In brief: Oxygen adjustment, in-person visits, PromptCare sale, Glooko’s raise 

WASHINGTON – CMS has published an adjusted fee schedule for oxygen therapy for April 2021 that no longer includes a percentage reduction to meet the budget neutrality requirement. 

The adjustments result in an increase in fee schedule amounts ranging from $6.72 to $8.19 in former competitive bidding areas; $5.17 to $5.43 in other non-rural areas; and $4.14 to $6.82 in non-contiguous and rural areas, according to the VGM Group. 

The fee schedule amounts are not retroactive – they’re only effective for dates of service on or after April 1, 2021. 

The adjusted fee schedule is effective for the following codes: E0424, E0431, E0433, E0434, E0439, E0441, E0442, E0443, E0444, E0447, E1390, E1391, E1392, E1405, E1406, and K0738. 

A COVID-19 relief package passed by Congress late last year removed the budget neutrality requirement for oxygen therapy in rural areas. 

MedPAC on certain DME: Stick to in-person visits post-PHE 

WASHINGTON – The Medicare Payment Advisory Commission (MedPAC) recommends requiring clinicians to provide a face-to-face visit before they order high-cost DME or high-cost clinical lab tests in a March 2021 report to Congress. 

The group recommends that CMS should, after the public health emergency, require clinicians to provide a face-to-face, in-person visit with a beneficiary on the date they order a high-cost DME product or lab test for that beneficiary or within six months before such date. 

“This approach – which was described in a prior commission report – would prevent clinicians from ordering expensive DME items or lab tests during a telehealth visit,” MedPAC writes. “It would help ensure that a beneficiary needs a product or test based on a needs assessment conducted by a clinician before Medicare pays for it.” 

To meet the current requirements for certain DME items, a clinician must have had an in-person or telehealth encounter with the beneficiary on the date the DME product was ordered or within six months before such date. 

“The safeguard that we are proposing differs from the current policy because our approach would require an in-person visit, while the current policy requires an in-person or telehealth visit,” MedPAC writes. “In addition, our proposal would apply to high-cost DME items and high-costs lab tests, whereas the current policy applies only to certain DME items.” 

To back its recommendation, MedPAC highlights, among others, the Department of Justice recently charging more than 300 defendants with submitting more than $6 billion in false and fraudulent claims to federal health programs and private insurers, including more than $4.5 billion related to telemedicine.  

PE firm puts PromptCare up for sale 

NEW PROVIDENCE, R.I. – The Halifax Group, which invested in PromptCare Companies in 2017, is now looking to sell the company, according to PE Hub. 

The process is in its second rounds, with first-round bids already submitted, according to the publication. 

Because PromptCare has two distinct businesses – home infusion therapy and complex respiratory therapy – there may be two separate transactions, according to PE Hub. 

PromptCare has nearly tripled in size since Halifax made its investment in 2017, expanding its presence beyond the mid-Atlantic, according to the publication. Most recently, on March 3, the company announced it had acquired the assets of NBN Infusions, expanding its footprint in the Northeast. 

Halifax says it is dedicated to partnering with founders and managers of lower middle-market businesses with total enterprise values generally between $50 million and $300 million. 

Glooko raises $30M to accelerate growth 

PALO ALTO, Calif. – Glooko, a provider of remote patient monitoring and chronic care management solutions including diabetes and obesity, has raised a $30 million Series D round of funding.  

The company will use proceeds from the funding to accelerate organic growth and strategic initiatives across its product line of digital health solutions, including increasing adoption of is remote patient monitoring platform, widening commercialization of products in clinical research and expanding into additional areas. 

"Glooko has done a remarkable job of bringing to market cutting edge digital health care platforms, which empower people with diabetes to better manage their disease and improve their lives,” said Charles Boorady, founder and managing partner of Health Catalyst Capital, which led the financing. “As a result of Glooko’s innovations, the company has experienced rapid market adoption, growing its global ecosystem to more than 7,500 clinics, and has entered into partnerships with many of the world's largest diabetes medical device companies and pharmaceutical companies, as well as top health care systems.” 

