In brief: Error rate, Lifeway Mobility, Protech Home Medical

WASHINGTON – The CERT error rate for DMEPOS is 31.8% for 2020, an 0.8% increase compared to 2019, according to a recent report from Medicare. 

Insufficient documentation is at the root of about 65% of errors, according to the “2020 Medicare Fee-For-Service Supplemental Improper Payment Data,” which reviewed claims from June 2018-June 2019. 

Medical necessity represented a small percentage of errors. Other types of errors include: no documentation, incorrect coding, and other unspecified errors. 

Error rates vary by category, with diabetic shoes (68.2%), lower limb orthoses (65.7%) and upper limb orthoses (42.3%) having the highest rates. 

Similar to previous years, power mobility devices have the lowest error rate, dropping to 4% from 7% in the 2020 report. The low error rate is attributed to prior authorizations. 

In January, the Office of Inspector General released a report that said CMS and its contractors did not use CERT data to identify providers with higher error rates. The agency recommended CMS review the list of 100 error-prone providers identified and take action such as prior authorization, prepayment reviews and post-payment reviews, and use annual CERT data to identify individual providers that have an increased risk of receiving improper payments and apply additional program integrity tools to these providers.  

CMS disagreed. 

Lifeway Mobility grows West Coast presence 

HARTFORD, Conn. – Lifeway Mobility has invested in Gamburd, a Los Angeles-based provider of accessibility solutions for people with limited mobility. 

Israel Gamburd, the company’s founder, together with his wife, Regina, will continue in their current roles. 

“Israel is a true accessibility pioneer,” said Paul Bergantino, president of Lifeway Mobility. “The Gamburd team has extraordinary technical expertise and a tireless determination to satisfy each customer. It will be exciting to support their growth throughout California and the western states.” 

Garmburd, which has two locations in California serving customers in 250 cities throughout the state, is a licensed dealer of stairlifts, wheelchair lifts, residential elevators, ramps, step-in tubs and overhead lifts. It also offers bath safety equipment and other home modifications. 

Lifeway Mobility serves Connecticut, Massachusetts, Rhode Island, southern New Hampshire, Illinois, Minnesota, western Wisconsin and California. 

Lifeway Mobility makes second investment 

PITTSBURGH, Pa. – Lifeway Mobility is pleased to announce that it has invested in the assets of Accessible Home Automations, LLC, doing business as StairBusters.com, a provider of accessibility solutions throughout western Pennsylvania for more than 20 years. StairBusters, a certified dealer of stairlifts, wheelchair lifts, residential elevators, ramps, overhead lifts and bath safety equipment, is a participating provider in various Veterans Administration, state, county and agency funding programs. It also offers affordable consumer financing and rental programs. Company founder Andrew McKowan, Sr., his son, Andy Jr., and their team will stay on. “For over 20 years the StairBusters family has helped our community members stay in the homes they love by offering safe, effective and low-cost accessibility options,” said McKowan. “Whether injury, illness, or the natural aging process, we assist in finding the best equipment and solutions tailored to each of our customer’s needs. Our mission has always been, and will continue to be, providing extraordinary customer care with dignity.” 

Protech reports ‘robust’ results 

CINCINNATI – Protech Home Medical reported revenue of $25 million for the fourth quarter of its fiscal year 2020 compared to $19.5 million for the same period the previous year. It reported revenue of $97.8 million for the year vs. $81 million for 2019, a 21% increase. 

Adjusted EBIDTA for the fourth quarter was $5.9 million vs. $3.5 million year over year, and for 2020, $20.8 million vs. $14.8 million year over year. 

“Our fourth quarter results showcase the continued momentum across the entire business as our revenue and adjusted EBITDA growth continued to be robust with continued margin expansion,” said Greg Crawford, CEO and chairman. “The investment we made in technology to remove friction points across the organization have aided in the robust nature of our results and our telehealth platform allowed for the interaction between our frontline workers and patients to continue seamlessly. As a result, we were able to capture the meaningful tailwinds that continue to present themselves.” 

Among the operational highlights Protech reported: 

• Its customer base increased 20% year over year to 91,650 unique patients in 2020. 
• Leveraging technology and centralized intake processes, the company says respiratory resupply setups and/or deliveries increased to 19,613 for the fourth quarter, a 54% increase year over year. 
• It says its sleep business regained momentum, as well, as stay-at-home orders were lifted and is confident “this vertical will surpass historical levels in 2021.” 

Additionally, the company shared it has applied to list on the NASDAQ. 

