Archive: February 2003

BOSTON - Massachusetts home infusion providers absorbed a body blow in January when the state added an additional $1.30 tax onto each prescription. The tax - the state's calling it an assessment - applies to all retail pharmacies, which home infusion providers have been lumped in with because regulators don't understand what they do, said Bob Simmons, owner of Boston Home Infusion. “We are like a hospital without walls,” Simmons said. “We do everything a hospital does yet the...

RALEIGH, N.C. - Almost four years and thousands of dollars later, Paul Smith can finally breathe a sigh of relief. After a long legal battle with Palmetto GBA, the Medicare carrier for Region C, an administrative law judge heard Smith's appeal in January and overruled the decision claiming he owed the Medicare carrier more than $71,000. Palmetto now has 60 days upon the decision to appeal or pay Smith $12,500 for the claims approved after his suspension. “I feel vindicated,” said the...

SAN DIEGO, Calif. - A new study has borne out what HME provider Renee McPhee has suspected for quite awhile: You can't be a 379-pound NFL lineman with a 26-inch neck and not have sleep apnea. “You just can't,” said McPhee, a sleep specialist who owns Southern Medical in Atlanta. “I'm 99% positive.” McPhee issued her observation in early January, a couple of weeks before the Super Bowl. A week later, the prestigious New England Journal of Medicine published a clinical study...

WASHINGTON - Improper Medicare benefit payments made during 2002 totaled $13.3 billion, about 6.3%, of the $212.7 billion in processed fee-for-service payments reported by CMS, according to a new report by the OIG. As a rate of error, the current 6.3% estimate is the same as last year's rate, which was the lowest to date and less than half the 13.8% reported for FY 1996. “As a taxpayer I'm glad the rates are going down,” said Bently Goodwin, president of RemitData, a company that helps...

Q. What's the outlook on Medicaid reimbursement for HME? A. According to the U.S. General Accounting Office, Medicaid is a “high-risk” program that is in need of sweeping Medicaid reform. Many state governments are facing the worst budget shortfalls in over 50 years. A solution being proposed by the Bush Administration is a cash infusion for states that choose a new, more-flexible Medicaid option. This option would provide for two annual federal allotments: one for acute-care health...

INDIANAPOLIS - Indiana rehab providers who once did a healthy business with the state's nursing homes and long-term care facilities are witnessing a dramatic disappearance of that business as the state responds to an $850 million budget deficit. Until late last year, Medicaid would approve and pay for non-standard rehab equipment required by residents of long-term care facilities. But starting around Thanksgiving, the state has been to deny non-standard equipment, arguing that the facility should...

LONGMONT, Colo. - The gears in Sunrise Medical's executive offices shifted again last month as the company announced its new president of commercial operations, including home care in North America. The latest addition is Mark Liebetrau, a former v.p. and general manager of a $1.1 billion division at Hillenbrand Industries. Liebetrau slides into the Sunrise Medical space vacated by John Kitts last summer. Kitts had wanted to lead Sunrise Medical in North America and had been frustrated by the company's...

OSA, obesity share common genes BOSTON - Obstructive sleep apnea has long been linked to couch potatoes but researchers have now identified a genetic link between bulging bellies and a lousy night's sleep. Researchers did not identify specific genes, but found areas of the genome associated with apnea and obesity. The relationship between apnea and health problems, however, is more complicated than genetics. Often, one condition exacerbates another, and weight loss is often enough to reverse OSA,...

WASHINGTON - Congressman Pete Stark can't understand why the administration and the new Senate majority leader is so high on shifting Medicare beneficiaries from fee-for-service to private HMOs. When it comes to efficiency, Stark argues that Medicare consistently outperforms private health insurers. “Medicare increased payments to providers such as hospitals, home health agencies, and nursing homes and still managed to keep overall spending growth to 7.8% in 2001,” Stark said In January....

SAN DIEGO - The long suspected causal link between hypertension and sleep disordered breathing both weakened and strengthened in new studies published in leading clinical journals in January. In Circulation, a peer review journal published by the American Heart Association, a study conducted in Germany and Australia showed that effective CPAP therapy can reduce blood pressure by 10 mm of mercury. Lowering blood pressure by that amount can cut coronary heart disease risk by 37% and stroke risk by...