Subscribe to On the Editor's Desk RSS Feed

On the Editor's Desk

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.

by: Liz Beaulieu - Thursday, March 26, 2015

With everything going on in Washington, D.C., these days, even for our little HME industry, is it any coincidence that AAHomecare has launched a Legislative Council?

I know Managing Editor Theresa, who owns the legislative affairs beat here at HME News, is having a hard time keeping up.

The big news last week was not only the passage of H.R. 284, a bill in the House of Representatives to reform the competitive bidding program, but also the introduction of H.R. 1516, a bill in that same House to create a separate benefit for complex rehab.

Then this week comes word, via any news outlet with a pulse, that there’s actually a good chance that the House and Senate will pass, and the president will sign, a so-called SGR bill with a permanent so-called “doc fix,” a move that will save physicians from an impending 21% cut in reimbursement.

The House actually passed H.R. 2 today, with a vote of 392-37. Now the bill is on to the Senate for a vote, possibly as early as tomorrow morning.

We won’t be sad, by the way, to never again have to write about the SGR bill. It brings up too many sensitive subjects—mainly the fact that a pay cut to physicians is such a big deal. Cuts to other healthcare professionals (ahem, HME providers)? Not so much.

But I digress.

Then Theresa and I learned from the hard working folks at The VGM Group that language from H.R. 284, the bid reform bill, is actually in H.R. 2, the SGR bill.

Why is that necessary, you ask, when the House has already passed H.R. 284? Theresa says industry sources say it’s because the language has a better chance of getting through the Senate as part of the SGR bill than as part of a standalone bill.

Also this week, Sens. Chuck Grassley, R-Iowa, and Mark Warner, D-Va., introduced a bill what would apply accreditation and other standards for providers of orthotics and prosthetics to Medicare beneficiaries.

Oh, and while Theresa was reporting on that story, she found out that Rep. Mark Meadows, R-N.C., has introduced a bill to reform Medicare’s audit program. She tells me the bill would prevent CMS from collecting more than 50% of any recoupment amount before a hearing by the administrative law judge has been conducted.

Theresa will have a story or two (or five) about all of this stuff in Monday’s HME Newswire.

Speaking of competitive bidding, there was also that little bit of news about the deadline closing this week for submitting bids for the Round 2 re-compete (well, after a one day extension).

Provider Woody O’Neal posted this picture to twitter after submitting his bids.

I think we could all use a tall one after this week, especially Theresa, only she drinks wine, not beer.

by: Liz Beaulieu - Thursday, March 19, 2015

It’s not uncommon for me to be at a loss for blog ideas.

That’s certainly the case this week, especially after Managing Editor Theresa used WTF in her blog (yes, I noticed) and Associate Editor Tracy cited a handful of celebrities in hers (ditto).

How can I beat that?

In all seriousness, this got me to thinking: What do you, dear reader, like reading about in blogs, anyway?

So I logged in to the ever-helpful Google Analytics to find out what our most read blogs were so far this year.

It turns out the top two blogs aren’t even from the editors but guest blogs from Gary Rench and Andrea Stark. I’m not surprised: Rench really hit a nerve with his detailed and thoughtful account of what CMS’s sometimes ludicrous paperwork requirements mean in everyday life to everyday people.

And Stark, whose blog reviewed top denials and reason codes, is a go-to source on all things regulatory matters.

Another of the most read blogs, this one written by me, actually stemmed from a webcast that I did with Stark. During the webcast, she detailed what regional pricing might look like under the national rollout of competitive bidding scheduled to take place Jan. 1, 2016.

As for the most read blogs from the editors, Theresa topped the list with her critique of a recent episode of Mike & Molly featuring Mike wearing a CPAP mask in bed. Guess what? No one even mentioned it! To which Theresa asked: Is the humble CPAP finally becoming mainstream?

The most read blog from me (besides the one mentioned above) was a schedule of upcoming HME News TV interviews to be published on our website.

OK, what am I gleaning from this exercise?

That you like to hear from your peers (Rench), and you like to read about denials (Rench and Stark) and competitive bidding (me and Stark).

That you like to read about how HME is perceived by Hollywood.

And that you’re avid watchers of HME News TV.

Dually noted.

by: Liz Beaulieu - Tuesday, March 3, 2015

I know I’m not the first person to have my sleep patterns interrupted by a new baby, but if you knew how I slept before said baby, you’d feel for me, I swear.

Before said baby, I was the type of person who went to bed at 9 p.m.—9:30 p.m. the latest. I’d read a few pages of The New Yorker and fall asleep uninterrupted until 6:30 a.m.—maybe 6 a.m. if I was going for a morning run.

That’s right, I got about nine hours of sleep nearly every night.