The funding follows a successful 2020 for Glooko, its most successful so far, despite the global pandemic. Last year, the company’s growth included key partnerships with major health care systems and extended long-term existing partnerships with several global diabetes companies such as Insulet and Novo Nordisk.  

Others participating in the funding include existing investors Canaan Partners, Georgian, Novo Nordisk, Insulet and Mayo Clinic. 

CMS delays rule outlining new technology pathway 

Rule also implements standards to be used in making reasonable and necessary determinations 

WASHINGTON – CMS has delayed the January effective date of a final rule that established a Medicare coverage pathway to provide beneficiaries access to new, innovative medical devices designated as breakthrough technology by the U.S. Food and Drug Administration. 

The agency says it is delaying the final rule’s effective date for 60 days to ensure that the rulemaking process was procedurally adequate; that it properly considered all relevant facts; that it considered statutory or other legal obligations; and that it had adequately considered public comments objecting to certain elements of the rule. 

The move follows a Jan. 20 memo from the assistant to the president and chief of staff titled “Regulatory Freeze Pending Review” that directs agencies to consider delaying the effective date of rules published in the Federal Register that have not yet become effective, consistent with applicable law, for the purpose of reviewing any questions of fact, law and policy the rules that may arise. 

The final rule, published in the Federal Register on Jan. 14, also implemented regulatory standards to be used in making reasonable and necessary determinations under the Social Security Act for items and services that are furnished under Medicare Part A and B. 

The Medicare Coverage of Innovative Technology (MCIT) pathway will result in four years of national Medicare coverage starting on the date of FDA market authorization or a manufacturer chosen date within two years thereafter. 

HHS is accepting public comments on this interim final rule for 30 days.  

Poor sleep quality: Is it stress or apnea? 

SAN DIEGO – For half of Americans, stress over the past year of the pandemic is negatively impacting the quality of their sleep, according to the results of nationwide survey of 1,000 adults conducted by ResMed. 

While COVID-related stresses are often noticeable, one of the biggest stealers of sleep might be something people can’t easily detect: sleep apnea, the company says. 

“While data show that stress and worry are key factors impacting many people’s sleep, now is an opportunity for everyone to take measure of all the factors that could be impacting the quality of sleep, which could include sleep disorders that can have negative long-term impacts to overall health,” said Carlos M. Nunez, M.D., chief medical officer for ResMed. 

ResMed published the survey in conjunction with National Sleep Awareness Week (March 14-20) and World Sleep Day (March 19), and as part of “Sleep for a Better Tomorrow,” an education and outreach initiative to build awareness of the critical role good sleep plays in physical and mental health. 

The survey found 78% of those who snore aren’t concerned it could be related to an underlying health condition, despite snoring being a top symptom of sleep apnea. Additionally, nearly half of respondents said their doctor had not asked them about their sleep quality, reinforcing the importance of consumers being aware of the potential health impacts of poor sleep and acting on key sleep apnea symptoms, such as snoring. 

The survey also found: 

• 35% of women reported worse sleep quality in the past year compared to 26% of men; 
• More individuals working from home reported improved sleep quality since the pandemic began vs. those who haven’t worked from home (39% vs. 21%); and  
• Across all respondents, more than one-third say they are having a harder time falling asleep and nearly one third say they are sleeping less over the last year, with one-quarter taking naps more often. 

Protech adds locations in Fla, NH 

CINCINNATI – Protech Home Medical has accelerated its organic growth initiatives by opening new locations in Daytona Beach, Fla., and Concord, N.H. “With the addition of new locations in Florida and New Hampshire, we continue our aggressive path of scaling our business,” said Greg Crawford, chairman and CEO of Protech. “Our patient-centric model leveraging our interconnected health care platform is providing us much opportunity to gain market share and this is just the beginning for us.” The location in Daytona Beach will have a heavy respiratory focus, the company says, and will help it to better reach surrounding areas and cut down on logistical costs. In February, Protech bought Mayhugh’s Medical Equipment in Jacksonville, Fla., to build a foundation in the state. The location in Concord will also have a heavy respiratory focus, the company says, and will allow it to further penetrate New Hampshire and surrounding areas. 

