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On the Move

by: Elizabeth Deprey - Friday, May 3, 2013

Twitter is a funny thing. It’s both more and less revealing than Facebook—Facebook has more personal details, but you can make your profile friends-only. On Twitter, anyone can follow you—for the most part...there are ways to lock people out, but it kind of defeats the point of Twitter the way a lot of people want to use it. 

Of course, people use it in all sorts of different ways. From what I can tell, a lot of people use it as a way to express what they’re a fan of. I wonder how many accounts have a photo of Justin Bieber as the profile pic? (The username is usually something like Belieber4Life.)

Others create accounts and never post a thing—they just follow different celebrities or news sources and check their Twitter feed once in a while for updates.

Others make constant posts of every random thought they’ve ever had: Why do I always forget how terrible my showered-at-night hair looks the next day? Two hours after lunch and I’m already hungry. What ever happened to Salute Your Shorts? Wow, it’s hot today. (The good news is they only have 141 characters to make these comments in.)

I use mine mostly as a news source. I follow as many HME-related people I can find, as well as all the local newspapers and TV stations.

I also use it as a news transmitter—the minute I hear something cool, I tweet it. When Don Clayback told me Sen. Shumer would introduce a Senate companion bill to H.R. 942, I got right on Twitter and let my 400-or-so followers know about it. 

No matter who you are or what you use Twitter for, please, if you value my sanity, avoid these two pet peeves of mine. 

#1: Unless you are live-tweeting an event or something, please don’t post 15 items in rapid succession. It makes me not want to read any of those tweets. 

#2: Facebook and Twitter do not mix. Please don’t use Facebook to post to Twitter. It seems like a great idea—two social media outlets with one post. But at least half the time, we don’t get to see the end of your sentence. 

Example:

I am so excited to tell you guys that I fin… fb.me/234gL1EX8 

Then, when you click on the link, it doesn’t take you to the end of the post. It takes you to the link the Twitter user posted at the end of his or her Facebook post: some random website you have no context for. 

You’re not getting the chance to communicate your thoughts, and we’re not getting the chance to see them. Not so great. 

So what kind of Twitter user are you? Comment below, email me or tweet and let me know!

 

by: Elizabeth Deprey - Monday, April 22, 2013

I read a great article over the weekend about introverts that got me thinking about the HME industry. 

Now, I love talking to people and meeting new people and learning new things—that’s why I went into journalism. But I need to balance that out with some hermit time or I get kind of…jittery. 

My introverted tendencies sent me into print journalism, where there’s a little less of a spotlight than broadcast journalism. Those same tendencies have me sneaking out of the Stand Up for Homecare reception after the speeches. (Sorry guys, you know I like you. I just need my space.)

But what about HME providers? My first thought was that most of you must be extroverts. You spend your whole day dealing with the public, helping people find what they need to be safe and healthy at home. Then, after hours, you’re taking calls and making emergency visits to help patients in need. 

For an introvert, that disruption of your expected downtime would be pretty unsettling and stressful, but it’s all part of the HME provider package. 

Could an introvert enjoy a job like that?

Maybe. The article says there are just as many introverts as extroverts out there. It stands to reason that some would end up in the HME profession. 

In some ways, it could be a good fit: A lot of working with HME patients is one-on-one or in smaller groups. The massive piles of paperwork you guys deal with could be a solitary break from the interaction. 

I’d be interested to hear from you guys whether you think HME is a better fit for introverts or extroverts. Shoot me an email, comment below or reach out on Twitter and let me know what you think.

Update: Chris Rice at Diamond Medical sent me this video on the same topic, definitely worth watching.

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by: Elizabeth Deprey - Wednesday, April 10, 2013

This is Elizabeth Deprey reporting to you live from the first-ever National CRT Leadership and Advocacy Conference. Keep an eye on my tweets for some updates. There was so much info at the first event, an industry panel discussion, Twitter could never do it justice.

You can thank my iPhone for the blurriness of this photo of some of the smartest people in the complex rehab industry getting ready to hold the panel discussion. What a chance to hear Cara Bachenheimer of Invacare, Mike Ballard of NSM, Paul Bergantino of Numotion, Scott Meuser of Pride Mobility, Mike Proffitt of Sunrise Medical and Tom Rolick of Permobil—all in one place, all talking about the future of the industry.