Enter said baby, and I’m getting six hours of interrupted sleep every night. (Never mind the mind-boggling early days of three or four hours of interrupted sleep every night. I never want to go back there, ever again.)

I now have a new appreciation for how not only the quantity but also the quality of your sleep can affect every aspect of your life. If you’re low on both, your energy (sluggish), your relationships (fragile), your concentration (fleeting)—they all suffer. I don’t even want to think about what it’s doing to my health.

This got me to thinking the other day: Is this what it feels like—the interrupted sleep and the resulting negative effects—to have sleep apnea? (By the way, I don’t want to minimize what it’s like to sleep with a CPAP mask strapped to your face, but if I could wear one and guarantee I’d get eight hours of uninterrupted sleep, I’d wear one tonight with glee.)

Luckily, I know the reason why I’m sleeping poorly, and one day (please God), I hope to return to my 9:30 p.m. to 6:30 a.m. uninterrupted sleep pattern.

But for many people with sleep apnea, they don’t know why they’re sleeping poorly and why they feel sluggish, etc. That’s why the Sound Sleep Institute, a sleep consulting and treatment program from IntegraSleep and Active Healthcare, released a fun music video this week called “All About That Sleep” that parodies “All About That Bass.” The video showcases how patients can be unaware of their sleep disorder until their bed partner recognizes the signs like snoring and pauses in breathing, and they finally get help.

The Sound Sleep Institute released the video to celebrate Sleep Awareness Week, a national campaign by the National Sleep Foundation to educate Americans about the importance of sleep.

I, for one, now consider myself very educated.

by: Liz Beaulieu - Tuesday, February 24, 2015

I had conversations this week with two very smart women, Tammy Zelenko and Michelle Templin, about how referral sources and payers have no idea what HME providers actually do.

I expect this of most lawmakers, but referral sources and payers?

Templin, vice president of strategic development for Managed Health Care Associates, interacts with a number of payers in her work to promote the company’s ACO Network, a national network of post-acute providers.

“The perception, from the payer perspective, is, ‘Oh yeah, the DME people, they deliver walkers and wheelchairs,’” she told me. “Yes, that’s one aspect of it, but not all it. There are higher end things that they do.”

Templin says providers need to do more to rebrand themselves.

Cue in Zelenko, president of AdvaCare Home Services.

Zelenko has organized the services that her company provides—clinical care, patient advocacy, respiratory programs, technology and outcomes—into a formal and organized program called the Patient Partner Program (Read about it in our April issue).

“What we do is so complicated that people don’t understand it,” she said. “This spells out the value-added services we provide.”

Zelenko has started shopping the program around to hospitals. She says the hospital, the patient and the payer all reduce their costs as a result of the program—the hospital sees fewer ER visits and readmissions, the patient sees fewer co-pays and the payer pays for less expensive care in the home. What does AdvaCare get? An increase in referrals.

“This is really a new way for us to market ourselves,” she said. “We, as an industry, are doing a terrible job of that.”

 Templin agrees.

“There’s a need for the HME provider to be seen as not purely a supplier but as an active participant and collaborator,” she said.

by: Liz Beaulieu - Friday, February 13, 2015

Managing Editor Theresa Flaherty wins the award for most interesting stories for the upcoming March issue.

Let’s start with the front page. Theresa wrote a story about Med-Care Diabetic Supply being raided by the FBI. This is the same Med-Care whose president was subpoenaed by a senator in 2013 to testify about the company’s marketing practices.

As you move through the issue to the Providers section, you’ll see that Theresa wrote a story about Lincare accelerating its M&A strategy. This follows the news that Rotech and AeroCare are buying again. Who doesn’t like to read a good story about a national?

Also in the Providers section, you’ll see that Theresa wrote a story about FullCircle Medical Supplies, which plans to acquire several DME providers for stock, notes and cash. Is the buyer long on vision, but short on cash, she asks?

Then as you move to Theresa’s bread and butter, the Specialty Providers section, you’ll find a story on Walgreens’ decision to sell a majority stake in its home infusion business and a look at the M&A market for home infusion in the wake of the news (hint: It’s still hot).

I don’t mean to give short shrift to Associate Editor Tracy Orzel. After all, I sent her on a wild goose chase, when she tweeted a story about naming repair techs as one of the best jobs and I suggested she turn it into a story for the Providers section. Turn it into a story she did—one that landed on the front page of the March issue. Bravo.

As for me, I couldn’t help but write a couple of stories for the Vendors section about two startups that are bending the idea of bent mental: WHILL with its space agey looking personal mobility device and Metamason with its 3-D scanning and printing produced custom CPAP masks.

I’m mentioning all these things, dear reader, in case you’ve forgotten that the stories that you read in HME News you won’t read anywhere else.