In brief: HHS scores win in appeals fight, Superior HealthPlan makes changes to Medline contract

 - 
Friday, August 18, 2017

NEW YORK – The D.C. Circuit on Aug. 11 ordered a federal judge to take a deeper look at whether or not the U.S. Department of Health and Human Services can clear a backlog of about 600,000 appeals by 2021, while still protecting taxpayer dollars, according to Law360. The ruling is a setback for the American Hospital Association, which has been fighting HHS in court over the backlog for several years. The D.C. Circuit, in a 2-1 ruling, said the judge didn’t properly evaluate HHS’s assertion that it could only clear the backlog by entering into mass settlements that would pay hospitals regardless of the merits of their appeals, something that would violate the agency’s legal duty to pay only legitimate claims, Law360 reports. The AHA first filed a lawsuit over the backlog in 2014 and since then the case has gone back and forth between the district and circuit courts. Most recently in January, the U.S. District Court for the District of Columbia stood its ground, with Judge James Broasberg refusing to rescind a previous order on Dec. 5 requiring the agency to eliminate the backlog by 2021.

Superior HealthPlan makes changes to Medline contract

AUSTIN, Texas – Superior HealthPlan, a managed care company that’s administering part of the state’s Medicaid program, has decided to delay a contract with Medline until Oct. 1, according to the San Antonio Express-News. The contract, which includes 244 codes for DME and supplies, was set to start Sept. 1. Superior Health Plan, part of Centene Corp., also plans to recast the contract as “preferred provider” vs. “single source,” making it clearer that Medicaid recipients will still have their choice of provider, the newspaper reported. The changes to the contract come on the heels of a hearing before the state’s Committee on Human Services in the House of Representatives on Aug. 9. During the hearing, lawmakers suggested that Superior HealthPlan amend its notice to patients to say they can “opt out for any reason or no reason at all,” the newspaper reported. Prior to the hearing, a number of providers, including Respiratory & Medical Homecare and Alliance Medical Supply, had sent letters of protest to different offices of the Texas Health and Human Services Commission, as well as Superior HealthPlan. Superior HealthPlan’s contract in Texas is only one of many such contracts between managed care companies and distributors spreading nationwide.

NSM buys Alabama Wheelchair Specialists

NASHVILLE, Tenn. – National Seating & Mobility has acquired Alabama Wheelchair Specialists in Birmingham, Ala. NSM will serve the company’s clients from its existing branch in Pelham, Ala. “This acquisition not only expands our service area in the state, but also broadens the service offerings and choices for individuals with mobility challenges in Alabama,” said Bill Mixon, NSM CEO. Assistive technology professionals Mike Oliver and Dave Nix, representing 77 years of experience, will continue to service clients from the Pelham branch. NSM will also add a funding specialist and technician to the branch’s staff. NSM also serves clients in the state from branches in Mobile and Montgomery, Ala. Already this year, NSM has acquired Mobility Healthcare, with locations in Carrollton and Lewisville, Texas; Dependable Medical Equipment in Seattle; Columbus Medical Equipment in Columbus, Ohio; and most recently, the mobility division of Wright & Filippis in Rochester Hills, Mich.

PA update: Docs may request decision letter

WASHINGTON – The prescribing physician/practitioner may contact the DME MAC to request a copy of the prior authorization decision letter, CMS has announced. The request for the letter may be included with the documentation sent to the provider as part of the prior authorization request, or may be made separately. The DME MAC will not automatically send the letter. AAHomecare, which has expressed concern with the lack of physician involvement in the correspondence of the PA decision, applauded the change. “Unlike the PMD demonstration, under the PA expansion, DME MACs cannot automatically communicate with referring physicians on the PA decision,” the association stated. “AAHomecare thanks CMS for the opportunity to provide feedback and for implementing a crucial modification to the program.” In July, providers in all states began submitting prior authorization requests for two complex rehab codes, K0856 and K0861.

Lofta launches website for AirMini

SAN DIEGO – Lofta, a home medical device retailer, has launched a new e-commerce website devoted exclusively to the AirMini, ResMed’s new travel CPAP device. The website, www.buyminicpap.com, features a la carte purchasing for the AirMini and compatible full-face, nasal and nasal pillows masks, as well as complete bundles. Lofta offers unlimited access to its support team through the website’s online chat or by phone. The company also offers a 30-day risk free trial period and a zero interest 12-month payment program. In addition to the new website, Lofta offers a “Complete Path” for sleep therapy, a streamlined, concierge-style service that moves sleep apnea sufferers through the necessary steps to therapy, all from the convenience of their own homes. ResMed launched the AirMini this summer.

Aeroflow criticizes decision to drop sleep reg

ASHEVILLE, N.C. – Aeroflow Healthcare says the federal government’s decision to scrap a regulation to require sleep apnea screening for commercial drivers and rail workers is ill advised. “This is a clear and present danger on our roads, rails and highways,” said Michael Trufant an industrial manager at Aeroflow, in a statement. “Our traveling public should not be exposed to danger on their commutes.” Trufant says the arguments against the regulation have everything to do with the cost of testing and treatment, not with safety. “The cost is minimal,” he said. “The safety imperative is pressing.” Aeroflow released the statement in support of Sen. Chuck Schumer, D.N.Y., who says the rulemaking process for the regulation should be re-instated. Earlier this month, the Federal Railroad Administration and the Federal Motor Carrier Safety Administration said they were scrapping the regulation, arguing that it should be up to trucking and railroad companies to decide whether or not to screen their employees. It’s a change in direction for the agencies under President Donald Trump, who has pledged to drastically slash federal regulations. Last year, the agencies announced a proposal to require screening for commercial drivers and railroad workers, and sought public input.                                                                            