The mood here is optimistic. HR 942 is on the floor and the group here plans to hit the Hill and continue to build its momentum later this week.

"I think we're in the best position we've ever been in," Don Clayback says. There's awareness in Congress, stakeholders are making inroads on the state level, and there's better collaboration between members of the CRT community—manufacturers, consumer groups, clinicians and providers, he said.

Paul Bergantino opened the panel's talk with a discussion about challenges and cirtical success factors. "We all recongize we can't continue to operate as we've always operated," he said.

Top on the list for improvements: service and repairs, which are a low-margin, high-touch process for providers. They're also critical to the clients providers work with. Also on the to-do list: the industry's reputation.

"I'm concerned," Bergantino said.

Mainstream news stories about mobility haven't been favorable lately. The separate benefit, though, will be a "game changer," Bergantino said. "This will help outsiders understand who we are," he said. The industry needs to rally and support NCART's Medicaid efforts. "We need more firepower," he said.

Mike Ballard, addressing the same  topic, said efforts need to focus on the "Three Rs": respect, reimbursment and returns.

"We are making progress, but it's glacial," he said.

To gain respect, the industry needs to self-regulate; choose one accredititing body to build a brand with; and pull the ATP certification from anyone who doesn't adhere to the industry's standards. Ballard says the industry needs to treat payers like customers instead of acting like they're the enemy, and truly show them what CRT is about.

"Our industry grew up on the wrong side of the tracks," he said, and is now lumped in with DME, which faces heavy bureaucracy because of "past sins."

Cara Bachenheimer shed some light on the current climate on the Hill. In today's environment, "there needs to be significant compromise" to get anything done, she said.

"Our issue is not partisan, and that bodes well," she said. However, once the president drops his budget this week, all talk on the Hill will center around that. Top issues will be the debt ceiling and health care.

"We need to make sure we're making ourselves visable," Bachenheimer said.

Making progress on the Hill involves the right mix of policy and politics, she said. "It is tough—that's how the founders designed it," Bachenheimer said. There's no good news to be had on audits, she said, but she expects the MPP bill to come next week and says there are efforts underway to at least postpone comeptitive bidding.

Scott Meuser says there's lots of innovation on the way. The reimbursement challenges may dampen efforts a bit, so more people need to get involved advocating for the industry. "We need to have the ability to serve clients the way we want to, the way they deserve," Meuser said. "We need to get past the activists doing everything—it's the same people at every conference and it's only 10% of the industry."

The industry is fighting a good fight, but "there's a lot of apathy in this town," Meuser said. Still, manufacturers will continue to invest in innovation for CRT, because clinicians and providers embrace the new products. "Innovation is appreciated and rewarded with business," he said. "The coolest part of being a manufacturer is to innovate."

Mike Proffitt says looking at functional necessity will drive innovation, but the industry needs to prove outcomes. Proof of effectiveness from manufacturer studies appear biased. That proof can go to payers instead of the soundbites they hear on TV. With reimbursment cuts, the industry is going to be "risk-adverse," Proffitt said. "We're going to work on the things that matter most," he said. Top on the list: servicability. 

Tom Rolick says he's been in the industry for 20 years, and complex rehab today has more resources than it has ever had. While competitive bidding has and will hurt the entire HME industry, the fact that CRT was carved out has given the idea of a separate identity a boost, he said. "Where we're at is a very good place," he said.

While consolidation in CRT could reach a point where companies are too big, we've got a long way before that happens, Rolick said. In the meantime, the bigger companies will be stronger, more stable and have more brainpower. "It's amazing to me the opportunities we have," he said. 

These leaders will join others in the CRT indusry to tell the story of complex rehab on the Hill tomorrow. Let's hope they can do what Bachenheimer suggested and ensure CRT remains visible on the legislative radar. 

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by: Elizabeth Deprey - Friday, April 5, 2013

I’m relatively new to LinkedIn. I joined Facebook in college, way back when it was only open to college students, and I'm pretty familiar with it.

LinkedIn—a similar person-to-person connection site—was new to me when I joined HME News.

When I first started on LinkedIn, Liz and I connected my Twitter feed to the account, so people would see my tweets as updates on their LinkedIn homepage. 

