In brief: MACs miss standards, health spending stays low

Friday, January 10, 2014

BALTIMORE – Medicare Administrative Contractors (MACs) failed to meet one-quarter of CMS’s performance standards, according to a new report from the Office of Inspector General (OIG). “Given the billion of dollars awarded to Medicare Administrative Contractors and the critical role they play in administering the Medicare program, effective oversight of performance is important to ensure that they are adequately processing claims,” the OIG states. The OIG based its findings on a performance assessment of 13 MACs conducted from September 2008 to August 2011. Of the 25% unmet standards, MACs had not resolved issues with 27% of those standards as of June 2012, the report states. Many of the standards CMS sets for MACs require 100% compliance, but the OIG found CMS did not require action plans in 12% of the unmet standards, leaving those problems four times more likely to go unresolved. CMS contractors can earn award fees for performing beyond basic requirements, but the OIG found problems, here, because some troublesome areas highlighted by quality-assurance reviews are not metrics in the award program. The OIG recommends CMS require action plans for all unmet standards; use reviews to select award fee metrics; meet timeframes for completing quality-assurance reports and award fee determinations; establish timeframes for issuing performance reports; and work with legislatures to increase the time between contract competitions to give CMS more flexibility awarding new contracts. CMS agreed on all six points, according to the report.

CMS: Growth in health spending remains low

WASHINGTON – Overall national health expenditures grew at an annual rate of 3.7% in 2012, marking the fourth consecutive year of low growth, the CMS Office of the Actuary reported Jan. 7. Health spending as a share of gross domestic product fell slightly from 17.3% in 2011 to 17.2% in 2012. “For the second straight year, we have seen overall healthcare costs grow slower than the economy as a whole,” said CMS Administrator Marilyn Tavenner in a release. “This is good news. We will continue to work with tools given to us by the Affordable Care Act that will both help us control costs for taxpayers and consumers, while increasing the quality of care.” The Office of the Actuary’s report has been published on the CMS National Health Expenditures website and has been featured in an article in the January issue of Health Affairs. Continued low growth in 2012 was driven by slower growth in prescription drug, nursing home, private health insurance and Medicaid expenditures. The ACA also contributed to slow growth, but it had a limited impact on overall spending as it was still being implemented in 2012, according to the report. Despite a large up tick in enrollment, Medicare spending growth slowed slightly in 2012, increasing 4.8% for the year compared to 5% in 2011. Total Medicare spending per enrollee grew by only 0.7% in 2012, the report states. Total Medicaid spending grew 3.3% in 2012. While an increase over 2011, it still represents historically low overall growth rates tied to improved economic conditions, as well as efforts by states to control costs, the report states.

Implantable device makes gains on CPAP therapy

CLEVELAND – A new device that stimulates a nerve at the back of the tongue to open a person’s airway effectively treats obstructive sleep apnea (OSA), making it a viable alternative to CPAP therapy, researchers say in a study published in the Jan. 9 issue of the New England Journal of Medicine. The implantable device is called Inspire Upper Airway Stimulation. It delivers a mild electrical stimulation to the base of the tongue, preventing it from collapsing and blocking the airway. Patients turn the device on and off with a hand-held programmer. “This device is a first of its kind therapy, and has the potential to help the many people suffering form moderate to severe sleep apnea who are unable to use or cannot tolerate CPAP,” said Kingman Strohl, senior study author, pulmonologist at University Hospital Case Medical Center and professor of Medicine at Case Western Reserve University School of Medicine. Researchers studied 126 patients with moderate to severe sleep apnea who could not use or adhere to CPAP therapy. To qualify for inclusion, study subjects could not be obese and had to show their OSA was tongue-related. Earlier studies showed the implant is less effective in obese patients and those with soft-palate collapse, according to news reports. To conduct the study, researchers measured the patients’ apnea-hypopnea index (AHI) and oxygen desaturation index (ODI) and found that after a year using the device patients’ median AHI score fell 68% and their median ODI score dropped 70%, according to the release. A sub-study then found a sharp rise in the AHI index, fatigue and snoring of 23 patients who had the device removed for a week, researchers said. The FDA is reviewing data on the Inspire Upper Airway Stimulation device, which has been provisionally approved for use in Europe, according to the release. Device maker Inspire Medical Systems funded the study.

