In brief: CGM coverage, Viemed earnings, BetterNight funding

WASHINGTON – The DME MACs have released the updated LCD and policy article for continuous glucose monitors (CGMs), finalizing expanded coverage. 
  
To be eligible for coverage of a CGM and related supplies, the beneficiary must meet all of the following initial coverage criteria (1)-(5): 

• The beneficiary has diabetes mellitus (Refer to the ICD-10 code list in the LCD-related Policy Article for applicable diagnoses); and, 
• The beneficiary’s treating practitioner has concluded that the beneficiary (or beneficiary’s caregiver) has sufficient training using the CGM prescribed as evidenced by providing a prescription; and, 
• The CGM is prescribed in accordance with its FDA indications for use; and, 
• The beneficiary for whom a CGM is being prescribed, to improve glycemic control, meets at least one of the criteria below:  
• The beneficiary is insulin-treated; or, 
• The beneficiary has a history of problematic hypoglycemia with documentation of at least one of the following (see the policy specific documentation requirements section of the LCD-related Policy Article (A52464)):  
• Recurrent (more than one) level 2 hypoglycemic events (glucose <54mg/dL (3.0mmol/L)) that persist despite multiple (more than one) attempts to adjust medication(s) and/or modify the diabetes treatment plan; or, 
• A history of one level 3 hypoglycemic event (glucose <54mg/dL (3.0mmol/L)) characterized by altered mental and/or physical state requiring third-party assistance for treatment of hypoglycemia 
• Within six (6) months prior to ordering the CGM, the treating practitioner has an in-person or Medicare-approved telehealth visit with the beneficiary to evaluate their diabetes control and determined that criteria (1)-(4) above are met. 

The effective date for the new LCD and Policy Article is April 16, 2023, a few weeks before the anticipated May 11 COVID-19 PHE end date.  
  
You can view the DME MAC's response to the comments submitted on the LCD here. 
  
Viemed in 'strong position' 

LAFAYETTE, La. – Viemed Healthcare reported net revenue of $37.5 million for the fourth quarter, a 30% increase over the same quarter in 2021, and $138.8 million for full year 2022. 

Net income for the quarter and year totaled $2.4 million and $6.2 million, respectively. Adjusted EBITDA totaled approximately $9.3 million and $30 million, respectively. 

“Our favorable resolution of the OIG matter, debt free balance sheet and access to $90 million of additional liquidity through new credit facilities have us in an incredibly strong position to capitalize on the positive trends in our industry," said Casey Hoyt, VCEO. "The health care market and regulatory environment are stabilizing, and we are at an inflection point of opportunity for both organic and inorganic growth. I'm extraordinarily proud of the current state of our organization and very excited about upcoming opportunities to treat a rapidly expanding patient base.” 

Viemed expects to generate net revenues attributable to its core business of about $38 million to $39 million during the first quarter of 2023. 

Additionally, on March 6, 2023, at 9:15 a.m. ET, representatives from Viemed will be at the Nasdaq MarketSite in Times Square while Hoyt rings the Opening Bell. A live stream will be available at: https://www.nasdaq.com/marketsite/bell-ringing-ceremony 

BetterNight receives $33M in funding 

SAN DIEGO – BetterNight, a provider of comprehensive sleep care through its virtual care platform, has secured $33 million in growth funding led by NewSpring.  

The company will use the proceeds from this transaction to continue its nationwide expansion through partnerships with physician practices, health systems and insurers, and to accelerate the adoption and growth of its value-based sleep solution to employers and health plans. 

"With awareness surrounding the health complications caused by sleep disorders rising, the sleep care industry is growing quickly and is ripe for disruption,” said NewSpring Partner Mike Kaplan. “BetterNight's comprehensive virtual care sleep solution is perfectly positioned to offer patients, providers, and payers a superior sleep care experience. The data shows that BetterNight is best in class in enabling patients to adhere to sleep therapy."  

BetterNight partners with physicians, health systems, clinics and health plans to provide a full continuum of care for patients with sleep disorders. The company is focused on addressing obstructive sleep apnea (OSA) and insomnia to boost clinical outcomes, lower health care costs and improve patient lives. 

The financing round includes participation from existing investors HCAP Partners and Hamilton Lane via its Impact Fund II and other accounts managed by the firm. 

