In brief: OIG says access intact in bid areas, GAO says to extend prior auths

Friday, May 25, 2018

WASHINGTON – Round 2 of Medicare’s competitive bidding program does not appear to have impacted access to oxygen or enteral supplies for most beneficiaries, according to two new reports from the Office of Inspector General.

The OIG analyzed claims data from three months before and six months after the July 1, 2013, kick-off of the program in both CBAs and non-CBAs.

For oxygen, the OIG found that Medicare payments continued for 86% of beneficiaries in CBAs and 89% of beneficiaries in non-CBAs. Those rates were consistent with payments being made for 88% of beneficiaries in 2012.

For enteral nutrition supplies, the OIG found that Medicare payments continued for 91% of beneficiaries in CBAs and 94% in non-CBAs, slightly lower than the 95% in 2012.

In both cases, the OIG said that the slightly higher percentages of beneficiaries in the CBAs “may or may not indicate disruptions,” and that the difference could also be attributed to the program reducing unnecessary equipment and supplies, as CMS has claimed in the past.

The OIG reports follow an interim final rule recently released by CMS that validates concerns raised by industry stakeholders about the significant reimbursement challenges and the decline of suppliers in certain areas.

A 2017 survey of beneficiaries, suppliers and discharge planners commissioned by AAHomecare found that 59% of oxygen patients reported access issues.

GAO: Extend prior auth program

WASHINGTON – CMS should continue with its prior authorization programs and expand prior authorizations to include power wheelchair accessories, according to a new report from the Government Accountability Office.

The prior authorization demonstration project launched in seven states in 2012 and was expanded to an additional 12 states in 2014. Originally set to expire Aug. 31, 2015, the deadline was pushed to Aug. 31, 2018 and CMS has not announced plans to extend the deadline again.

The GAO estimates the prior auth program for power mobility devices saved nearly $608 million though March 2017.

Although the HME industry is largely in favor of prior authorizations, suppliers reported some challenges, such as obtaining the necessary documentation from referring physicians.

In addition, suppliers expressed concerns about whether PMD accessories are subject to prior authorization. CMS in 2017 said if an accessory is essential to the functioning of a K0856 or K0861 wheelchair, it would be considered part of the base and covered under the prior authorization process. 

CMS neither agreed nor disagreed with the GAO’s recommendations but said it would continue to evaluate the prior auth program and take the GAO’s recommendations into consideration in developing plans or determining next steps, according to the GAO.

CMS adds templates for enteral nutrition

WASHINGTON – CMS will host a Special Open Door Forum to allow feedback on draft templates and clinical data elements for parenteral nutritional therapy (order, progress note and lab test results) and enteral nutritional therapy (order and progress note). The forum is scheduled for May 31 at 2 p.m. EST. CMS recently released draft templates and CDEs for RADs, PAPs and vents; infusion pumps and nebulizers; and oxygen therapy. To participate in the forum call 800-837-1935 and use the ID 8778137.

Merits signs contract with Numotion

CAPE CORAL, Fla. – Merits Health Products has signed a contract with Numotion to become the Brentwood, Tenn.-based national complex rehab provider’s preferred provider for Group 2 power wheelchairs. The contract covers Merits’ full line of Group 2 power wheelchairs, including its popular Vision series and its new tilt-only Vision Ultra. “We are excited about this contract and happy to be partnering with one of the nation’s top providers,” said Chris Blackmore, vice president of sales and business development for Merits. “We feel this is a true testament of how far we have come with this company and product development.” Merits launched a complex rehab division called Avid Rehab in 2015, and a home access division called Pilot last year.