Oventus adds two agreements 

BRISBANE, Australia – Oventus Medical has secured a new agreement with Connect DME to make available its home care oral appliance therapy to third-party administrator beneficiaries. Connect DME, which provides DME to TPAs, will leverage virtual consultations with physicians and dentists across its national footprint of customers to facilitate the use of the O2Vent Optima for sleep apnea treatment. The agreement calls for an initial contract of three years and automatically extends for another three years, unless either party terminates the agreement. Oventus has also signed a distribution agreement with Circadian Australia, which will make the company’s sleep treatment platform available to clients across many different industry sectors, including mining, aviation, transport and oil and gas. The agreement calls for an initial 12-month term with an automatic renewal for successive 12-month periods, unless a party gives notice of its intent not to renew. “These two additional agreements demonstrate the flexibility and scalability of the virtual lab-in-lab model and why Oventus believes that this model will be a significant driver of growth over the coming quarters,” the company stated in a press release. 

NCPA names innovators 

ALEXANDRIA, Va. – The National Community Pharmacists Association has named five community pharmacies recipients of the NCPA Innovation Center for Excellence Awards for 2021. They are by category: 

• COVID-19 Best External Modification – McCoy-Tygart Drug in Sheridan, Ark. 
• COVID-19 Best Internal Remodel – Medi-Wise Pharmacy in Newcomerstown, Ohio 
• Best Exterior Sign – Webb’s Family Pharmacy in Rochester, Ind. 
• Best Delivery Vehicle – Happy Druggist in Mechanicsburg, Ohio 
• Best Marketing/Promotion – Norland Avenue Pharmacy in Chambersburg, Pa. 

“Independent pharmacies have always been ahead of the curve when it comes to business model innovations, care and other services that make patients’ experience more rewarding, but this has never been more on display than during the coronavirus pandemic,” said Kurt Proctor, president of the NCPA Innovation Center. The awards, sponsored by QS/1, were created four years ago to recognize pharmacies for their efforts to enhance their value, promote their services and better serve clients. The NCPA received 79 submissions for the awards. Three independent judges reviewed the submissions and selected the winners. 

3B Medical lands on list of fastest-growing companies 

WINTER HAVEN, Fla. – 3B Medical has been recognized as one of Florida’s fastest growing private companies by Inc. magazine. The manufacturer of the Lumin disinfecting device and other products ranked No. 53 on the annual Inc. 5000 Regionals: Florida. Between 2017 and 2019, the 250 companies on the list had an average growth rate of 202%. “3B Medical is proud to call Central Florida home,” said Justin Smith, COO. “We would love to be the catalyst to building a med-tech focused economy in our area. Our incredible year over year growth has been exciting to be a part of.” 

Permobil innovates for individuals 

LEBANON, Tenn. – Permobil is updating its brand with a new corporate mission, values and website at permobil.com. The updated brand, “Innovating for Individuals,” reflects Permobil’s focus on solutions beyond hardware, including advanced software and services, and a holistic view of product quality. “Our users have the right to hardware, services, and connectivity of the same standards as they meet in other areas of their everyday lives,” said Bengt Thorsson, CEO of Permobil. “We develop personalized assistive solutions tailored to meet the user’s day-to-day reality, and offer increased function with hardware, accessories, and connectivity. This raises the expectations on future products, and we are prepared to fulfill them with the combined passion for our users and the possibilities that digitalization and artificial intelligence create.” Permobil has also developed new core values: trusted, leading and passionate. Additionally, to better meet the needs of the global market, the company has updated its corporate website to unite all the websites from different regions under one simple address: permobil.com. 

