and don’t come up for air for hours. They’re still important. We still need them. The paper. I miss it.

Now, about that headline, ask Mario LaCute. I bet he remembers. Then again, if I’m 50, well then Mario must be… I’m not going to say in a facility. I hope he’s at home.

by: Liz Beaulieu - Thursday, April 2, 2015

Is it me, or is healthcare-related technology popping up more than usual lately?

Two items caught my eye yesterday: A new mobile app developed by the Johns Hopkins Center for Sleep to help doctors who are not specially trained better identify patients who might have a chronic sleep disorder, and another app being piloted by Mount Sinai that helps COPD patients monitor and manage their symptoms.

This morning, I was reading a couple of stories from Managing Editor Theresa Flaherty (filed from Medtrade Spring no less) about how providers need to get in front of CMS’s plan to use bundled payments for CPAP devices, and how providers need to look beyond setups to make money in the sleep therapy market.

One key to overcoming both challenges: You guessed it, technology.

Technology allows providers to collect and analyze compliance data and improve their outreach efforts, which, in turn, allows them to improve compliance, which, in turn, helps them reduce costs for payers and increase their revenues.

More on that last point: Over a five-year period, a compliant patient generates $1,569 in revenues vs. $410 for a non-compliant patient, according to Philips Respironics (See Theresa’s story in the HME Newswire on Monday for more details).

This is obvious, but I’ve never seen dollar amounts attributed to compliance like this.

It’s no surprise that three of the four examples above involve sleep therapy. This is where technology is having the most impact on HME right now, I think.

There will be at least two tech-related sessions at the HME News Business Summit this year, Sept. 13-15 in Nashville. One of those sessions: a panel discussion with representatives from the three biggest manufacturers in the sleep therapy market about how a connected health delivery model—and the massive amounts of data it generates—is transforming how care is provided in the home.

Mark my words: It’s time to get on the tech bandwagon before it’s too late.