In brief: Homecare Champ, new home infusion code, supplies survey, seat elevation comments

DALLAS – Kam Yuricich has been named the 2023 Van Miller Homecare Champion for her achievements as the executive director for OAMES and the Great Lakes Home Medical Equipment Association. 

Yuricich will be honored at the Stand Up For Homecare reception at Medtrade in Dallas on Wednesday, March 29. 

“Kam is a star and a stalwart for HME,” says Tom Ryan, AAHomecare president and CEO. “She’s brought home bottom-line wins for her members and she’s also made important contributions that resonate across the industry. Kam’s earned a lot of respect in the HME community, and I’m excited that we are formally recognizing her success and service to this industry.” 

Yuricich’s efforts to build relationships with state legislators and regulators were critical in securing relief for suppliers in Ohio and Indiana through American Rescue Plan Act funds. She has led efforts to derail proposed Medicaid reimbursement cuts and has ensured HME has a seat at the table on state policy initiatives affecting the industry.  

Yuricich has also served as chair of the State Leaders Council and is known for her willingness to share her experience and encouragement in support of her state association executive peers. 

Tickets to SUFH can be purchased here or at the door. 

NHIA secures coding changes to modernize benefit 

ALEXANDRIA, Va. - The National Home Infusion Association has successfully petitioned CMS to secure a new billing code for injectable immunotherapies and revise an existing code to facilitate administration of a wider range of monoclonal antibodies for respiratory syncytial virus (RSV). 

The request is part of a broader effort to modernize the Healthcare Common Procedure Coding System used by commercial health plans, including some Medicare Advantage and Medicaid programs, to reimburse for infusion services.  

“NHIA appreciates that CMS is acknowledging the broader range of medications being administered in the home setting by creating this new code,” said NHIA President and CEO Connie Sullivan, BSPharm. “Payors and providers should work to incorporate these changes into their home and alternate site infusion contracts.”   

CMS has established a new HCPCS Level II code, S9563, “Home injectable therapy, immunotherapy, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.”   

It has also revised the HCPCS Level II code S9562, “Home injectable therapy, palivizumab, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem” to read “Home injectable therapy, palivizumab or other monoclonal antibody for RSV, including administrative services, professional pharmacy services, care coordination, and all necessary supplies and equipment (drugs and nursing visits coded separately), per diem.”   

The NHIA says without a code to use for newly approved therapies, providers were forced to use “not otherwise classified,” or NOC codes, which have several disadvantages for both providers and payers. 

“The association plans to submit additional code requests in the future to ensure that coding and claims practices accurately reflect the services delivered by home and alternate site infusion providers,” said Bill Noyes NHIA’s senior vice president of reimbursement policy. 

Strong show of support for power seat elevation 

WASHINGTON – A total of 2,128 stakeholders submitted public comments in response to a proposed national coverage determination that would expand coverage for power seat elevation on Group 3 wheelchairs. 

Stakeholders ranged from NCART to U.S. Rehab to power wheelchair users to caretakers to the American Occupational Therapy Association to an ATP/CRTS at National Seating & Mobility to Merits to the Amputee Coalition. 

“Miller’s supports Medicare coverage of this important seating technology to establish important access for Medicare beneficiaries with disabilities and complex medical needs,” wrote Johnny Miller, president of Miller’s Rentals & Sales. “Power seat elevation is an important component of a complex rehab power wheelchair that allows people to perform or participate in the essential mobility-related activities of daily living (MRADLs) in his or her home. The need for and benefits of a power seat elevation system not only improves transfers, but it also improves beneficiary access to the vertical environment for reach and line of sight requirements to safely and effectively engage in one’s MRADLs. This is supported in the research, by subject matter expert consensus, patient-centered outcomes data, and is recognized by national disability and medical professional organizations. It is also supported by third-party payers such as state Medicaid programs, commercial payers, and the Veterans Administration that already provide coverage under their programs. We strongly believe it is time for the Medicare program, as the single largest health care insurer in the nation, to provide coverage for this enabling technology in the same manner, as well.” 

AAHomecare outlined its comments here. 

CMS published the proposed NCD on Feb. 15 and accepted comments through March 17. 

The agency will next publish a final NCD. 

AAH launches supplies survey 

WASHINGTON – AAHomecare is launching two nationwide surveys to gather intel on the rising costs of products, shipping and labor for those providing disposable medical supplies. 

The association will use aggregated data from the surveys in its advocacy efforts. 