ResMed: Remote monitoring, resupply improve compliance

SAN DIEGO – Remote patient monitoring and resupply can improve patient adherence to PAP therapy, according to two studies presented by ResMed at the ATS 2018 International Conference. In the first study, medXcloud, a ResMed-assembled group of healthcare key opinion leaders, examined de-identified data of more than 2.6 million PAP users from its AirView network in the U.S. and found that 75% met the CMS compliance threshold. In the second study, ResMed and researchers found that over a one-year period patients who enrolled in a resupply program slept 5.6 hours on PAP each night, compared to 4.5 hours for those not enrolled. “These two studies demonstrate significantly effective ways to help patients achieve 90-day compliance with cloud-based remote monitoring and to keep them compliant over the long term with mask resupply programs,” said Adam Benjafield, researcher on both studies and ResMed’s vice president of medical affairs. 

ResMed: OSA affects more than previously thought

SAN DIEGO – Obstructive sleep apnea is more prevalent than previously estimated, with more than 936 million worldwide affected—according to a new data analysis from ResMed. Presented this week at the ATS 2018 International Conference, the study, “Global Prevalence of Obstructive Sleep Apnea (OSA)” was conducted by a group of international researchers seeking to provide a clear scope of the impact of the chronic sleep-disordered breathing condition. The previous estimate of OSA prevalence of 100 million came from a 2007 World Health Organization study. “This study should encourage physicians to talk with their patients about how sleep affects our overall health,” said ResMed Chief Medical Officer Carlos M. Nunez, M.D. “It should also cause more people to ask themselves, ‘Do I or my bed partner have this?’ Those who have sleep apnea don’t often realize they have it and, therefore, don’t realize they can do something to mitigate the resulting chronic fatigue or its more harmful long-term health risks.” 

More news from ATS 2018: Philips, ResMed back combined therapy

SAN DIEGO – Royal Philips announced new data at ATS 2018 that suggests combining home oxygen therapy with home non-invasive ventilation as treatment for chronically hypercapnic COPD patients is more effective and less expensive than HOT alone. Comparing the accumulated costs of devices, doctor visits, medication and hospitalizations using a U.S. economic model, HOT-HMV exhibited an average annual cost savings of $3,927 per patient. Results of the five-year, multi-center study were announced at ATS 2017 and published in the Journal of American Medical Association, but the potential health economic impact was previously unknown. The original trial data were used to develop an economic model from the U.S. payer perspective. This analysis indicated the base-case incremental cost per quality adjusted life year (QALY) gained was negative $50,856, suggesting HOT-HMV as a dominant strategy to both save costs and improve quality of life…ResMed announced the results of two studies at ATS 2018 that demonstrate the cost effectiveness of combining home oxygen therapy and home non-invasive ventilation therapy for patients with persistent hypercapnia following a life-threatening exacerbation of COPD. The ResMed-backed Home Oxygen Therapy – Home Mechanical Ventilation (HOT-HMV) health economic studies build on earlier data demonstrating the clinical and cost effectiveness of combined therapy. A U.K. study found that HOT-HMV treatment reduced exacerbation frequency and 28-day hospital readmissions. A U.S. analysis based on the U.K. study found a 58.3% reduction in 30-day readmissions for HOT-HMV patients and the ability to save patients money while improving their quality of life.

Aeroflow applauds vents decision

ASHEVILLE, N.C. – Aeroflow Healthcare will be able to provide even more support for its patients now that North Carolina Medicaid reimburses for home non-invasive ventilators. “For years, N.C. Medicaid patients with chronic respiratory failure, hypoventilation, neuromuscular disorders, and other diagnoses were unable to receive non-invasive ventilation (NIV) therapy, because Medicaid would not cover it,” said Rob Hunter, Aeroflow sales director. “Now that NC Medicaid will cover NIV, patients have access to a much greater level of care, such as with using the Trilogy ventilator, that will significantly reduce hospital readmissions.” The “Clinical Coverage Policy 5A-2, Respiratory Equipment, and Supplies” was updated to include policy guidelines for home and non-invasive ventilators and added HCPCS E0466 to the DME fee schedule as a continuous rental. Aeroflow says this means that Medicaid and North Carolina Health Choice will cover home ventilators with a non-invasive interface for qualifying patients. The devices must be necessary for the treatment of respiratory disorders other than obstructive sleep apnea (OSA).