“Our goal at BetterNight is to provide a superior sleep care platform that empowers patients to take control of their health by getting a better night's sleep," said BetterNight CEO Dave French. "The NewSpring team has a strong track record of building successful, scalable healthcare companies, and we believe they are the perfect partner to help power our company's next stage of growth." 

NSM outsources billing and collections 

NASHVILLE, Tenn. – National Seating & Mobility has chosen AGS Health, a revenue cycle management solutions provider, as a strategic partner to perform administrative functions related to funding, billing and collections. 

NSM expects the partnership to maximize its revenue cycle performance through continuous process- and tech-enabled productivity improvements, while improving quality and cycle times for clients. 

“While this is clearly the right decision to further strengthen our business, it will impact current team members,” said Bill Mixon, CEO of NSM. “To that end, we have been working with several external organizations to provide the support and resources to help those impacted.” 

AGS employes more than 11,000 team members globally and partners with more than 100 clients across a variety of care settings, specialties and billing systems. 

NSM has 2,600 team members that care for more than 300,00 clients annually. 

NHIF recognizes Upstate Home Care’s Janice Elliot  

ALEXANDRIA, Va. — The National Home Infusion Foundation (NHIF) has named Janice Elliott, BS, RN, CRNI, VA-BC, as the recipient of the 2023 Lynn Giglione Women in Leadership Award.  

The award recognizes and honors trail-blazing and emerging women leaders who have demonstrated exemplary service to patients and their peers while promoting the mission of NHIF. 

Elliott, who has 28 years of nursing experience in a home care setting, currently serves as the director of vascular access at Utica-N.Y.-based Upstate Home Care.  

“Janice’s peers say she is a trailblazer who makes them better providers through her compassion, dedication, knowledge and positivity,” said NHIF Board Chair David Franklin, MSA. “This is the same spirit that Lynn modeled, and that this award was designed to celebrate.”  

The award was established in 2015 to commemorate the late Lynn Giglione, a trailblazer in the home and alternate site infusion industry and a founding board member of NHIF. 

Elliott has administered infusion therapy, developed vascular access teams, and provided education for clinicians in the home, long-term care, hospice and acute care settings. She has also worked for various U.S. medical device companies as a clinical specialist, preceptor and educator. She started a mobile vascular access team 17 years ago using portable ultrasound technology in the home that she continues to lead today.  

Elliot will receive the award at National Home Infusion Association’s 2023 Annual Conference on March 28. 

RestorixHealth, AMT rebrand 

METAIRIE, La. – RestorixHealth and American Medical Technologies have completed an extensive rebrand and will unite under the RestorixHealth name. The two companies, which merged in 2021, together manage 260 wound centers across 36 states, serve more than 6,000 post-acute facilities across all 50 states and contract with more than 2,400 payers. Bringing the two companies together under one name reinforces their unified position and reputation as leaders in the wound care industry dedicated to advancing their mission to restore health and improve the quality of life – and access to care – for patients with wounds. The brand name, RestorixHealth, is rooted in the company’s commitment to restoring health and best reflects its values and commitment to excellence in wound care. In addition, the RestorixHealth At-Home Wound Healing Services and At-Home Wound Care Supplies service lines will join AMT under the RestorixHealth name. 

BMA joins sign-on letter 

WASHINGTON - Better Medicare Alliance has joined 40 other organizations in signing an “ally” letter to CMS Administrator Chiquita Brooks-LaSure urging the administration to reconsider risk adjustment changes proposed for the 2024 plan year to Medicare Advantage plans. "We are pleased to join a robust and diverse group of 40 provider, minority health and community-based organizations who are concerned that CMS's proposal will harm the 30 million seniors and people with disabilities who rely daily on Medicare Advantage," said Mary Beth Donahue, president and CEO of Better Medicare Alliance. "These organizations are focused on one thing: ensuring America's seniors have access to affordable, high-quality, stable health care." The letter cites a recent analysis by Avalere that shows the impact these changes could have on beneficiary premiums and benefits, with an average reduction of $540 per beneficiary per year and higher impacts in many underserved metropolitan communities. The organizations urge CMS to reconsider and not move forward with these changes for the 2024 plan year and, instead, work with all stakeholders to assess the impacts these proposals will have on beneficiaries. They ask that any proposals finalized for future implementation based on a thorough review of stakeholder input should be phased in over multiple years to maintain program stability for beneficiaries. To read the letter, go here. 