“AAHomecare’s Medical Supplies Council is acutely focused on issues impacting the disposable supplies space and wants to empower the industry with data and tools that can be leveraged to educate payers on today’s market realities,” said Ashley Plauché, AAHomecare’s director of membership & public relations.  “Information from surveys like these help breathe life into our messaging on the need for sustainable reimbursement to preserve the HME infrastructure and ensure end user access.”  

The deadline for the surveys is April 14. 

AAHomecare says the surveys build on last year’s incontinence survey, which the association used as the foundation for an infographic and letter to Medicaid directors. Providers were also able to leverage the survey results in individual contract negotiations with their payers, including MCOs and commercial plans.    

Go here for the Enteral Survey (enteral nutrition, pumps, kits, and/or supplies)   

Go here for the Supplies Survey (wound care, ostomy, and/or urological supplies) 

McKesson secures federal contract 

RICHMOND, Va. – McKesson Medical-Surgical Government Solutions has been awarded a five-year contract by the U.S. Department of Veterans Affairs for medical equipment and supplies. 

The contract, used by the VA and other federal agencies, affords greater access to McKesson brand supplies, including respiratory accessories, disposable surgical instruments, hospital clothing, exam tables, adhesive bandages and hundreds of other products. 

“Securing this contract represents a critical milestone in McKesson’s effort to support federal agencies,” said Deborah Haywood, vice president of Government Solutions at McKesson Medical-Surgical Government Solutions. “It broadens our ability to demonstrate the positive impact McKesson’s products and capabilities can have on patients’ lives and further enables us to create cost efficiencies within the overall health care system. We are particularly excited to continue our commitment to offering high levels of service for America’s veterans and the military community.” 

Industry leaders in ‘hot seat’ at Medtrade 

DALLAS – Members of AAHomecare’s Executive Committee will answer questions from the industry at the AAHomecare Update at Medtrade on Mar. 29. In this new format, the association will look to Bill Guidetti of Apria, Josh Marx of Medical Service Company and Ryan Bullock of Aeroflow to offer up their vision of the future. Questions received from the industry for the panelists include:  What are you doing to address the problems we’re having with other payers? Does the DMEPOS industry factor into value-based payment? What is your opinion on the administration’s plans for competitive bidding’s future? AAHomecare President and CEO Tom Ryan will moderate the one-hour, interactive session. 

Sunset to distribute SleepRes device 

CHICAGO – Sunset Healthcare Solutions is partnering with SleepRes to distribute V-Com, a device that softens peak respiratory flow for patients using CPAP, APAP and bi-level PAP therapy. “We are always looking for strong partnerships and ways to bring solutions to providers to help them grow their business and create added value,” says PJ Ruflin, vice president of business development. “SleepRes and their V-Com product fit this objective perfectly, and we look forward to helping get it into the hands of providers and patients alike, to improve their outcomes and adherence with PAP therapy.” V-Com launched in June 2022. 

Brightree among finalists for NHIA Innovation Award 

ALEXANDRIA, Va. – The National Home Infusion Association has announced the finalists for its 2023 Innovation Award. The award recognizes groundbreaking products or services that advance the home and alternate site infusion industry. The finalists are: Amsino Medical Group for the PUGGLE Enteral Feeding Pump; Brightree for Brightree Digital Experience; Gasgon Medical for AirVault; and Stratix Labs for the Enverify Surface Sampling Competency Kit. “The home infusion industry was born out of innovation and will continue to advance thanks to the efforts of companies like (these),” said Tim Affeldt, chair of NHIA’s board of directors. “I would like to thank all of the companies who entered and encourage more to do so as the award progresses.” The winner will be selected by a panel of NHIA provider member organizations and will be announced at the general session during NHIA’s 2023 Annual Conference on March 28. 

Last call for MAMES board nominations 

STILLWATER, Minn. – MAMES seeks nominations for directors for its board of directors from Iowa, North Dakota, South Dakota and Wisconsin. The association also seeks an associate member. All positions are for a three-year term, from 2023-26. The deadline to complete applications is March 31. The board meets up to four times each year: prior to the Spring Conference and Fall Conference; and up to two other times, either virtually or face-to-face. MAMES will conduct the annual election of the board of directors on April 26 during the opening session of the MAMES Spring Conference. For questions, contact MAMES Executive Director, Rose Schafhauser, info@mames.com or 651-351-5395.   