Coloplast reports 8% organic growth for Q3

MINNEAPOLIS – Coloplast says its integration of Comfort Medical continues to “progress to plan” and its U.S. chronic care business saw double-digit organic sales growth in the third quarter. The company, which has its U.S. headquarters here but is based in Denmark, announced last year that it was buying Coral Springs, Fla.-based Comfort Medical for $160 million in cash, combining a manufacturer of ostomy, urology, continence and wound care supplies with a provider of those supplies. Overall, Coloplast reported organic growth of 8% in the third quarter of the 2016-17 fiscal year. Growth by business was 7% for ostomy care, 10% for continence care, 10% for urology care, and 1% for wound and skin care. Coloplast reported EBIT was up 9% for the quarter at constant exchange rates and EBIT margin was at 33% at constant exchange rates. The company says revenues for the third quarter were adversely affected by a one-off adjustment made after the company identified “incorrect management of contractual obligations” related to an agreement with the Department of Veterans Affairs for 2009-17. Coloplast continues to expect organic revenue growth of 7% to 8% at constant exchange rates. EBIT margin guidance remains at 33% to 34% at constant exchange rates.

Cancer survivor opens HME business

WINDSOR, Colo. – A 27-year-old cancer survivor has opened a medical supply business here called I Love Lucy’s Home Medical Supply and Equipment. Lucia Sodre told the Greeley Tribune she hopes her medical supply store will help others experiencing life-altering health issues, with a focus on offering education and options. "Just because you're going through an illness or a difficulty in your life and you have certain limitations doesn't mean that you don't want to be normal, that you don't want to look good," she told the newspaper. "And it doesn't mean that you're done living." After being diagnosed with cancer and having a lump removed from her throat, Sodre used a machine at home to keep her throat clear and a cane to help her walk.

Delivery system in jeopardy, new white paper shows

WATERLOO, Iowa – U.S. Rehab, a division of the VGM Group, has released a white paper analyzing the current state of the DME industry. The paper, “The Delivery of DMEPOS is in Jeopardy,” provides a data-driven perspective on the adverse effects of competitive bidding on both patients and providers of DME, complex rehab and O&P. “If the current issues with reimbursement are not addressed, irreparable harm will be done to this delivery system,” said Greg Packer, president of U.S. Rehab. “With reimbursement rates below cost of many products and repairs of those products, we are already seeing the rationing of health care and the inability of patients to receive products and services that have always been available and guaranteed by Medicare.” The paper is the first in a series that aims to provide stakeholders with tools to engage members of Congress and to share with advocates.

Aeroflow moves up top ranked list

ASHEVILLE, N.C. – Aeroflow Healthcare has ranked #2450 on the 2017 Inc. 5000, a list recognizing the country’s fastest growing private companies. This is the third consecutive year that Aeroflow has ranked on the list, coming in at #3089 in 2015 and #3100 in 2016. Only one in five companies makes the list three times in a row, the company says. Helping Aeroflow to move up this year: record-breaking yearly sales growth of 146%, the company says. “Aeroflow Healthcare is once again on track to have a record year in sales, achieving over $73.6 million in 2016,” it stated.

Mediware signs up another HME biz

LENEXA, Kan. – Quirantes Orthopedics has licensed CareTend Software for its HME business, Mediware has announced. Quirantes specializes in a full range of orthotics and prosthetic supplies to residents in Florida. “With CareTend software, we saw many opportunities to automate our business and save time using the workflow, reporting and inventory tools,” said Marino Reyes, vice president at Quirantes. “We look forward to using CareTend and transitioning from our manual, paper-based process to a completely automated business management solution.”

Studies: COPD deaths increase, CPAP therapy improves with support from partner

In 2015, 3.2 million people died from COPD worldwide, an increase of 11.6% compared to 1990, according to an article published in the journal The Lancet. There was a decrease in the age-standardized death rate of 41.9%, but this was counteracted by population growth and aging of the global population. From 1990 to 2015, the prevalence of COPD increased by 44.2%, whereas the age-standardized prevalence decreased by 14.7%. Smoking and ambient particulate matter were the main risk factors for COPD followed by household air pollution, occupational particulates, ozone, and secondhand smoke. Together, these risks explained 73.3% of disability-adjusted life years due to COPD…A person’s partner may play a pivotal role in diagnosing sleep apnea and adhering to therapy, suggests a study published in the journal Sleep Health. “Couple-directed interventions that advocate for a mutually engaging perspective and promote supportive relationships and positive dyadic coping may be targets for improving CPAP adherence,” the study states. Researchers found that facilitators to CPAP use were: the partner aiding diagnosis and treatment, couples working together using CPAP, the perceived benefits of CPAP for both partners, the patient being motivated to use CPAP for the benefit of the partner, and various types of support provided by the partner to encourage CPAP use, according to the study.

Short takes: AAHomecare, Brightree

“On account of requests from several providers,” AAHomecare is extending the deadline for submissions for second quarter 2017 data for the HME Audit Key to Aug. 25. The association reminded providers that individual data is not required to participate, just cumulative counts of pre- and post-payment audits and appeal claim outcomes. The survey is open to all providers…Brightree will hold its 2017 Brightree Summit on Oct. 23 at the Omni Hotel in Atlanta in conjunction with Medtrade, Oct. 23-25 at the Georgia World Congress Center. The Summit offers a variety of training, education and consulting tracks covering resupply, billing and AR, mobile delivery and more. New this year: an app for event information, and a networking reception from 5:30 to 7:30 p.m.