 Medtrade highlights workshops 

DALLAS – There is still limited space available for workshops at Medtrade, which takes place March 28-30 at the Kay Bailey Hutchison Convention Center in Dallas. Workshops include “Get Credential Training at Medtrade with BOC,” led by Abel Guevara of Abilitech Medical; “Team@Work Sales Bootcamp,” led by Ty Bello of Team@Work; and “Retail Fundamentals Workshop,” led by Rob Baumhover of Independent Medical Equipment. Times and fees (where applicable) vary. For questions about registration, call 864-342-6295, Monday - Friday 9:00am – 5:00pm (EST). Customer service can also be reached at https://registration.experientevent.com/ShowMTH231/ContactUs. 

Sunset Healthcare joins VGM as vendor partner 

CHICAGO – Sunset Healthcare Solutions will join VGM & Associates as a vendor partner. “Sunset and VGM each have a lot of unique strengths, knowledge and expertise in the home care industry,” said PJ Ruflin, vice president of business development at Sunset. “The creation of this partnership, and ability to now work even more closely together to, ultimately, create better offerings and solutions for our customers is very exciting. The more we can support this industry, our customers and their patients, the better for all. This is a big step forward in that regard.” Sunset is already a longtime partner of VGM Fulfillment. Through the new partnership, Sunset will offer flexible shipping options direct from one of its warehouses in Phoenix or the Chicago area or through distributors like VGM, McKesson or Cardinal. “At VGM, it is our goal to simplify our members’ day to day so that they can provide the service their patients deserve,” said Boone Lockard, director of VGM Respiratory. “We take great care in selecting only the best products and services for our vendors.” 

Dynarex offers scholarships 

ORANGEBURG, N.Y. – Dynarex Corp. is proud to announce the 2023 “We Care Like Family” Scholarship — Distributor Employee Program. Dynarex will award more than $5,000 to assist students pursuing educational opportunities in the medical field and other areas of study. The scholarship is open to the children of all employees of active Dynarex distributors. “This exciting scholarship program will help supplement tuition and other expenses associated with post-secondary education—such as textbooks, school supplies and transportation,” said John Burns, director of Dynarex University Corporate Training & Events. “This is just another example of how much Dynarex values its distributors and reinforces our guiding principle, ‘We Care Like Family.’” Scholarship funds will be awarded to five first-place winners, each receiving $1,000, and two second-place winners, each receiving $500. For full eligibility requirements and application guidelines, go to https://dynarex.com/dynarex-university. 

NRRTS seeks nominations for annual leadership awards 

LUBBOCK, Texas – NRRTS is accepting nominations for several annual awards: the Leadership Award, Distinguished Service Award, Consumer Advocate of the Year and Simon Margolis Fellow. The organization will accept nominations for the awards until March 17. “Each year, NRRTS’s board of directors awards individuals and groups who have contributed to the advancement of CRT through leadership, advocacy or distinguished service,” the organization states. “The board wants to give you an opportunity to recognize CRT industry leaders for their dedication and hard work.” Nominations can be emailed to Weesie Walker at wwalker@nrrts.org. A selection committee will determine the recipients of the awards and NRRTS will present the awards at the International Seating Symposium, April 13-15 in Pittsburgh. To learn about the requirements for each award, please go here. The Simon Margolis Fellow, for example, recognizes NRRTS registrants who have made long-standing and significant contributions to NRRTS, the CRT profession, and the seating and wheeled mobility community. They must be a registrant for at least 10 years and have the CRTS credential.  

