In brief: CMS details capacity, UHC admits error, VGM opens invite

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Friday, May 17, 2019

WASHINGTON – CMS will use a bidder’s estimated capacity—or their historic capacity plus their projected increase in capacity—along with their bid amount, to rank bids, reports the coalition behind www.dmecbpeducation.com. “(CMS’s) newly released capacity policy shows how influential a bidder’s capacity is to setting the rate,” said Mark Higley, vice president of regulatory affairs for the VGM Group. “While CMS does not guarantee volume, bidders who overestimate their capacity could lead the SPA to be artificially low.” CMS will evaluate the estimated capacities of bidders to try to avoid over-estimates, the coalition says, but it is important that bidders understand the role that capacity plays in setting the rates. The coalition encourages providers to visit www.dmecbpeducation.com and use the bid calculators on the website when formulating their bids.

CPAP denials done in error, UnitedHealthcare says

MINNEAPOLIS, Minn. – Recent confusion about whether or not UnitedHealthcare would pay for certain CPAP supplies was the result of a systems error, says the payer. Providers in April received letters stating the insurer would not pay for “essential” supplies during the rental period for a CPAP device. “We have not made any changes to our reimbursement policy for CPAP/PAP supplies,” said Tracey Lempner, director of communications. “We did discover that a CPAP code was incorrectly added to a policy update. As soon as we were aware of the error, we corrected it and we are adjusting claims.”  Providers began seeing denials for claims on April 1, with an effective date on the letter of Jan. 1, 2019.

VGM’s Heartland Conference invites all providers

WATERLOO, Iowa – VGM has opened up its annual Heartland Conference to all HME providers for the first time. The move was driven by CMS’s plans to consolidate all competitive bidding areas for Round 2021, the company says. “Due to the changes in competitive bidding, VGM will carry the torch to support all HME providers whether they’re part of our membership community or not, because it’s best for patients, providers and the industry as a whole,” said Clint Geffert, president of VGM & Associates. Non-members will be required to attend a pre-conference session, “Interpreting & Preparing for Competitive Bidding 2021,” lead by Mark Higley, VGM’s vice president of regulatory affairs, on June 10. The conference will take place June 10-12 in Waterloo, Iowa, featuring more than 80 sessions. Registration for non-members is $599 and includes education, meals, networking events and local transportation. FMI or to register: www.vgmheartland.com/cbedu.

VMI accepts funding to grow biz

PHOENIX – Vantage Mobility International has reached an agreement in principle with its investors and financial lenders to accept a new round of funding designed to strengthen the company’s balance sheet and accelerate the growth of its business. As part of the deal, VMI will receive a “meaningful cash infusion” that will be used to invest in growth. “I am delighted to announce this news, which will help VMI realize its vision of improving the customer experience of renting, leasing, buying and owning a wheelchair accessible vehicle,” said Mark Shaughnessy, CEO. The funding will allow the company to invest in several longer-term strategic projects, including product development, supplier relationships and customer partnerships. VMI will also retire certain debts incurred as part of its acquisitions of AMS Vans in September 2017 and Revability in December 2018. VMI is a portfolio company of Nautic Partners, a middle-market private equity firm based in Providence, R.I.

Inspire touts therapy specifically for Medicare patients

MINNEAPOLIS – Inspire Medical Systems has announced the results of a study that shows Medicare-aged patients, in particular, respond well to and adhere to its therapy. The study, led by physicians at the University of Alabama at Birmingham, followed 235 Medicare-aged patients and 365 younger-aged patients and collected information on sleep apnea severity, quality of life and any complications with the procedure. The results demonstrated that, while all patients positively responded to Inspire therapy, the Medicare-aged patients had a slightly higher response, as well as a slightly higher adherence, to the therapy. “This study corroborates the growing evidence supporting the safety and efficacy of Inspire therapy for treatment of OSA in properly selected CPAP-intolerant cases,” said Dr. Kirk Withrow, associate professor at the university and lead author of the publication of the study the Journal of Otolaryngology-Head and Neck Surgery. “In addition, it specifically affirms the benefit of Inspire therapy for older patients, who have been previously shown to have experienced worse outcomes with other types of sleep surgery.” The study concludes that Inspire therapy should be strongly considered in the treatment of older patients who are CPAP intolerant and eligible per the established inclusion criteria. Inspire’s therapy is an FDA-approved neurostimulation technology that provides a safe and effective treatment for moderate to severe OSA.

OIG recommends CMS review Part B drug prices

WASHINGTON – The average sales price for 10 drug codes for the fourth quarter of 2018 exceeded the average manufacture price by 5% or more for two consecutive quarters, according to a new report from the Office of Inspector General. Another five drug codes exceeded the AMP by at least 5% during the quarter but did not meet other price substitution criteria. When the ASP exceeds the AMP by 5%, the Department of Health and Human Services substitutes the ASP-based amount with a lower calculated rate, either 103% of the AMP or the widely available market price, whichever is less. The OIG has provided the 10 drug codes to CMS for review to determine whether or not the agency should pursue price substitutions that would limit excessive payments for Part B drugs.

Get ready to ‘Bid Smart’

WASHINGTON – The coalition behind www.dmecbpeducation.com will host a “Bid Smart 2019” webcast on Monday, 11 a.m. to 12 p.m. EST. Presenters Cara Bachenheimer, head of the Government Affairs Practice at Brown & Fortunato, Kim Brummett, vice president of regulator affairs for AAHomecare, and Mark Higley, vice president of regulatory affairs for VGM Group, will lead an in-depth discussion of major upcoming changes to Medicare’s competitive bidding program. Topics will include lead-item pricing and bid surety bonds. “Industry experts will highlight new calculator tools and share their insights, tips and strategies for this new round of bidding so you can be prepared to bid in Round 2021,” reads a description of the webcast. “This is also an opportunity to ask—and get answers to—your specific questions.” CMS plans to open the bid window for Round 2021 on July 16.