CMS adds ZIP code to Round 2021 

WASHINGTON - The following ZIP code has been added to Round 2021 of the DMEPOS competitive bidding program to conform with United States Postal Service ZIP code changes within the identified competitive bidding area (CBA): 56963 Washington, DC CBA. No HCPCS codes were added or removed during this quarter. CMS has not indicated when it may hold any future rounds of the bidding program, after the last round largely failed due to lack of cost savings.   

Beyond HME, ACU-Serve partner with S3 

SARASOTA, Fla. – Beyond HME, a patient outreach specialist that provides support in CPAP resupply, compliance, consulting and other disease states, has announced a new partnership to integrate S3’s patient-focused Resupply SaaS platform to provide a complete resupply solution. “Beyond HME’s goal is to create a healthcare alliance with the best software solutions, service organizations and health care providers in the HME industry,” says Jim Dragatsis, CEO of Beyond HME. “Having access to the S3 platform enables us to provide the best, most comprehensive resupply solutions for our customers.” In February, Beyond HME partnered with ACU-Serve, a provider of HME revenue cycle management solutions, to provide resupply and compliance and full-service consulting to its clients. 

Soleo’s Drew Walk named to NHIA board 

FRISCO, Texas – Soleo Health CEO Drew Walk has been to the National Home Infusion Association’s 2023-2024 board of directors. Walk joins a group of seasoned home infusion experts on the board. “It is both a privilege and an honor to be asked to serve on NHIA’s board of directors alongside industry leaders and individuals who lead well-established and respected companies in the home infusion arena,” said Walk. “I am proud to have an opportunity to add my voice to theirs as we work collectively to further the important role home infusion plays for all stakeholders – patients, payers, physicians, health systems and pharmaceutical manufacturers.” The 2023-2024 board will be installed after the NHIA’s Annual Conference in Washington, D.C., March 25-29. Each member will serve a three-year term. 

Study finds statins, but not CPAP therapy, can reduce heart disease 

NEW YORK – A new study from Columbia University researchers suggests that cholesterol-lowering drugs called statins can potentially reduce heart disease in people with obstructive sleep apnea. But, while CPAP therapy improves sleep quality and reduces daytime fatigue in people with OSA, findings from several recent clinical trials show it does not improve heart health as physicians originally hoped, according to a press release by Columbia University Irving Medical Center. “Alternative methods to reduce heart disease in sleep apnea patients are urgently needed because the condition is known to triple the risk of having a heart attack, stroke or another serious cardiovascular event,” according to researchers.  The study, led by Sanja Jelic, MD, associate professor of medicine at Columbia University Vagelos College of Physicians and Surgeons, included 87 people with recently diagnosed obstructive sleep apnea who were being treated with CPAP. The patients were randomized to receive treatment with either statins or a placebo. The study was published in the Annals of the American Thoracic Society. 

OM lays off 60-plus employees 

RICHMOND, Va. – Owens & Minor has laid off 61 employees in Franklin, Mass., according to a WARN notice filed with the state. The company, which announced a realignment on Feb. 28, laid off the employees nine days earlier on Feb. 17, according to the notice. Owens & Minor officials said during a conference call to discuss the company’s fourth quarter and year-end financial results* that they had kicked off an ambitious, companywide program to “right size” the business in the face of new market conditions. OM expects the move to drive $30 million of adjusted operating income in 2023 and provide between $250 million and $400 million of working capital benefits by 2025. The realignment is being led by Dan Starck, executive vice president of OM, president of the Patient Direct segment and CEO of Apria. OM has more than 20,000 employees globally. 

Inspire OK’d for use in kids 

MINNEAPOLIS – Inspire Medical Systems has received approval from the U.S. Food and Drug Administration to offer its obstructive sleep apnea therapy to pediatric patients with Down syndrome. The approval includes patients with Down syndrome who are at least 13 years old, with an apnea hypopnea index between 10 and 50, and who do not have the ability to benefit from CPAP. “Since our first FDA approval in 2014, the research team at Mass Eye and Ear, led by Dr. Christopher Hartnick, have pioneered the use of Inspire in this important group of people and we are thrilled to announce this most impactful approval on World Down Syndrome Day,” said Tim Herbert, president and CEO of Inspire. “We acknowledge and appreciate the persistence of Dr. Hartnick’s team, as well as the teams at the many participating institutions, to collect the necessary clinical evidence to support the FDA approval. We would also like to thank the LuMind IDSC Down Syndrome Foundation for their support of our FDA application. Inspire intends to immediately begin educating healthcare providers across the U.S. about the benefits of Inspire therapy for children with Down syndrome.” Inspire has been prescribed to adults with Down syndrome for several years, but previously only to patients who were at least 18 years of age. Inspire’s proprietary Inspire therapy is the first and only FDA-approved neurostimulation technology that provides a safe and effective treatment for moderate to severe obstructive sleep apnea. 