Alas, Twitter and LinkedIn ended their partnership a while ago. 

And still, I’m getting half a dozen LinkedIn friend requests each week—despite the fact that you guys aren’t getting news updates from me on there anymore. What gives?

I reached out to my go-to social media guy, Dave Bargmann, to find out just what LinkedIn is good for. 

“LinkedIn is a business social network that allows a individual or business to present a professional profile in a manner that you can connect within the HME/DME industry,” he told me. 

Providers might set up a business page, almost like a Facebook page, that allow people to keep track of updates, he said. It’s also a good platform for discussions and job networking, he said. 

It basically offers networking and consulting advice, a place to poll people and get information out—all for free. 

After getting some insight from Dave, here's my conclusion:

It seems to me your LinkedIn connections are your business connections—a way to keep in touch without Facebook, which is more for maintaining family and friend connections. As such, users have an easy way to keep in contact without having to be bombarded with personal life posts.

I’m hoping all you guys connecting with me on LinkedIn are using the site almost as a way to "bookmark" me. That way, whenever you have news you want to share, I’ll be easy to find. 

Get in touch or leave a comment below and let me know why you make connections on LinkedIn. I’d be interested to hear your take.

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by: Elizabeth Deprey - Friday, March 29, 2013

Back when I was in college and worked on our student-run paper, the best issue of the year was during April Fool’s week. 

All of the writers got the week off, and the editors went crazy thinking up far-fetched and hilarious stories. For that one issue, the Maine Campus became “The Maine Crapus.”

Picture stories about the university president getting fired for drinking Pepsi or the dean of students throwing a kegger, etc. 

The basic premise: A lot of “opposite day” style stories with silly inside jokes that really wouldn’t make sense outside the Maine Campus readership, often done in the style of tabloids that talk about two-headed robot babies.

I wonder what a satirical version of HME News would look like? Headlines might look something like this:

Medtrade Spring 2014 to be held on the moon: Gaffney recommends spacesuits

Medicare issues clear, sensible guidelines

Dave Bargmann: Eschew social media, try balloon messages 

Lawmakers beg for industry input

Don Clayback, Simon Margolis to skip CRT conference: ‘We’re sure you guys are all set’

All audits cancelled: Rick Worstell retires to Tahiti

HME News staff to take July, August off to enjoy Maine summer

Shelly Prial: HME industry is ‘just OK’

Bennies hate being in community, contributing to society: ‘We want to remain in the home’

Any ideas? Leave comments below!

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by: Elizabeth Deprey - Friday, March 22, 2013

It’s been rough going for the mobility providers I’ve spoken to this month.

Provider Scott Scobey says he’s ready to give up on mobility altogether. 

“I wouldn’t provide another power wheelchair for all the tea in China,” he said.

Scobey, president of Low Country Mobility in Savannah, Ga., says it’s not worth staying in business when auditors are holding up cash flow on legitimate claims.

“I’m being killed by RAC audits,” he said. Scobey has had four in the last six months—including claims that have passed muster with ADMC. 

“You’ve got to go through the process, eventually get to the ALJ, and win your money back,” said Scobey. “But it’s not even about ‘Did this person need this chair?’ It’s about them saying a date stamp is missing when it’s not.”

He's extremely frustrated by the auditors' tactics. One claim got kicked back because the home evaluation wasn’t dated—when the LCD doesn’t even require that, he said. 

Scobey says he’s planning move on to something else in the industry—and it will be something that Medicare is not involved in at all. 

If it’s not audits, it’s the demo, other providers say. 

Provider Craig Rae says three doctors in his Salisbury, N.C. area in the past two weeks have decided not to do power mobility for Medicare altogether because of all the denials they’ve seen. 

Peggy Walker says most denied prior authorizations are for technicalities. 

“We’re seeing very picky denials,” said Walker, billing specialist for U.S. Rehab. “They always seem to find something.” The problems are in Jurisdiction B more than anywhere else, she said. The demo states there are Michigan and Illinois. 

Meanwhile, provider Cory Baker said he’s had Scooter Store patients ask him to make repairs while the provider has been out of commission. 

“We’ve had a few contact us,” said Baker, compliance officer at Abilene, Texas-based Choice Medical Supply. “They’re reaching out to anybody in the phone book.”

Will Baker get paid for helping these patients?

