In brief: Survey says, Dynamic Infusion buys, United Spinal challenges

WASHINGTON – The expired 75/25 Medicare blended reimbursement rates in non-bid, non-rural areas are affecting business operations and the ability to serve patients and communities, according to a national survey from AAHomecare. 

The association is still analyzing survey results, but it shared some of the open-ended responses in a recent bulletin: 

• Reimbursements are so low now that it is hard to keep up with expenses and payroll. We may have to close. Medicare Advantage plan reimbursements are based on the extremely decreased Medicare rates. We have been in business for 24 years and have never had this type of terrible treatment. 

• The rate cuts have cost our company an average of $55,000 per month and going up as more and more payers are using the new rates, both rural and non-rural patients. This is putting us into the red instead of being slightly profitable.  

• Reduced staff, reduced coverage area, reduced revenue. We have been in business for over 23 years and it seems like the durable medical equipment business cannot get a win; Medicare Advantage plans and commercial plans go by the Medicare allowable so when they reduce rates everyone reduces rates. We cannot sustain at the current rates. 

• Because of the loss in revenue and increased product cost and labor cost, our business has been forced to lay off employees, turn away high usage oxygen patients and stop providing options on masks for patients to choose from. We are now looking into the cheapest products in the market just to keep the margins from being negative. We are to the point if reimbursement doesn't increase soon we will be shutting our doors and leaving 15,000 patients without a provider. 

 AAHomecare will use survey results to help develop new advocacy materials to share with Congress and CMS in support of restoring the 75/25 blended rates, which expired on Jan. 1. 

Dynamic Infusion buys Infusicare 

DALLAS – Dynamic Infusion has acquired IV Solutions Group, d/b/a Infusicare, strengthening its presence in New Jersey and aligning with its goal of building a national platform for home infusion nursing services. 

"Infusicare is known for its quality of patient care,” said Peter Harris, CEO & president of Dynamic. “This transaction will allow Dynamic to reach central and northern regions of New Jersey. We genuinely welcome the clients, nurses and patients of Infusicare to our Dynamic family." 

Dynamic Infusion is the new affiliate brand of Dynamic Access. It supports the operations of two legacy companies, each with more than a decade of experience delivering home infusion nursing services to patients throughout the Northeast: Infusion Ventures in New England, and NursePro in the Mid-Atlantic. 

Infusicare has been providing home infusion nursing services on behalf of specialty pharmacies throughout New Jersey for almost a decade under the direction of its founder and owner, James Reardon, who will continue working with Dynamic in the region. 

"Combining services with Dynamic is the culmination of our work during the last several years," said Reardon. "We are excited to join forces with Dynamic and continue to grow as a top-notch home infusion nursing services provider for this region and beyond." 

Dynamic visits patients in their homes more than 12,500 times a year across nine states on behalf of more than 40 specialty pharmacies, with plans to expand further. 

The provider partnered with RiverGlade Capital, a Chicago-based health care services-focused private equity firm, in 2021.   

Other recent home infusion deals include: 

• Access Infusion Care’s acquisition of Big Sky I.V. Care 
• Frazier Healthcare Partners’ acquisition of BioMatrix Holdings 

United Spinal relaunches Corporate Challenge   

NEW YORK – United Spinal Association has relaunched its Corporate Challenge, a program aimed at encouraging companies to seek allyship with the disability community and to support disability inclusion. The relaunch, featuring a new look and new content, coincides with the 34th anniversary of the Americans with Disabilities Act and Disability Pride Month. “The Corporate Challenge is a call to action to the business community to raise awareness about the importance of disability inclusion,” said AJ Assaadi, vice president of corporate partnerships. “We’re helping companies inspire other companies to make inclusive corporate culture the baseline. Together, we’re cultivating a strategic business mindset around disability inclusion based on the lived experience and desires of United Spinal's constituency: the 5.5 million wheelchair users living in the U.S.” The Challenge prompts entrants to reflect on a series of topics relating to accessibility and the recruitment, empowerment and retention of employees with disabilities. It covers fundamentals around physical and digital accessibility of workplaces and emphasizes the effective use of tools available to employers, such as disability etiquette training and employee resource groups. By completing the Challenge, entrants receive a Corporate Challenge medallion and publicity via United Spinal’s extensive social media presence. 
 