NCPA gets behind Drug Transparency in Medicaid Act 

ALEXANDRIA, Va. – The National Community Pharmacists Association supports bipartisan legislation reintroduced March 17 to improve transparency and prevent the use of “spread pricing” in Medicare managed care programs. Spread pricing is when pharmacy benefit managers overbill the state or Medicaid managed care programs, under-reimburse pharmacies for medications dispensed and retain the difference, the association says. A broad ban on these practices would save the federal government more than $1 billion over the next 10 years, with state governments also saving hundreds of millions of dollars in Medicaid costs, it says. “Through spread pricing in Medicaid alone, PBMs can hoard hundreds of millions of dollars each year,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “That this tactic hasn’t yet been banned is good for the mega-middlemen, but terrible for the beneficiaries and taxpayers left paying inflating prescription drug costs as a result.” In addition to banning spread pricing, the Drug Transparency in Medicaid Act would also require pharmacy reimbursements in all state Medicaid managed care programs to be at a rate of pharmacy’s average acquisition costs based on the National Average Drug Acquisition Cost survey, plus the state’s Medicaid fee for service dispensing fee; limit payments to PBMs to solely administrative fees; and mandate NADAC reporting to CMS by all pharmacies participating in state Medicaid programs. The legislation was reintroduced by Reps. Buddy Carter, R-Ga.; Vicente Gonzalez, D-Texas; Rick Allen, R-Ga.; Jake Auchincloss, D-Mass.; Elise Stefanik, R-N.Y., and Deborah Ross, D-N.C. 

MedPAC makes payment recommendations 

WASHINGTON – MedPAC recommends a higher-than-current law fee-for-service payment update in 2024 for acute care hospitals, as part of its March 2023 “Report to Congress: Medicare Payment Policy.” It also recommends positive updates for clinicians paid under the physician fee schedule and outpatient dialysis facilities; and negative updates for skilled nursing facilities, home health agencies and inpatient rehabilitation facilities. Additionally, it recommends a positive payment update in 2024 for hospice providers concurrent with wage adjusting and reducing the hospice aggregate Medicare payment cap by 20 percent. The report also reviews the state of Medicare Advantage and the prescription drug benefit. On Medicare Advantage, the group says it remains committed to including private plans in the Medicare program and allowing beneficiaries to choose among coverage options; however, it believes the government is overpaying these plans. The full report is available at MedPAC’s website (http://www.medpac.gov). 

Tandem study shows benefits of its insulin pump tech in kids 

SAN DIEGO – Tandem Diabetes has published results from the pediatric artificial pancreas (PEDAP) clinical trial in the New England Journal of Medicine showing an increase of about three hours per day time in range in children ages 2-5 years old using the t:slim X2 insulin pump with Control-IQ advanced hybrid closed-loop technology compared to those on a standard insulin pump or multiple daily injections. “The safety and efficacy outcomes observed in this study support using Control-IQ technology for young children with type 1 diabetes to enhance quality of life and minimize the risk of long-term complications,” said Dr. R. Paul Wadwa, professor of pediatrics at the Barbara Davis Center for Diabetes, University of Colorado Anschutz Medical Campus and protocol chair for the PEDAP Clinical Trial. “Studies using Control-IQ technology have shown impressive results in different age groups, now in a sequence of randomized controlled trials published by the New England Journal of Medicine, demonstrating more time in range with low risk of hypoglycemia.” The study was a 13-week randomized, multi-center trial, featuring 101 children age 2 to <6 years old with Type 1 diabetes. It was funded by the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) through a grant, with product support was provided by Tandem Diabetes Care and Dexcom, Inc. Previously, results from the Protocol 3 study (DCLP3) of the International Diabetes Closed Loop (iDCL) trial evaluating the use of Control-IQ technology in ages 14 and up, and from the Protocol 5 study (DCLP5) of the iDCL trial studying use in ages 6 to 13 were published by the New England Journal of Medicine in October 2019 and August 2020, respectively.