In brief: Appeals process, acquisitions and readmissions

Friday, November 16, 2012

WASHINGTON – The Office of Inspector General (OIG) recommends “coordinated training” for administrative law judges (ALJs) and qualified independent contractors (QICs) on the Medicare appeals process in a new report. The OIG has found that the ALJs, which administer the third level of appeal, reversed 56% of the decisions by the QICs, which administer the second level of appeal. This trend, according to the OIG, is due to different interpretations of Medicare policies and other factors. The OIG found that when CMS participated in appeals, ALJ decisions were less likely to be favorable to appellants. The OIG recommends, among other things, that the Office of Medicare Hearing and Appeals and CMS provide more coordinated training on Medicare policies for ALJs and QICs, and that they identify and clarify Medicare policies that are unclear and interpreted differently.

Home Health Depot acquires Genesis

INDIANAPOLIS – Home Health Depot has acquired the majority interest of Genesis Healthcare Services, an Atlanta-based provider to hospice organizations, according to a press release. The acquisition is Home Health Depot’s fourth this year. Genesis, which has five locations in the Atlanta area, will become a complex rehabilitation equipment provider in addition to servicing hospice organizations. “We are thrilled to partner with Genesis and expand our offerings to Georgia,” stated David Hartley, CEO of Home Health Depot, in the release. “Our expansion into hospice services adds to our healthcare offerings and makes us an even better partner to healthcare systems that provide the complete continuum of care to their patients.”

Graymark Healthcare lands new investor

OKLAHOMA CITY – Graymark Healthcare, a provider of diagnostic sleep services, has agreed to a new equity investment from Oklahoma Health Partners (OHP), according to a press release. OHP intends to purchase 1.4 million shares of Graymark’s common stock for $650,000. The funds will be used to right-size the company, according to company officials. “We recently initiated a cost reduction plan that is expected to save the company approximately $2 million in 2013,” stated Stanton Nelson, CEO of Graymark, in the release. “In addition to the cost reductions, which include reductions in our labor force, corporate expenses and bad debt expenses, we are developing a plan to identify and close underperforming lab locations.” Graymark’s net revenues for the third quarter of 2012 were $4.3 million, decreasing 4.3% from $4.5 million in the same quarter of 2011. The decrease was primarily due to lower reimbursement rates for sleep studies and CPAP devices, according to the release.

Dynamic Healthcare buys HomeTown Oxygen

HARRISBURG, Pa. – Dynamic Healthcare Services, a provider of home medical equipment and respiratory therapy products and services, has acquired HomeTown Oxygen, according to a press release. HomeTown, a distributor of medical products, sleep apnea equipment and respiratory supplies, has locations in Monroeville and Latrobe, Pa., with a service area that includes several Pennsylvania counties. Terms of the acquisition were not disclosed.

CDC report: Diabetes rates spike across US

ATLANTA – From 1995 to 2000, there was at least a 100% increase in the prevalence of diagnosed diabetes cases in 18 states, according to a Morbidity and Mortality report from the Centers for Disease Control and Prevention (CDC), published Nov. 16, 2012. Forty-two states saw an increase of at least 50%. Type 2 diabetes, for which obesity is a major risk factor, raised the most risk in southern states, where obesity levels are highest. Oklahoma had the highest increase (226%), while Kentucky was second, with a 158% increase, followed by Georgia (145%) and Alabama (140%). The American Diabetes Association says about 8% of the U.S. population—25.8 million people—have diabetes, while another 79 million are pre-diabetic. The CDC report comes on the heels of a report in the American Journal of Preventive Medicine estimating that 42% of the U.S. population will be obese by 2030.

A study of hospital readmission: Medicare Advantage vs. fee-for-service

ROCKVILLE, Md. – After adjusting for risk and controlling for self-selection, Medicare Advantage patients have a “substantially higher” likelihood of readmission within 30 days of discharge than fee-for-service patients, according to a study by researchers at the Agency for Healthcare Research and Quality (AHRQ). Before making adjustments, Medicare Advantage patients were found to have a slightly lower likelihood of hospital readmission than fee-for-service patients; however, the report notes that Medicare Advantage patients tend to be younger and less severely ill. The study used statewide inpatient databases maintained by the AHRQ for five states in 2006.

ISS registration open

PITTSBURGH – Registration for the 2013 International Seating Symposium (ISS) is now open, according to a University of Pittsburgh press release. The event will be March 5-9 at the Gaylord Opryland Hotel & Convention Center in Nashville, Tenn. ISS boasts more than 100 sessions and a 70,000-sqaure-foot exhibit hall. Keynote speaker will be John Register, inspirational speaker and Paralympic medalist. FMI:

NRRTS, CMSA team up

WALSENBURG, Colo. – NRRTS has entered into a corporate partnership with the Case Management Society of America (CMSA), according to a press release. Simon Margolis, NRRTS executive director, stated in the release that the partnership will help garner the support needed to obtain a separate benefit complex rehab. Based in Little Rock, Ark., CMSA is a nonprofit association dedicated to developing the profession of case management. The association serves more than 11,000 members, has 20,000 subscribers, and supports 75 chapters through educational forums, networking opportunities and legislative advocacy.

Short takes

Pride Mobility Productsand Specialty Equipment Market Association (SEMA) recently unveiled the Victory ES 10, a mobility scooter customized by car designer Chip Foose. Foose, best known for his television show “Overhaulin’,” drew up the hot rod modifications for the scooter, adding a roadster grill, pinstriping and color-keyed upholstery for a vintage look…Breathe IDTF now allows its HME provider customers to receive text message alerts when their patients have qualified for oxygen using the Breathe Oximetry System. Receiving text messages in the field helps the provider’s sales reps know when to follow up with physicians and get patients on oxygen faster, the company stated…PDG Drives Technology, a manufacturer of motor control systems for industrial and mobility electrics vehicles, including power wheelchairs, has been acquired by Curtiss-Wright, an engineering company…The Braff Group closed its 200th transaction on its 17th deal this year, the Pittsburgh-based M&A firm has announced. Since launching in 1998, The Braff Group has completed an average of 14 deals per year.

People news

Claudia Zacharias, president and CEO of the Board of Certification/Accreditation, International (BOC) has been elected to the board of directors of the Institute for Credentialing Excellence (ICE). ICE is a professional membership association that advances credentialing through education, standards, research and advocacy to ensure competence across professions and occupations.