Florida Medicaid announces additional contracts 

TALLAHASSEE, Fla. – Florida’s Agency for Healthcare Administration has announced additional statewide Medicaid managed care contracts for five companies following appeals of the original awards in April, AAHomecare reports. 
 
The full scope of awards now includes: 

• Aetna Better Health of Florida* – Regions D, E, I 

• Florida Community Care* – Statewide 

• Humana Medical Plan – Statewide 

• Molina Healthcare of Florida* – Region I 

• Simply Healthcare Plans – Statewide 

• South Florida Community Care Network, dba Community Care Plan – Regions E, F, G, H, I 

• Sunshine State Health Plan – Statewide 

• UnitedHealthcare of Florida* – Regions B, D, I 

*denotes new or expanded award following appeal. 
 
The new contracts will take effect on Jan. 1, 2025.  

NCPA renews call for PBM reform after latest hearing 

ALEXANDRIA, Va. – The National Community Pharmacists Association in a statement criticized pharmacy benefit managers who appeared at a hearing held by the House Committee on Oversight and Reform yesterday. Testifying at the hearing were executives Adam Kautzner, PharmD, president, Evernorth Care Management and Express Scripts; David Joyner, executive vice president, CVS Health, and president, CVS Caremark; and Patrick Conway, MD, CEO, OptumRx. “Among members of the Oversight Committee, there was broad support for finalizing comprehensive PBM reforms – and much skepticism about the excuses, and at times downright lies, the PBM executives were attempting to feed them about the roles of their organizations in increasing prescription costs and decreasing patient access to health care,” said Douglas Hoey, NCPA CEO. “Patient steering, self-dealing formularies, spread pricing, take-it-or-leave-it contracts, the fee-for-nothing scam…legislators have seen enough that the PBM-insurers can no longer obfuscate these important issues. We applaud the committee for its work and encourage its members and the rest of their colleagues in Congress to finish the fight. Finalize PBM reform now and rein in these and other harmful PBM tactics.” The Oversight Committee launched its investigation into PBMs in March 2023, and its chairman, Rep. James Comer, R-Ky., spoke at NCPA’s Congressional Pharmacy Fly-In the following month. As part of this most recent hearing, the committee released a report finding that the three largest PBMs – CVS Caremark, Express Scripts, and OptumRx – have prioritized deliberate pricing tactics to line their own pockets. The NCPA recently launched an ad as part of its ongoing campaign asking lawmakers to enact PBM reform. 

Women’s health boutique manager charged with fraud 

CHICAGO — The office manager for a suburban Chicago medical equipment boutique has been indicted on federal health care fraud charges for allegedly billing private insurers for products that were never provided, including breast prostheses, compression garments and wigs for cancer survivors. Judy Strzelecki, who worked at A Woman’s Place in Downer’s Grove, Ill., is accused of submitting fraudulent claims from 2015 to 2020 to Blue Cross and Blue Shield of Illinois and other health care benefit programs for equipment that was either not provided or was not medically necessary, according to an indictment returned in U.S. District Court in Chicago. Strzelecki and others also fraudulently billed the programs for more expensive products than were provided to seek higher reimbursement rates, the indictment states. As a result of the scheme, Strzelecki and others fraudulently obtained at least $1.8 million in payments from health care programs for equipment that was not provided as billed, the indictment states. She is charged with seven counts of health care fraud.  Each count is punishable by up to 10 years in federal prison, and restitution is mandatory.  Arraignment is set for July 23, 2024, before U.S. Magistrate Judge M. David Weisman.