Medline gets nod from Mass General Brigham 

NORTHFIELD, Ill. - Medline will be the exclusive provider of medical and surgical supplies across Mass General Brigham’s continuum of care, including its acute care facilities and network for ambulatory surgery centers and physician offices. At the start of the COVID-19 pandemic, Mass General Brigham tapped Medline to augment its storage capacity with third-party logistics (3PL) solutions enabled by Medline's 840,000-square-foot distribution center Uxbridge, Mass. With the expansion of the strategic relationship, Mass General Brigham will also leverage Medline's supply chain optimization and logistical expertise to advance its supply chain operations and resiliency efforts. "Working with Medline allows us to leverage their entire scope of expertise in the areas of supply chain logistics and clinical solutions to ultimately help improve our operating performance," said Lisa Scannell, vice president of supply chain for Mass General Brigham. "We look forward to evolving this strategic relationship to achieve greater resiliency and standardization in our system's supply chain." As part of the agreement, on-site Medline analysts will work hand-in-hand with leaders to address specific caregiver needs and help drive new ways of optimizing care to provide enhanced support and service. In addition, Mass General Brigham will have the ability to easily monitor key metrics, such as item utilization, contract compliance, price accuracy and spend by product categories through Medline's analytics platforms. "We are honored to expand our business relationship with Mass General Brigham and are committed to becoming an extension of their team, going to great lengths to understand the system's needs," said Jim Digiacomo, executive account director for Medline. "Combining their mission to serve the community with Medline's agility and scale, this partnership will enable us to create customized solutions to help health care run better." 

X-PLOR POC marketed through GoodRx 

LONDON and PLANO, Texas – Belluscura has announced its X-PLOR portable oxygen concentrator is now marketed in the U.S. through GoodRx. The X-PLOR will be the first medical device in its field marketed through GoodRx’s website, www.goodrx.com. "In our continued goal of broadening product distribution and making supplemental oxygen more accessible to people throughout the U.S., we are excited to have the X-PLOR marketed through GoodRx, a recognized leader in making health care more accessible and affordable in the U.S.,” said Robert Rauker, CEO. GoodRx’s free website and mobile app tracks prescription drug prices and provides coupons for discounts. The company also operates a telemedicine platform. 

NHIA says CMS’s policies are to blame for decline in access 

ALEXANDRIA, Va. – The National Home Infusion Association (NHIA) says a new report from CMS supports its assessment that the home infusion benefit, as currently implemented, continues to lack sufficient participation from providers to ensure equitable access to beneficiaries across the U.S. The “HIT Monitoring Report, February 2023,” showed that utilization has remained essentially flat over a 26-month study period despite growing enrollment in Medicare over the same timeframe. The NHIA says the lack of provider participation is directly related to CMS policies, including lack of payment for professional pharmacy services, and new requirements for providers to obtain accreditation to bill for services. “This new CMS report shows once again that the HIT services benefit is not attracting a sufficient number of providers to serve all eligible Medicare beneficiaries, thus there is an urgent need for Congress to act and pass legislation to correct CMS’s failures,” said Connie Sullivan, BSPharm, NHIA president and CEO. “By not accounting for the full range of services, CMS is again ignoring the fact that many of Medicare’s most vulnerable seniors are losing access to home-based IV care.” As a result of low provider participation, on average, only 1,250 beneficiaries are receiving Part B home infusion services per quarter, a small fraction of the patients eligible for the service, according to the report, the second such report CMS has published. The NHIA says when comparing data maps from the two reports, the number of states that have no services provided to beneficiaries increased from three to six (Alaska, Montana, North Dakota, South Carolina, Vermont and Wyoming). “Access to home infusion services under the Part B HIT benefit is declining at a time when demand is spiking in other sectors that embrace the pharmacy-driven model,” said Tim Affeldt, PharmD, NHIA board chair. “While nursing services are an essential component of home infusion, the pharmacist-driven services to coordinate care, provide compounded sterile drugs, perform clinical monitoring, and ensure patients meet the overall goals of the plan of care are equally important and should be reflected in the benefit.”  

Medtrade promotes regular registration, mobility course 

DALLAS – Regular registration rates are now in effect for Medtrade, scheduled for March 28-30 at the Kay Bailey Hutchinson Convention Center in downtown Dallas. A conference pass includes access to the show floor and the Consultant Cocktail Hour. An expo pass includes access to the show floor. “Regular rates still amount to an amazing deal, and they are in effect right up to the final day of the show,” said York Schwab, show director. To register for Medtrade, go here...Attendees with either the conference pass or the expo pass will have access to a three-part course focused on seating and mobility presented by Alex Chesney, OTR, ATP/SMS, clinical sales manager for Quantum Rehab. The course – comprised of “Seating and Mobility Foundations,” “Balancing Function and Independence” and “Beyond Drive Control” – is being offered for continuing education units. To register for the course, email bfry@quantumrehab.com.