MED Group sees Golden opportunity

LUBBOCK, Texas – The MED Group has partnered with Golden Technologies to make the manufacturer’s full line of products available to its members. “Life chairs and mobility products are key growth areas for our members and we are excited that they will now have access to the Golden Technologies product line,” stated Jeff Woodham, senior vice president of The MED Group, in a release. The Old Forge, Pa.-based Golden makes lift chairs, scooters and Group 1 and Group 2 power wheelchairs. “The Med Group and its members are a natural fit for Golden,” stated Richard Golden, CEO, in the release. The MED group has nearly 500 provider members with more than 1,700 locations.

IDS opens California lab, expands insurance coverage

DECATUR, Ala. – Instant Diagnostic Systems (IDS) has opened a new lab in Valencia, Calif. With the new facility, the in-home diagnostics company is able to expand contract coverage with health insurance plans, according to a release. Other recent developments: IDS has become an in-network provider for Blue Cross and Blue Shield health plans, The Empire Plan, Scott & White Health Plan and Vanguard Health Plan, the release states. Both of IDS’s labs participate in Medicare and are accredited by the Joint Commission.

Centegra goes with Medline for supplies distribution

MUNDELEIN, Ill. – Medline Industries is now the preferred medical and surgical supplies distributor for Centegra Health System, which expects to save $1 million in supply-chain costs as a result of the arrangement, according to a Jan. 9 release. The three-year deal is expected to be worth $30 million, the companies said. “Medline’s manufacturer-direct approach and supply chain management expertise are critical to driving down cost,” said David Tomlinson, Centegra CFO, in the release. “Their strong logistics capabilities and robust product offering will allow us to effectively get products when and where our clinicians need them most, no matter the location.” Medline has 37 distribution centers throughout the country, and will help Centegra spend less through product standardization and better reporting capabilities, according to the release. 

PharMerica picks up BGS Pharmacy Partners

LOUISVILLE, Ky. – PharMerica, a national provider of institutional, specialty home infusion and oncology pharmacy services, has acquired BGS Pharmacy Partners, the company announced Jan. 10. The deal expands PharMerica’s footprint in Reno, Nev., and deepens its presence in Las Vegas and Salt Lake City, said CEO Greg Weishar. “BGS has a talented team and has built a strong business based on patient care, clinical expertise and customer service,” Weishar said, in a release. BGS is a provider of comprehensive pharmacy services to long-term facilities.

OIG to CMS: Update guidance on EHRs to prevent fraud

BALTIMORE – CMS needs to provide guidance to contractors on how to detect fraud associated with electronic health records (EHRs), according to a report from the Office of the Inspector General (OIG). Additionally, CMS needs to direct contractors to use audit logs, which distinguish EHRs from paper records, a valuable tool when reviewing medical records. The OIG issued its guidance after conducting an online questionnaire and finding out CMS did not change program integrity strategies after the adoption of EHRs and provided limited guidance on fraud vulnerabilities to contractors, according to a recent release.

ResMed, Invacare dive into R&D in 2014

SAN DIEGO and ELYRIA, Ohio – ResMed has been awarded a patent for a device to treat apnea and hypopnea by detecting and responding to events by adjusting the positive airway pressure a patient receives, according to news reports. Invacare has a patent in the approval process for a wheeled-vehicle suspension, according to news reports. The suspension system involves a pivot arm, front and rear casters, a stabilizing system and a sensor, according to the patent application.

Active Healthcare launches new website

CARY, N.C. – Active Healthcare has launched a new website, featuring an online store, as well as educational resources and forms, the company has announced. “Our vision always has been to make things simple for both provider and patient,” said Steve Feierstein, Active Healthcare cofounder, in a release. “We believe the new site accomplishes this, while also creating an easy interface for exchange of information and services.” Active Healthcare offers sleep, respiratory and diabetes care products.