“Most likely not,” he said. 

With providers and doctors feeling discouraged enough to drop out of Medicare altogether, how long can the providers who are left take care of patients out of the kindness of their hearts? And who’s going to be left to take care of patients when they can’t anymore?

 

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by: Elizabeth Deprey - Monday, March 11, 2013

The complex rehab community rejoiced last week—there’s a new CRT bill on the floor, and stakeholders are ready to do up some new material and hit the Hill with it next month during the National CRT conference.

There are two representatives stakeholders won’t have to convince: our old friend Rep. Joe Crowley, who introduced the bill last year, and the Republican who agreed to co-introduce the new bill with him, Rep. Jim Sensenbrenner.

Now, having met Rep. Crowley and had the opportunity to pose for photos with him and shake his hand, most stakeholders should feel familiar with him. My impression was of a very busy, very friendly guy who sits on the Ways and Means Committee. He’s represented the Bronx and Queens area in Congress since 1998.

A Google image results search for him shows a lot of photos of people who are not him. The ones he’s in, he’s usually smiling or shaking hands with people. There’s a cool one of him playing the guitar

Here’s what he had to say about H.R. 942 in the press release Don Clayback sent me:

“For people with disabilities or other medical conditions, complex rehabilitation technology products aren’t a luxury, they’re a necessity,” said Rep. Crowley. “Our legislation will help ensure more patients can access the high‐quality products and services they need to help them lead a better, more independent life. And, it puts forward much‐needed quality standards and consumer protections, making the Medicare program stronger for individuals and suppliers as a result.”

Definitely sounds like he gets the message stakeholders have been working to send.

So that’s Mr. Crowley.

Now the new guy.

Mr. Sensenbrenner won his seat in 1978 and has been reelected to represent his part of Wisconsin since 1980. Yep. 35 years. He’s on lots and lots of committees, according to his website:

Jim’s current committee assignments include serving on the Committee on Science and Technology and the Committee on the Judiciary. Congressman Sensenbrenner is Chairman of the Crime, Terrorism, Homeland Security and Oversight Subcommittee.  He is also a member of the Subcommittee on Courts, Intellectual Property, and Internet, and the Subcommittees on Environment and Oversight.

Whew!

Since he’s been in politics all this time, most of the photos of him that come through a Google image search are actually Mr. Sensenbrenner. He looks very serious in a lot of his photos. There’s a great one of he and his wife being honored by the American Association of People with Disabilities

Here’s what he had to say about H.R. 942:

“As someone who has been a leader in the past, fighting for the rights of the disabled, I want to ensure that all Americans have full access to the best tools available, giving them the ability to live each day to the fullest,” said Rep. Sensenbrenner. “Disabled Americans should not be denied the benefits of proper rehabilitation or medical equipment that can provide them the opportunity to live and work freely and independently. With increased flexibility and proper oversight, we can ensure help for those in need while inhibiting fraud and abuse.”

So those are the gentlemen already standing for the CRT bill. The bill received support from both Republicans and Democrats last year, but hopefully having these two senior representatives from both sides of the aisle on board from Day 1 will mean even more support this time. 

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by: Elizabeth Deprey - Monday, March 4, 2013

I spoke with MESA Executive Director Liz Moran today, following up on her members’ brainstorming session.

She said there was a lot of participation and a lot of input, but the overall theme was: there’s some mutual culpability for HME fraud.

Yes, fraudsters shouldn’t target Medicare and home medical equipment, putting the funding in jeopardy that people all over the country need to be safe and healthy at home. But shouldn’t CMS have some safeguards in place?

Liz told me about an incident years ago where CMS paid out more than 40 times for the same wheelchair with the same serial number. Seriously? I’d think a second-year computer programming student could come up with a code to prevent that particular error. 

“We vehemently oppose fraud,” Liz told me. 

That’s a sentiment I hear echoed by all of the providers and stakeholders we talk to each month. 

Since competitive bidding is supposed to be in place to prevent fraud, the MESA brainstorming session was full of alternatives that would prevent fraud but also prevent small businesses from closing their doors. 

Among them: nationwide licensure and increased surety bonds. 

These ideas had a lot of pros and cons, of course, but I think the goal is a great one. 

