In brief: Bid bill to drop this week, House committee launches inquiry into prosthetic changes

Friday, May 6, 2016

The “Patient Access to Durable Medical Equipment Act of 2016” will join a bill already introduced in the Senate that also seeks to push back the date of the cuts, which will usher in reimbursement based 100% on the competitive bidding program, from July 1, 2016, to Oct. 1, 2017.

Unlike S. 2736, however, the House bill does not seek to speed up plans to limit federal Medicaid reimbursement for DME to Medicare reimbursement as a “pay for.” A draft of the bill states: “This act should not be enacted unless the increase in federal expenditures under this act is fully offset through a decrease in other federal expenditures.”

The “pay for” for a bill in the House has been a sticking point for lawmakers there.

Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.D., introduced S. 2736 back in March.

The first round of cuts in rural areas—a 50/50 blend of current and adjusted reimbursement—went into effect Jan. 1.

House committee launches inquiry into prosthetic changes

WASHINGTON – The House Committee on Oversight and Government Reform has launched an inquiry into the draft local coverage determination for prosthetics.

In a letter to Department of Health and Human Services Secretary Sylvia Burwell, the committee says the LCD, released in July, relies on outdated data to limit access to clinically appropriate and medical necessary prosthetic care for Medicare beneficiaries.

“We are concerned that this draft LCD would deny access to advanced and higher quality prosthetics that improve mobility, function and independence of those beneficiaries,” the committee states.

To help it understand the draft LCD, the committee requests, among other things, documents to determine CMS’s justification and process for deferring to LCDs, rather than the national coverage determination.

Last week, Rep. Renee Ellmers, R-N.C., introduced a bill that would halt the changes to coverage for prosthetics. The “Preserving Access to Modern Prosthetic Limbs Act of 2016” would restrict CMS from implementing the draft LCD until at least June 30, 2017.

The bill would also require the agency and its contractors to remove the draft LCD from their websites. Private payerslike United Healthcare and Cigna have made coverage changes since it was made public in July.

Hollister, Byram settle for millions

BOSTON – Hollister and Byram Healthcare Centers have agreed to pay $11.4 million and $9.3 million, respectively, to resolve allegations that they engaged in a kickback scheme designed to increase sales and profits, the U.S. Attorney’s Office for the District of Massachusetts announced April 29.

The settlement with Hollister resolves allegations that, from 2007 through 2014, it paid kickbacks to Byram in return for marketing promotions, conversion campaigns, and other referrals of patients to its ostomy and continence care products.

The settlement with Byram resolves allegations that, in 2012 and 2013, it received numerous kickbacks from Hollister and three other manufacturers of ostomy and continence care products—Coloplast, Montreal Ostomy and Safe N’ Simple—in return for its agreement to conduct promotional campaigns and to refer patients to the products of these manufacturers. It also resolves allegations by the federal and California state governments that Byram submitted inflated claims to the Medi-Cal program in violation of state regulations that limit the amount a provider can bill for certain products.

The settlements resolve allegations in a whistleblower lawsuit filed by two former employees and one current employee of Coloplast under the qui tam provisions of the False Claims Act.

In response to the settlements, Bryam stated, "There is no finding of liability."

"We are pleased to have put this matter behind us," stated Perry Bernocchi, CEO. "We look forward to continuing to serve our customers by delivering high-quality supplies and services prescribed by their health care professional, supporting their treatment and improving their health and quality of life."

Claims against two other defendants, Coloplast and Liberator Medical Supply, were resolved in December 2015 for almost $3.7 million. The new settlements bring the total recovery in the case to $24.6 million.

BOC to sunset new certifications

OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) plans to stop accepting new applications for its orthotist (BOC), prosthetist (BOCP) and pedorthist (BOCPD) certifications. BOC says the move will help the organization grow and streamline the profession’s credentialing options. “BOC has been a recognized partner in these fields for more than 30 years and remains firmly committed to supporting our certificants and the millions of people who depend on BOC professionals to improve the quality of their lives,” said L. Bradley Watson, BOCO, BOCP, LPO, and chairman of the BOC board of directors.BOC will accept applications for the orthotist, prosthetist and pedorthist certifications through July 31, 2016.

CVS touts infusion care at home

WOONSOCKET, R.I. – Home infusion care is safe and clinically effective, and improves quality of life, all the while reducing costs, according to a new study by CVS Health Research Institute that has been published in Healthcare: The Journal of Delivery Science and Innovation. “As the U.S. healthcare payment system shifts from volume to value, we are focused on identifying new approaches to health service delivery that provide better care and improve patient outcomes, while lowering costs,” said Troyen Brennan, M.D., study author and chief medical officer for CVS Health. “Our research shows that home infusion care is a promising model that is both cost- and clinically effective, and is overwhelmingly preferred by patients when intravenous therapy is required.” Researchers conducted a systematic review of existing peer-reviewed research, evaluating infusion care for several conditions. They compared measures of quality, safety, clinical outcomes, quality of life and costs of home infusion services to those provided in medical settings. From a cost perspective, they found savings ranging between $1,928 and $2,974 per course of treatment for infusion care provided in the home vs. an institutional setting. CVS provides home infusion services through Coram, which it bought in 2013.

