In brief: AAH, VGM call on Price to take action; stakeholders question CMS’s authority to bundle

Friday, March 24, 2017

WASHINGTON – AAHomecare has outlined several recommendations for fixing the competitive bidding program in a new letter to Health and Human Services Secretary Tom Price.

Those recommendations are:

• Use market clearing price to determine the single payment amount for any item included in competitive bidding.

• Use historical claims data to determine supplier capacity.

• Increase transparency of the competitive bidding program.

• Reform competitive bidding product categories.

• Apply uniform payment rules for transitioning DMEPOS competitive bidding beneficiaries.

• Remove CMS’s authority to move forward with bundled payments for CPAP and standard power wheelchairs.

“HME suppliers, patient groups and leading economists and auction experts have voiced concerns about major structural problems with the bidding program since it first took effect,” said Tom Ryan, president and CEO AAHomecare.  “With the next round of the bidding program set to consolidate the two rounds into one entity, the time is right for CMS to make these much-needed and common-sense changes.”

AAHomecare recommends CMS go through the formal rulemaking process to instate the proposed reforms.

This week’s letter follows a letter in February to Dr. Price requesting a repeal of the full phase-in of the Medicare adjusted fee schedule rates for non-competitive bidding areas that went into effect July 1, 2016.

VGM calls on Price to take action

WATERLOO, Iowa – The VGM Group outlined three priorities that need “immediate action,” including relief for HME providers rural areas, in a March 20 letter to Health and Human Services Secretary Tom Price.

The top priority: speeding up six months of payments owed to HME providers as part of a retroactive delay of reimbursement cuts that went into effect in non-competitive bidding areas on July 1, 2016. A provision in the Cures Act delayed the cuts until Jan. 1, 2017. CMS in February notified the DME MACs that they could begin dispersing payments on May 1, with implementation by July 3.

“This delay is unnecessary as more suppliers are forced to close their businesses on a weekly basis while waiting for payments on services provided nearly one year prior,” VGM stated in the letter.

The other two priorities: delaying these cuts to non-bid areas indefinitely, until an impact analysis is released; and correcting CMS’s application of two different statutes to determine payment methodologies for oxygen concentrators.

Additionally, VGM called on Price to reform the overall competitive bidding program; implement a broader prior authorization program to reduce audits; establish a separate benefit for complex rehab; and work with Veterans Affairs and Tricare to match their reimbursement rates to Medicare’s fee schedule.

“With the implementation of these proposed regulatory recommendations to the administration, we firmly believe that home medical equipment suppliers across the nation will have a renewed ability to provide care to the most vulnerable patients in the healthcare system,” the letter states.

Stakeholders question authority to bundle

WASHINGTON – CMS does not have the authority to implement bundled bidding programs for CPAP or other HME, because it would jeopardize patient access to specific equipment, say industry stakeholders.

Bundling a CPAP device, consumable items, maintenance and service into a single monthly payment will cause disruption for suppliers and will provide an incentive to furnish inferior products and provide a lower quality of care to compensate for shrinking margins, said AAHomecare in its weekly newsletter.

Additionally, “it could substantially increase co-payments and out-of-pocket expenses for beneficiaries,” said Larissa D’Andrea, government affairs director for ResMed. “Plus, layering untested bundled payments on top of expanded competitive bidding program rates could compound existing access challenges caused by these other cuts.”

AAHomecare and industry groups like AdvaMed, the CQRC and The VGM Group are developing a unified response to Medicare’s proposal to bundle payment for CPAP in future rounds of competitive bidding. They plan to outline their response a forthcoming letter to CMS.

CMS on Jan. 31 announced it had added 10 new competitive bidding areas for the CPAP category. In five of those CBAs, payment for CPAP devices, related accessories, and services will be made on a bundled, non-capped monthly rental basis, while payment in the other five CBAs will be made on a capped monthly rental basis like all other existing CBAs.

Brightree links to AirView, myAir

ATLANTA – Brightree has enhanced the integration between its HME billing and business management module and ResMed’s AirView and myAir. The enhanced capabilities include creating and updating patients in AirView, minimizing duplicate entry; receiving automatic patient compliance notifications from AirView, eliminating the need to check multiple systems; and inviting patients to register with myAir, helping to engage patients in their own therapy. “As the healthcare industry shifts to an outcomes-based model, Brightree and ResMed are working to provide innovative, seamless solutions to create greater visibility into performance and smarter decision making,” said Matt Mellott, Brightree’s president and CEO. AirView is a cloud-based sleep and respiratory care patient management platform; myAir is a patient engagement platform. ResMed bought Brightree in 2016.