Collaboration results in DMERT certification

WATERLOO, Iowa – The Durable Medical Equipment Repair and Training (DMERT) Group has been launched as a new certification body for the DME and complex rehab technology industry. The DMERT Group is a nonprofit organization meant to establish training guidelines and provide proper certification for repair technicians. U.S. Rehab, VGM Education and FIOS Repair Training collaborated to develop online tech training courses that are DMERT Group certified. The courses are designed to help prepare techs to take the DME RT challenge exams to earn certification. The group is guided by an executive oversight board that includes Greg Packer, president of U.S. Rehab, and Matthew Macpherson, ATP, director of FIOS DME Repair Training. “We’re excited to announce the addition of the DMERT Group as a resource to ensure quality standards which will further strengthen the credibility of repair technicians - who are intelligent, focused and repair-minded individuals,” Packer said. “This organization has a firm foundation and is advancing the certification for repair technicians that work in the DME and CRT arena.” 

United Spinal hosts outdoor enthusiast at Roll on Capitol Hill

NEW YORK – The United Spinal Association will host power wheelchair user Ian Mackay at its 7th Annual Roll on Capitol Hill, June 24-27 in Washington, D.C. Mackay, a California native, avid outdoor enthusiast and peer group leader, will attend the event for the first time to speak with legislators on issues that affect the independence and quality of life for people with spinal cord injuries and disorders and other pre-existing conditions. In 2016, he rode his wheelchair across the state to advocate for more accessible trails for wheelchair users and began hosting peer support groups. Last year, he rode more than 4,700 miles in four different states and won the national bike challenge in his area. Mackay now runs a nonprofit called Ian’s Ride to raise awareness of accessibility issues in his state.

Breathe Grace Medical Supply opens

OAKLAND, W.Va. – Breathe Grace Medical Supply has opened here, with a focus on respiratory products and services, according to the Garrett County Republican. The company will offer CPAP/BiPAP equipment and supplies, and oxygen equipment and supplies, including portable oxygen concentrators. One of the company’s owners, Jackie Rodeheaver, previously worked for a large DME company that served the tri-state area but closed in 2015. “After its closure, the local area went without something that it needed,” she told the newspaper. “Durable medical equipment is a growing need in our country and in Garrett County, and people still want the hometown service that we have always been accustomed to.” Breathe Grace is in the process of becoming accredited, so it can bill Medicare and Medicaid, as well as private insurances. Right now, it’s offering products and supplies for cash. The company also offers bath safety products like shower chairs and commodes, and mobility products like wheelchairs, walkers, canes and rollators.

Wilson to leave NHIA

ALEXANDRIA, Va. – Tyler Wilson is stepping down as president and CEO of the National Home Infusion Association, effective July 17. Wilson will work with the Board of Directors and staff leadership to develop a transition plan while the association searches for a successor. “I have enjoyed my three years at NHIA,” said Wilson in a press release. “The association is stronger today with a dedicated Board of Directors and a staff that strives to always protect and promote the interests of the home and specialty infusion community. With recent achievements on Capitol Hill and the addition of new member benefits, NHIA has a great future. Wilson took the reins in August 2015. He is best known in the HME industry for his tenure at the American Association for Homecare, where he served as president and CEO from 2006 to 2013.

Short takes: NSM, Viemed, NCPA

Nashville, Tenn.-based National Seating & Mobility will serve as a preferred CRT and home access provider for the Visiting Nurse Service of New York Choice Health Plans. In January, NSM became an in-network provider with Geisinger Health Plan in Pennsylvania … Lafayette, La.-based Viemed Healthcare has received final approval from the Toronto Stock Exchange to graduate from the TSX Venture Exchange to the TSX after receiving conditional approval earlier this month. Common shares will be listed May 23 under the existing symbol VMD. The National Community Pharmacists Association has named Karry La Violette as senior vice president of government affairs and director of the association’s Advocacy Center. La Violette had previously led the association’s government affairs programs.