Hoveround simplifies doctor-patient interactions

SARASOTA, Fla. – Hoveround has introduced a comprehensive kit for physicians to make it easier for them to identify and gather essential information about a patient during an examination. The kit’s documentation, charts and checklist also help ensure insurance requirements are properly evaluated and assessed during the examination. “Fitting a Hoveround power chair to a patient’s specifications is an important step in maintaining their comfort and well-being,” said Tom Kruse, founder and president, in a release. “Our kit helps assist doctors, staff and patients with selecting the items available to build a Hoveround power chair.” Late last year, the Office of Inspector General told Hoveround to pay back the federal government $27 million for power mobility devices that it says did not meet Medicare requirements. Hoveround disagreed with the findings, saying that the OIG applied incorrect standards, and that the agency influenced the medical review and biased the results. 

New tagline at Harmar ‘speaks to consumer’

SARASOTA, Fla. – Harmar has launched a new tagline, “Lifts for Life,” to represent its mission of making lives better with its line of lifts. “This simple identification speaks to what Harmar’s products do for people who are mobility challenged,” said David Baxter, vice president of marketing. “This change also helps Harmar’s brand speak to the consumer.” Harmar will begin using the new tagline this month.

Prism reports revenue increase

TORONTO – Prism Medical announced revenues of $14.7 million for the first quarter ended Feb. 29, 2016, an increase of 20% compared to the same period last year. Adjusted EBITDA was $1.5 million. The company says government funding for its products in Canada is a key driver of sales. Prism also believes that the U.S. market holds the greatest long-term potential for revenue growth in both the home care and institutional markets.

Convaid, R82 combine sales efforts

TORRANCE, Calif. – The sales and marketing teams at Convaid and R82 have been combined, Chris Braun, president of Etac North America, announced in a recent letter to partners. Convaid sold to Etac AB in 2015. Etac offers products for the pediatric market through its R82 brand. “I am happy to announce that as of May 1, 2016, we are combining the R82 and Convaid sales and marketing teams to bring you one premium pediatric product line to support your customers with the broadest offering to provide the child and their caregivers the greatest freedom and ability to go places,” he said. Among the benefits of the change, Braun says, is one business development rep in a territory to take care of all pediatric needs, whether it’s products from the Convaid or R82 brand. Convaid products will continue to be ordered, custom-made and shipped from Los Angeles. R82 products will continue to be ordered and shipped from Charlotte, N.C., Braun says.

PMDRX adds orthotic component

GLENDALE, Ariz. – PMDRX has launched a new orthotic bracing exam and documentation component for prescribing practitioners to help them determine patient medical necessity for off-the-shelf orthotic bracing. The tool does not “force” qualification—it assists prescribers in painting a clear picture of whether or not a patient has medical necessity for a brace, helping to eliminate documentation errors. “Previously, orthotic device providers were reporting a documentation error rate as high as 85%,” the company states in a press release. Upon completion of an evaluation, prescribers have the ability to auto-format the completed exam into a CMS-compliant comprehensive report. They can also electronically authenticate and sign the final documentation with their password-protected signature.

BioScrip reports loss in revenues

DENVER – BioScrip reported net revenues of $238.5 million for the first quarter of 2016, compared to $244.4 million for the same period a year ago, a decrease of 2.4%. Adjusted EBITDA was $7.4 millionvs. $4.9 million. The company said it was “pleased” with results and that the decrease in revenue stems from a planned shift in revenue mix away from lower margin chronic infusion revenue to its core infusion business.

Short Takes: HDIS, PlayMaker CRM, Somnoware Healthcare Systems

Home Delivery Incontinent Supplies, a provider of incontinence products, celebrates 30 years of business this year. Besides delivering incontinence supplies directly to homes, HDIS in recent years began offering personal care products, home safety items and aids to daily living…PlayMaker CRM plans to nearly triple the number of employees at its new Raleigh office this year from five to 14. “The developers we’re looking for, they’re just not in Nashville,” said Thad Parker, vice president of engineering, in a release. “They’re in Raleigh."…Somnoware Healthcare Systems, a cloud-based platform for sleep wellness and sleep disorder management, has secured $9 million in Series A funding led by TransLink Capital, with participation from World Innovation Lab. The investment will be used to help its customers better manage sleep apnea, lower costs and improve patient outcomes.

People in the news: Connally, Fletcher & Ricker, Whitehall, Vishnevetsky

Thad Connally, president of the Kentucky Medical Equipment Suppliers Association, will be presented with the AAHomecare/Mal Mixon Legislative Advocate Award at the association’s Washington Legislative Conference later this month for his advocacy record at both the state and federal levels…Derek Fletcher has been named adult products manager for Molift, Immedia and R82, while Steve Ricker has been promoted to eastern region sales manager of the pediatric group comprised of R82 and Convaid…Ian Whitehall has been appointed chief sales officer of SP Industries, managing and directing all of the company’s global sales programs for three divisions: SP Scientific, SP Scienceware and SP Ableware…Healthcare attorney Edward Vishnevetsky was recently recognized as a Chambers USA 2016 "Legal Leader in the Field of Health Law" and as a 2016 Texas Super Lawyers "Rising Star” for the third consecutive year.