Finnegan Medical Supply carries Nova Medical

LITTLE ROCK, Ark. – Finnegan Medical Supply is now carrying Nova Medical Products, including colorful and patterned walkers, canes, mobility accessories and bath safety equipment, the company announced Jan. 7. Finnegan Medical was attracted to Nova Medical by its Glamor line of mobility accessories, according to the release. “Most of the ambulatory products we normally see are gray or black and boring,” said Su-Lauren Wilson, CFO at Finnegan Medical, in a release. “Nova brings you colors and patterns that reflect who you truly are and make your cane or rolling walker an accessory, not a device.”

The CareGiver Partnership launches 2014 sweepstakes

NEENAH, Wis. – The CareGiver Partnership, a national retailer of incontinence products and other home healthcare supplies, has launched its 2014 “Helping You Get On With Life” sweepstakes. “We created this sweepstakes to raise awareness of the many product and service solutions available among the caregiver community,” said Lynn Wilson, co-founder, in a release. “Each item chosen represents a family caregiver solution—a product or service that helps seniors live more independently and gracefully in their homes.” To win the prize in January—an activity therapy systems kit from R.O.S. and the book “Activities 101 for the Family Caregiver”—participants must email, explaining how the prize will be useful to them and their loved ones. Entries will be accepted through Jan. 31.

CMS offers further analysis of PMD demo

BALTIMORE - CMS reported in December that its power mobility device (PMD) demonstration project brought down overall expenditures in seven states from $12 million in September 2012 to $4 million in September 2013. Expenditures in non-demo areas fell from $20 million to $9 million during the same timespan. In demo states, the agency estimates it saved $10.3 million through denials of claims without prior authorizations, $350,000 through non-affirmed requests, and $876,909 through claims whose denials were upheld under reconsideration. CMS says the agency's spending fell, in part, because providers have been better educated and have adjusted their billing practices. “While we recognize that multiple factors contributed to the decrease in PMD expenditures, there was also a significant decrease in the number of beneficiaries receiving PMDs in the demonstration states after the start of the demonstration,” the agency stated. “We believe this decrease is because prior authorization is ensuring that only beneficiaries who meet Medicare requirements receive a PMD.”

Mobility companies make donations

101 Mobility has teamed up with Homes for Our Troops to help provide an ADA-complaint, wheelchair accessible home for Army Staff Sgt. Alex Dillman, who was paralyzed by an IED blast in Afghanistan, according to a Jan. 6 announcement. “What we’re doing for him just seems so minor compared to what he’s done for us,” said Dennis Clouser, owner of 101 Mobility Tampa…Vantage Mobility International has donated an Access360 Northstar system for a 2013 Toyota Sienna to Charlie Harvey, a disabled veteran who won the Operation Independence Star Spangled Salute contest. VMI, Toyota and NASCAR driver Darrell Waltrip presented Harvey with the system on Jan. 8 “We launched the VMI Operation Independence initiative to better support our disabled veterans in obtaining their mobility vehicle benefits,” said Monique McGivney, VMI corporate communications director, in the release. The program now includes a dedicated advocate center and the Star Spangled Salute Contest, she said…A wheelchair user who helps people with disabilities play adaptive sports and a service dog trainer won donations through Sunrise Medical’s Propel Donation Program, the company announced Jan. 7. New Jersey resident Brandon Holiday was denied reimbursement for seating products, leaving him too uncomfortable to use his wheelchair for long; the program provided him seating products for his Quickie 2 wheelchair. Dogsong Animal Training and Behavior received a Quickie Q7 and a QM-710 to help the company train service dogs to work with people using wheelchairs.

DeVilbiss moves oxygen concentrator production to the US

SOMERSET, Pa. – In the latest step in its effort to move production from China to the U.S., DeVilbiss is now manufacturing its redesigned 5 Liter Oxygen Concentrator at its Somerset, Pa. headquarters, the company announced Jan. 6. The new two-piece cabinet design is quieter, easier to assemble and disassemble, and has more efficient cooling, according to a release. “We are proud to offer an improved concentrator that is built to last and easy to maintain,” said Jim Clement, director of global product management–respiratory solutions, in the release. The redesigned unit uses at least 15% less power than comparable designs, the release states.