Option Care Health to sell shares 

BANNOCKBURN, Ill. – Option Care Health has agreed to sell 12 million shares of the company’s common stock at $20 per share in an underwritten public offering. The selling stockholder, an affiliate of Madison Dearborn Partners, also granted the underwriter a 30-day option to purchase up to 1.8 million additional shares of common stock. The offering is expected to close today, March 17. This sale of shares represents approximately 6.7% of the current shares outstanding. Option Care Health will receive no proceeds from the offering. Option Care Health reported net revenues of $804.7 million for the fourth quarter of 2020 and $3 billion for the full year 2020. 

NSM’s Mixon receives Patriot Award 

NASHVILLE, Tenn. – Bill Mixon, CEO of National Seating & Mobility, has been named a recipient of the U.S. Department of Defense’s Employer Support of the Guard and Reserve (ESGR) Patriot Award. “I am honored,” he said. “As a veteran, it is of the utmost importance that NSM is committed to supporting those who serve this country. The freedom and opportunities we have are possible because of the sacrifices our service members have made in the past and make every day.” The Patriot Award honors individual supervisors who have directly supported service members and their families through actions like allowing flexible schedules, providing time off prior to and after deployment, caring for families and granting leaves of absence if needed. Supervisors must be nominated by an employee serving in the Guard or Reserve or the spouse of a Guard or Reserve member. Mixon credits his service as an officer and helicopter pilot in the U.S. Army for his leadership skills, approach and philosophy. 

3B Medical participates in dance challenge 

WINTER HAVEN, Fla. – 3B Medical has produced a video of its staff participating in the “Jerusalema” dance challenge. “This has been an insanely difficult year to cope with,” said Alex Lucio, CEO. “3B picked up the gauntlet. Some of our staff rolled their eyes, but once we set out to do it, it became a lot of fun and really improved office morale.” 3B now challenges other DME manufacturers and providers to create their own videos. The challenge, which has gone viral, started when an Angolan dance troupe recorded themselves dancing to “Jerusalema,” a hit South African house track by DJ Master KG and vocalist Nomcebo, last year. Now everyone from Romanian firefighters to Austrian Airlines employees to flash mobs have made videos of themselves dancing to the song. 

 NSM builds home base in Atlanta 

NASHVILLE, Tenn. – National Seating & Mobility has acquired Blue Moose Elevators & Stairlifts in Atlanta, broadening its mobility and accessibility options to clients in the metropolitan and surrounding areas. Blue Moose Elevators & Stairlifts, led by Dr. Jeremy Hammonds, was founded in 2005. “Blue Moose Elevators has an outstanding reputation and people-centered culture that aligns well with our own,” said Bill Mixon, NSM CEO. “We are pleased to welcome this team of experienced professionals to NSM and look forward to expanding the mobility and accessibility options available to clients in and around Atlanta.” Blue Moose Elevators has grown a reputation for installing stairlifts, vertical platform lifts and residential elevators. Four employees will transition to NSM, serving clients from NSM’s Atlanta branch. The acquisition also positions NSM to further expand its exclusive partnership with The Home Depot, which is based in Atlanta. 

WellSky earns health IT certification 

OVERLAND PARK, Kan. – WellSky’s Hospice & Palliative V.500 technologies have achieved Office of the National Coordinator for Health Information Technology 2015 Edition Health IT Module Certification through the Drummond Group, an authorized certification body. The stamp of approval means the software offers interoperability functionality that enables eligible providers and hospitals to meet the criteria of various regulatory programs that require use of certified electronic health record technology. “It’s WellSky’s mission to equip our clients with best-in-class technology that powers better outcomes,” said Bill Miller, CEO of WellSky. “By earning this CEHRT designation, we’re expanding our ability to help our hospice and palliative clients succeed and deliver high-quality end-of-life care to their patients.” As the U.S. health care system increasingly shifts to value-based reimbursement models that prioritize care quality over volume, CMS’s interoperability rules require providers to have CEHRT systems to participate in advanced care models. Now WellSky delivers a CEHRT solution to help hospice and palliative care providers succeed, as the industry continues its rapid evolution amid the ongoing COVID-19 public health crisis.