Upstate HomeCare doubles down on specialty infusion

CLINTON, N.Y. – Upstate HomeCare now has a dedicated management team, strategic plan and sales force for its specialty infusion services business. The provider shifted away from retail pharmacy into specialty infusion services last summer. “We’re very excited to be expanding our services and aligning our strengths with our mission,” said Gregory LoPresti, CEO of Upstate HomeCare. “This shift builds upon our strength, which is home infusion services and associated core therapies.” Upstate HomeCare will be serving patients across New York from Albany to Buffalo. The company also provides a full line of respiratory therapies, from oxygen concentrators to CPAP devices to ventilators.

Spring time at the Capitol: NCPA, United Spinal plan events

The National Community Pharmacists Association has scheduled its 2017 Congressional Pharmacy Fly-In for April 26-27. As part of the event, hundreds of community pharmacists will visit the Capitol to advocate for their businesses and their patients. The fly-in will feature a legislative briefing with former Rep. Jim McCrery, now a partner at Capitol Counsel; and a breakfast keynote by Jayne O’Donnell, a healthcare reporter for USA Today. Register at…The 6th Annual Roll on Capitol Hill Legislative and Advocacy Conference will take place June 11-14. The United Spinal Association hosts the event to advocate for the health, independence and quality of life of individuals with spinal cord injuries. Last year’s event drew more than 150 attendees from 33 states. FMI:

Governor recognizes GF Health Products for export excellence

ATLANTA – Georgia Gov. Nathan Deal, in conjunction with the Georgia Department of Economic Development (GDEcD), recently presented Graham-Field with the Georgia Launching Opportunities by Exporting (GLOBE) Award. “It is gratifying to know how well Graham-Field’s USA-manufactured medical equipment is respected throughout the world,” said President and CEO Ken Spett, who accepted the award. It is because of companies like Graham-Field that Georgia has earned a reputation as a leader in international trade, said the commissioner of the GDEcD. “With our strong international presence, Georgia is ready and able to support companies looking to achieve new levels of success,” Pat Wilson said. Graham-Field and its more than 300 employees make healthcare products for the acute care, extended care, homecare and primary care markets. Its brands include Basic American, American Medical Products, Everest & Jennings, Grafco, John Bunn, Labtron, Lumex and Lumiscope.

Sigvaris launches measurement system

PEACHTREE CITY, Ga. – Sigvaris has added an “initial pressure measurement system” to three of its inelastic compression wraps, the company announced March 21. The new system allows clinicians to prescribe a specific compression level (20-30mmHg, 30-40mmHg or 40-50mmHg) and patients to set the level themselves. “This product is going to change the market for inelastic wraps and finally give clinicians the confidence that patients will be able to accurately set their garment to the correct compression level at home,” said Scot Dubé, president and CEO of Sigvaris North America. The patent-pending Accutab system comes standard on Compreflex, Compreflex Lite and Compreflex NF.

Sleep therapy could help certain heart failure patients, ResMed study shows

SAN DIEGO – Further study is needed to determine how using adaptive servo-ventilation (ASV) therapy to treat sleep-disordered breathing helps people who have heart failure with preserved ejection fraction, according to a study published March 20 in the Journal of the American College of Cardiology. The overall results of the study were neutral, but they showed a statistical significant improvement in the primary endpoint for people with moderate to severe sleep-disordered breathing and this type of heart failure, ResMed stated in a press release. The primary endpoint was cardiovascular outcomes measured as a Global Rank Score that included survival free from cardiovascular hospitalization and change in functional capacity as measured by the six-minute walk distance. The study also assessed changes in functional parameters, arrhythmias, biomarkers, quality of life, and sleep and breathing. Leading cardiologists say the improvement for these patients signals a potential breakthrough in treatment, according to ResMed. "There are no recommended therapies specific for HFpEF patients, which accounts for half of all people living with chronic heart failure," said Dr. Christopher O'Connor, the study's lead investigator, a cardiologist and CEO of the Inova Heart and Vascular Institute. "These results from CAT-HF suggest we need to further study the role of whether addressing sleep-disordered breathing can help people who have heart failure with preserved ejection fraction." The study, the "Cardiovascular Outcomes With Minute Ventilation-Targeted Adaptive Servo-Ventilation Therapy in Heart Failure – The CAT-HF Trial," is a multicenter, randomized, controlled Phase II trial funded by ResMed to broaden the understanding of how best to treat diagnosed sleep apnea in patients that also have a particular form of heart failure.

ResMed-Brightree make Deal of the Year

SAN DIEGO – ResMed’s acquisition of Brightree was named Deal of the Year by Mergers & Acquisitions magazine. The deal underscores the ongoing shift in U.S. healthcare from a fee-for-service model to a value-based model, and the need for players across the healthcare continuum to use informatics and data analytics as tools to share information and deliver care more efficiently, said ResMed in a release. ResMed acquired Brightree for $800 million in February 2016.