COPD initiative shows reduction in readmissions, costs

MURRYSVILLE, Pa. – A collaboration between Philips and healthcare providers resulted in an 80% reduction in acute readmissions for COPD patients and saved $1.3 million, the company shared at ATS 2019 this month. Other findings from the Integrated COPD Care Initiative, launched by Philips in 2017, included a 70% reduction in all-cause diagnoses readmissions and $4.4 million saved in all-cause diagnoses readmission. “Given the need for cost-efficient improvements in the care of COPD patients, healthcare systems throughout the country would do well to emulate the initiative’s example,” said Philips. As part of the initiative, a group of institutions in Alabama, including an HME provider, a hospital system and a consulting and analytics firm, collaborated to capture event data from electronic medical records, physician portals, chart reviews, respiratory therapist interactions during home visits, and MedAdept respiratory therapy EMR. The initiative included 890 patients, who experienced from 1 to 11 hospital readmissions in the prior year.

MAMES convention a hit

DULUTH, Minn. – This year’s MAMES Spring Convention drew a record number of attendees and was the third consecutive year the event received a 4.0 rating from attendees, the association says. Rick Adamich, president of Oxygen One, won the MAMES Above and Beyond Award. “Rick has been a driving force within MAMES since the first day Wisconsin joined our ranks,” said Rose Schafhauser, MAMES executive director. “His ability to engage members into action has brought and across the MAMES territory to new levels.” The 2019 MAMES Fall Excellence in HME Midwest takes place Oct. 2–4 at the Treasure Island Resort & Casino in Welch, Minn.

PE firm merges three companies to form AleraCare

LOS ANGELES – St. Cloud Capital, a private equity firm based here, has announced a growth capital investment in AleraCare Holdings, a provider of home and community based healthcare and pharmacy services. AleraCare now comprises three companies: MedicoRx Specialty Pharmacy, a specialty and home infusion pharmacy serving the California market; Vasco Infusion, a physician healthcare practice with several ambulatory infusion centers serving the Arizona and northern California markets; and VascoRx Specialty Pharmacy, a specialty and compounding pharmacy holding licenses in 50 states. As AleraCare, these companies will provide a full spectrum of specialty pharmaceutical services to its current managed care partners, manufacturers, patients and physicians, as well as increase its presence and provide greater access to its services throughout the western U.S., the company says. “This merger will strengthen our position as a healthcare services provider,” said Russ Corvese, CEO of AleraCare. “The combination of the strengths of individual companies will create a leading physician healthcare and specialty pharmacy practice providing our patients and partners an unparalleled access to care, lowers costs and improved outcomes.” St. Cloud’s investment, in conjunction with a new ABL facility, was used to refinance existing senior debt, as well as fund numerous capital investment initiatives.

Advocacy heats up in Pennsylvania, Ohio, Minnesota

Tarentum, Pa.-based Blackburn’s hosted U.S. Rep. Conor Lamb, D-Pa., for a roundtable discussion with company executives, University of Pittsburgh researchers and other industry stakeholders, according to a local newspaper. The focus of the discussion: two bills, one that would stop competitive bidding pricing for accessories for complex rehab manual wheelchairs (H.R. 2293) and one that would create a separate benefit category for complex rehab (H.R. 2408). Lamb said the discussion was valuable, especially for a congressman like him, who has been in office for only about a year. “We have to make it better,” he said. “Nobody asked for this stuff to happen to them, so why would we not go the extra mile?”…OAMES testified before the state’s House Finance Committee on May 8 to voice their concerns with sole-source contracting for HME, according to a local newspaper. They’re backing a proposed amendment, HC 2371, that would, in part, prohibit such contracting. Their testimony came as lawmakers weigh changes to the proposed state budget…A group of women with diabetes in Minnesota pled with lawmakers on May 13 to address the rising costs of insulin, according to a local newspaper. During a press conference at the state Capitol, the group urged lawmakers to support a provision in health and human services bills in both the House and Senate that would give diabetics an emergency supply of insulin if they can’t afford it. The House bill would provide an emergency supply of 90 days, while the Senate bill would provide an emergency supply of 30 days.

FODAC raises $40K for donated equipment

TUCKER, Ga. – Friends of Disabled Adults and Children (FODAC) held its 19th Run Walk n’ Roll on May 4 at Stone Mountain Park, drawing 100 participants. The event, which included 5K and 3K courses, raised $40,000 for FODAC’s mission to provide HME such as wheelchairs at little to no cost to those with mobility challenges and their families. Prizes were awarded to the top individual fundraiser, Vicki Crowell, who raised $2,130; and to the top group fundraiser, St. Matthew’s Episcopal Church, which raised almost $1,000. The event also featured a continental breakfast, music, door prizes, clowns and face painting.

Short take: Dasco, Viemed, Invacare

WESTERVILLE, Ohio – Dasco Home Medical Equipment was named one of the 2019 Top Workplaces in the midsize organizations category in central Ohio, by Columbus CEO magazine. Results are based on an employee survey…The seven candidates nominated for election to Viemed Healthcare’s board of directors were elected by a majority of shareholders at the company’s annual general meeting on May 13. They are: Casey Hoyt, W. Todd Zehnder, William Frazier, Randy Dobbs, Nitin Kaushal, Timothy Smokoff and Bruce Greenstein. Hoyt is CEO of the company… Invacare’s board of directors has declared a cash dividend of $.0125 per share on its common shares payable July 22, 2019, to shareholders of record on July 5, 2019.