Protech Home Medical expands into Florida with acquisition 

CINCINNATI – Protech Home Medical has acquired Mayhugh’s Medical Equipment in Jacksonville, Fla., for $5.8 million. 

MME, which has trailing 12-month annual revenues of $7 million and adjusted EBIDTA of $1.2 million, is a respiratory focused provider with more than 10,000 active patients, including 5,000 that Protech can immediately add to its resupply program. 

The deal marks Protech’s first foray into Florida. 

“MME’s heavily weighted respiratory product mix, and diversification of the payer mix, provides Protech with a stable foundation to start its Florida operations,” said Protech CFO Hardik Mehta. “We will look to grow our scale in Florida, both organically and through strategic bolt-on opportunities that present themselves.”  

NSM, LUCI partner on distributorship 

NASHVILLE, Tenn. – National Seating & Mobility has partnered with LUCI to distribute its smart technology to power wheelchair users through its 170 locations nationwide. “LUCI’s advanced technology and innovative design ensure safer navigation and greater mobility for our clients,” said Bill Mixon, NSM CEO. “We are proud to partner with the LUCI team on the national distribution of this revolutionary product.” LUCI is a hardware/software platform that fits onto an existing power wheelchair and uses a patented sensor-fusion safety system combining data from cameras, ultrasonics and radar. LUCI was named to Time Magazine's 2020 annual list of the 100 Best Inventions. 

InfuSystem adds to DME platform with acquisition 

ROCHESTER HILLS, Mich. – InfuSystem, a provider of infusion pump therapy and other health care services, has acquired FilAMed, a biomedical services company based in Bakersfield, Calif. “The addition of FilAMed broadens and enhances our scope of biomedical services within our DME platform and provides us the opportunity to enter the acute care market,” said Richard DiIorio, CEO.  “Our customers will benefit from a broader range of services, including compression devices, defibrillators, electrosurgical units (ESU), and patient monitors.” Terms of the deal were not disclosed. 

Medtronics recognized by Fortune magazine 

DUBLIN – Medtronics has been named to Fortune’s 2021 World's Most Admired Companies List. The medical device maker, whose products include insulin pumps and continuous glucose monitors, ranked at No. 4 in the Medical Products and Equipment industry. “We're honored to once again be selected by Fortune for this prestigious recognition," said Geoff Martha, Medtronic chairman and CEO. "Every day, our teams around the world work to bring innovative products and solutions to deliver on our mission – to alleviate pain, restore health, and extend life. In an incredibly challenging 2020, we continued to put patients first and demonstrated to the world that Medtronic can be a force for positive change — not just within healthcare, but in the communities where we work and live." The annual list measures corporate reputation among the world's largest companies. 

Medicare Advantage organization releases TV spot  

WASHINGTON – The Better Medicare Alliance, a research and advocacy organization supporting Medicare Advantage, is airing a new television ad on broadcast networks in Washington, D.C., and cable news channels nationwide. The 60-second spot highlights MA’s preparedness in the face of health care challenges. “The COVID-19 pandemic has shown just how responsive and nimble Medicare Advantage is and how important it is to the health and wellbeing of beneficiaries,” said Allyson Schwartz, president and CEO of BMA. “We’ve seen health plans waive costs, lead a rapid transition to telehealth, and leverage supplemental benefits that help keep seniors safe in their homes.” The ad also cites data showing a 98% consumer satisfaction rating. BMS is a grassroots community of more than 500,000 beneficiaries and 156 ally organizations looking to improve health care through strong Medicare Advantage programs.    

Minnesota: Budget includes DME cuts, but it lacks Senate support 

MINNEAPOLIS – Minnesota Gov. Tim Walz’s 2022-2023 budget recommendations include cuts to DME, according to a bulletin from MAMES. Specifically, the budget proposes changing the Medical Assistance reimbursement formula for durable medical equipment that is also covered by Medicare but is not currently subject to the upper payment limit to the equivalent of the Medicare rate. The state’s Department of Human Services estimates the change would result in savings of 4.3%. The budget also proposes simplifying the reimbursement formula for products that don’t have a reimbursement rate by basing it on provider costs rather than billed charges. Additionally, the budget proposes amending state statute to clarify the agency’s current approach to applying the existing hierarchy for setting payment rates for DME items and services, and making clear exactly what payment methodology applies to which items or supplies. There is currently not support in the state Senate to move forward with the budget. MAMES will continue to work with key legislators to educate them on its impact on the ability of providers to serve Medicaid beneficiaries. 