Numotion strengthens New Orleans presence

MADISONVILLE, La. – Numotion has acquired New Orleans-area complex mobility provider Specialty Wheelchairs, the company announced Jan. 6. Jeff Cosentino, co-owner of Specialty Wheelchairs, will remain with the company. “The sale will allow me to pull back from the administrative duties of running a business and maximize my time serving customers who need complex mobility equipment to improve their daily lives,” Cosentino said in a release. The acquisition expands Numotion’s service area and strengthens its relationships with New Orleans-area referral sources, said James Hartman, Numotion regional vice president, in the release. 

Now hiring DME sales reps: West Corp.

SAN ANTONIO – West Corp. is adding 70 positions here to provide medical sales support to a new client and an existing client, both unnamed, according to the San Antonio Business Journal. The company seeks applicants with durable medical equipment or pharmaceutical sales experience, according to the story. Based in Omaha, Neb., West Corp. provides contact center sales and support to a variety of clients, including companies in the healthcare industry. Services include automated patient interactions, communication, care coordination and adherence monitoring, according to the company’s website.

Hope Medical acquires Wheelchairs Plus

SAN ANTONIO – HME provider Hope Medical Supply has acquired Wheelchairs Plus, adding complex rehab to its growing product portfolio. Wheelchairs Plus, which is located in a prime location in South Texas Medical Center, specializes in complex rehab for patients with disabilities, including children. Three employees, including former owner Tom Cottle, who will remain as professional team director, have assistive technology professional (ATP) certification. The acquisition is Hope Medical Supply’s latest attempt to develop niche markets. It recently expanded its specialty lines to include prosthetic limb and orthotic bracing. Hope Prosthetics and Orthotics is located in a downtown medical neighborhood.

Carolina’s HME now offers Medela breast pumps

CHARLOTTE, N.C. – Carolina’s Home Medical Equipment is now an authorized dealer of Medela breast pumps and negative pressure wound therapy devices, the company announced Jan. 3. Under the Affordable Care Act, most insurers are now required to pay for breast pumps. “This changes the market entirely, shifting a business previously dominated by retail to an insurance-covered item that generally must be billed via a DME provider,” said Andrew Trammell, CFO of Carolina’s HME, in a release. Carolina’s HME will be the first authorized Medela DME provider in the Charlotte market. It accepted contracts to provide respiratory, mobility and negative pressure wound therapy products as part of the Round 1 re-compete of competitive bidding.

People news

The Board of Certification/Accreditation recently announced BOC-certified orthotist James Hewlett is now chairman of its board of directors, succeeding John Kenney. Hewlett, most recently vice chairman, has been a member of the board since 2008…ResMed’s board of directors has announced Peter Farrell, executive chairman, has been appointed non-executive chairman, effective Jan. 1. The board has approved the following compensation arrangements: an annual $65,000 retainer, annual equity grant with a grant date fair value of $250,000 and an annual salary of $300,000. Farrell is eligible for a bonus for his service prior to Jan. 1, 2014, but not for his service after…The Community Health Accreditation Program (CHAP) has elected Elizabeth Buff chairwoman of its board of directors. Buff, senior vice president of quality management and clinical excellence at the Visiting Nurse Service of New York, was previously the board’s vice chairwoman. Joining her are new board members Steven Landers and Barbara McCann. Additionally, Nicole Silverman was reappointed to a four-year term on the board.

Short takes

The 2014 version of the National Home Infusion Association’s National Coding Standard for Home Infusion Claims under HIPAA is available to the public at no charge. Updated yearly, the document presents a comprehensive coding system, and provides procedures and examples for using codes, according to a release...Numotion is now a premier-level national partner of The ALS Association. The complex wheelchair provider will support the Walk to Defeat ALS and the National ALS Advocacy Day and Public Policy Conference; will be an exhibitor and presenter at the ALS Expo in Washington, D.C., on May 9; and will sponsor the National Clinical Conference Nov. 6-8.