Think about the money to be saved if fraudsters aren’t paid in the first place? Or the money that could be saved by not having to pay auditors to find typos on claims that will be paid anyway. 

I saw a report today that Medicare paid $5.1 billion to nursing homes that don’t meet minimum standards. The OIG issues reports like this all the time, and, if even half of them hold water, maybe CMS should rethink the way it spends its money—whether to fraudsters selling HME out of mailboxes or nursing homes that don’t provide sufficient care to patients. 

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by: Elizabeth Deprey - Tuesday, February 19, 2013

I spent some time last week checking in with state associations, and, as you can imagine, competitive bidding was the No.1 topic of discussion. 

Liz Moran at MESA plans to host a working luncheon during the association's Spring Conference Feb. 28 to brainstorm what providers’ next step should be.

“Where we are in this industry is not a good place to be,” said Moran. The brainstorming session should be a good step in making some big changes, she said. If not, “We’ll know we tried.”

Meanwhile, in West Virginia, WVMESA Executive Director Richard Stevens is worried what bidding will mean for the state’s many rural beneficiaries. 

West Virginia’s terrain is so mountainous, he said, that traveling anywhere is incredibly time-consuming. He says his state has the highest percentage of elderly people in the country, and most don’t have access to public transportation. If HME providers close up shop or stop delivering, those beneficiaries are in serious trouble. 

“We’ve been in contact with our representatives, and members are making appointments during the congressional recess,” he told me. 

Members have been in touch with lawmakers consistently, but, so far, all they’ve gotten is a flicker of recognition when they walk in the door. “They’re familiar with us and know our concerns,” said Stevens. “But this bidding method appears like it’s going to continue.”

At MAMES, Rose Schafhauser has gotten so many calls her portable phone’s battery keeps dying. 

What’s she hearing? People who weren’t offered Round 2 contracts are actually glad to be rid of the program, she said. 

“It’s so expensive to bill Medicare, and then there’s the audits and the staff time to deal with audits,” she said. “People are just done. They’ve had enough.”

Providers have had time to redesign their companies to prepare for not relying on Medicare, said Schafhauser. 

What’s more, Round 1 providers she’s talked to are happy to be out of the game. 

“Life is so much better without having to fight with Medicare,” she said. 

Still, Schafhauser worries about access issues as fed up providers give up on Medicare, or are unwillingly kicked out of the program—out of 50 calls received, almost all callers weren’t offered contracts, or just got one or two, which most don’t plan to accept. 

What will that mean for HME and services? 

 

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by: Elizabeth Deprey - Monday, February 11, 2013

At a time when every last dollar is being scrutinized in Washington, CMS is slashing and burning an industry that saves millions by keeping people out of hospitals and nursing homes. It makes absolutely no sense. 

But I don’t need to tell you that. The HME industry is well aware of the increasingly challenging environment you guys are trying to provide services in—unrelenting audits, decreasing reimbursements, and now these massive cuts under Round 2 of competitive bidding.

Who doesn’t know? Beneficiaries. Lawmakers. People outside the industry. How can the industry expect enough squeaky wheels to actually effect change, when so many people don’t even really understand what home medical equipment is? (How many times and ways have I tried to explain my job to friends and relatives? How many have you?)

The Internet is a great place to spread ideas from one or a few people all over the country like wildfire. One of the best ways to spread information seems to be through viral videos. These are videos people hear about on morning news show or spot online while surfing YouTube at lunch. They get massive amounts of views, comedians include them in monologues or SNL skits and they become part of the pop culture lexicon.

Could the HME industry come up with something like “Friday,” “Gangnam Style” or even this silly video about banana phones that’s racked up almost 4 million views? (Warning, you can’t unhear the Banana Phone song, so listen at your own risk.)

You may say these videos are silly, pop culture things that are easy to make popular, but what about that KONY 2012 video that hit last year? Regardless of the fallout and anyone’s feelings about it, it racked up over 100 million views, despite having a decidedly un-silly topic.

Different parts of the industry are trying to harness the viral video’s power—The complex rehab video at www.access2crt.org has made some good headway, and Theresa just wrote about a specialty provider movement to get the word out about O&P access through videos at Speak4OandP.com.

Whether it’s through a catchy song, humor, or a powerful message, the story we all know about HME and its future needs to get out.

 

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