3B Medical’s Luna G3 receives approval 

WINTER HAVEN, Fla. – 3B Medical has received 501(k) clearance from the U.S. Food and Drug Administration for its new third-generation bi-level device, the Luna G3 Auto-BPAP, to treat obstructive sleep apnea. The device is available with integrated heated tubing, cellular connectivity, and an advanced algorithm that automatically senses and adjusts pressure settings to ensure airway patency, according to the company. “We are excited by the FDA’s recent action approving use of the Luna G3 Auto-BPAP,” said Justin Smith, 3B Medical’s COO. “The Luna G3 is 3B Medical’s third generation platform and incorporates a new design, a smaller footprint and more advanced functionality.” The device also provides a backup rate that reduces the work of breathing with pressure settings up to 25 cmH20, the company says. 

Encore Healthcare offers ‘first step’ to outcomes-based model 

LIVINGSTON, Tenn. – Encore Healthcare has released the third version of its Nexus platform. The company, a vendor partner of VGM & Associates, says Version 3.0 makes it easy to tailor the software into a program to meet the growth, clinical and compliance goals of respiratory HME providers at any level. “With the launch of V3, Encore is releasing a Nexus solution for companies who are not ready for the full clinically enhanced disease management platform but want to take the first step into an outcome-based model,” a press release states. Encore says Nexus is being used nationwide on more than 9,000 patients and for 260,000 clinical assessments. Using the platform, HME providers have been able to grow year over year complex respiratory referral growth more than 25%, extend average months on service for their base populations by two months and reduce readmissions by more than 60%. 

PlayMaker, HealthRev Partners join forces 

NASHVILLE, Tenn. – PlayMaker Health and HealthRev Partners have combined their technology and services to deliver solutions that drive and maximize revenue growth, they say. HealthRev’s proprietary software and consultative approach to revenue cycle management maximizes reimbursement, drives faster turnaround and ensures accuracy for health companies, the companies say. “We know that revenue cycle management is a key factor to any post-acute organization,” said Gregg Boyle, CEO. “By incorporating a best-in-class solution with our post-acute sales enablement platform, our clients will be able to take their growth opportunities to the next level. We are thrilled to partner with HealthRev Partners and to combine technology and services that drive better results and business growth.” PlayMaker’s post-acute growth platform is used by more than 2,300 home health, hospice, HME, infusion and long-term care agencies nationwide. 

Inogen settles patent dispute 

CHICAGO – Inogen has settled allegations that its line of wearable ventilators infringes on patents by Breathe Technologies, according to Bloomberg Law. Inogen entered the non-invasive ventilators market with its acquisition of New Aera for $70.4 million in 2019. New Aera manufactures the Tidal Assist Ventilator system, which includes the SideKick RAV, a 4-ounce, pocket-sized portable non-invasive vent for people suffering from various chronic lunch diseases. In its lawsuit, Breathe, which is owned by Hillrom, charges Inogen with knowing about the patent infringement prior to its purchase of New Aera and using the deal to indemnify itself against claims of patent infringement. Gregory Kapust, who was Breathe’s CEO until 2011 and was listed as an inventor on the patent, founded New Aera shortly thereafter. 

Specialty Infusion Centers expands in NY 

NEW YORK – Specialty Infusion Centers has opened a new office in Staten Island, N.Y. The state-of-the-art location upgrades the standards of infusion and injection therapies for patients who have complex health conditions, with flexible appointments that include evening and weekend availability. “It’s imperative to provide resources to patients who need it the most and may not have other options to help, especially during a time of uncertainty,” said Dr. Jake Deutsch, founder and chief medical officer of Specialty Infusion. “At Specialty Infusion, we are committed to each patient’s experience and the needs of referring providers and look forward to providing relief to patients throughout Staten Island, with the help of our trusted providers.”  The new office is part of an ongoing company expansion plan within New York that will continue through 2021. It offers the same suite of services provided at the company’s other New York City locations, including a comprehensive list of infusions and injections that treat a wide range of conditions, including Crohn’s disease and ulcerative colitis, rheumatoid arthritis, multiple sclerosis, osteoporosis, dermatological disorders, endocrine disorders, neurologic disorders, enzyme replacement therapy, infertility and more. 

RESNA to hold virtual event 

ARLINGTON, Va. – RESNA will hold its annual event virtually July 7-9. “The RENA 2021 Virtual Conference will bring together assistive technology professionals from a variety of disciplines to exchange ideas about the latest innovations and research helping with disabilities lead independent, healthy lives,” the organization stated. RESNA will announce the conference program in the coming weeks and will kick off registration in late February. The organization also held its 2020 annual conference virtually in September.