In brief: PMD spending down, F&P earnings up

Friday, May 30, 2014

WASHINGTON – Spending on power mobility devices (PMDs) continues to fall nationwide since the September 2012 launch of a demo requiring prior authorizations in seven states, CMS says. Monthly expenditures for PMD codes dropped from $12 million in September 2012 to $3 million in December 2013 in demo states, and from $20 million to $6 million in non-demo states across the same time period, according to an update.  “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,” CMS wrote. “We believe this decrease is because prior authorization is ensuring that only beneficiaries who meet Medicare requirements receive a PMD.” CMS had previously reported that expenditures for PMD codes dropped from $12 million in September 2012 to $4 million in September 2013 in demo states and to $9 million across the same time period in non-demo states. From Sept. 1, 2012, to Dec. 31, 2013, the number of beneficiaries receiving PMDs fell by 75% in demo states and by 66% in non-demo states, CMS says. Of the 36,201 prior authorization requests submitted by Dec. 31, 2013, about half were denied.  Other findings in the update: The DME MACs completed reviews of submissions within 10 business days and of resubmissions within 20 business days, and just 2,537 of 44,030 submissions were sent electronically. Assuming monthly expenditures on PMDs stayed at $32 million per month, CMS estimates spending has decreased by $202 million since the demo began.

Fisher & Paykel posts record year, plays it safe for 2015

IRVINE, Calif. – Fisher & Paykel Healthcare on May 23 reported a net profit after tax of NZ$97.1 million for the financial year ended March 31, 2014, a 26% increase compared to the previous year. The manufacturer also reported operating revenue of NZ$623.4 million, a 12% increase. “Our record results reflect that hospital clinicians and homecare providers are increasingly using our innovative products to help to improve care and outcomes,” stated CEO Michael Daniell in a press release. By product group, F&P reported revenues of NZ$336.9 million for respiratory and acute care for 2014, a 12% increase over 2013; and NZ$270 million for obstructive sleep apnea, a 15% increase. Within OSA, F&P highlighted a 26% increase in operating revenue in the second half for masks. Looking to 2015, F&P projects net profit to be similar to 2014 and for operating revenue to hit NZ$640 million. “At current exchange rates, we anticipate an operating profit headwind of approximately NZ$32 million in the 2015 financial year from both reduced hedging and less favorable spot rates,” Daniell stated. “Despite the challenge of this large roll-off in hedging, we have momentum in both of our product groups and we believe that we can offset that headwind in the 2015 financial year.”

Brightree, McKesson streamline ordering

ATLANTA – As part of a new integrated electronic purchasing program with McKesson, Brightree users can now view item item availability in real time; perform one-touch drop shipments; and receive automatic confirmations, including delivery notifications. “This enhanced strategic relationship for Integrated ePurchasing will continue to provide common customers significant time and cost savings that come with real-time integration,” stated Jeff Bowman, vice president of homecare sales for McKesson Medical-Surgical, in a press release. “Customers are reporting improved efficiencies, reduced call volume and labor cost reductions.” The companies believe the program decreases shipping and delivery expenses; optimizes inventory by reducing carrying costs; and eliminates re-keying and data entry errors.

CareTouch expands staff

DENVER – CareTouch Communications has more than tripled its live call center staff since February of this year to accommodate an influx of new patient accounts. CareTouch reaches out to patients on behalf of healthcare providers to help them maintain their supplies for sleep apnea, diabetes, incontinence, oxygen and nebulizer treatment. The company combines interactive voice response (IVR) technology with its live, multi-lingual staff.

DME MACs update face-to-face guidelines

WASHINGTON – The DME MACs on May 29 revised a bulletin on the face-to-face requirement to add information clarifying who may perform the in-person visit and the responsibilities of the ordering physician. The face-to-face exam must be performed by a physician (MD, DO or DPM), physician assistant (PA), nurse practitioner (NP) or clinical nurse specialist (CNS) within six months of the written order for certain DME. The responsibilities of the ordering physician include: documenting that the beneficiary was evaluated and/or treated for a condition that supports the need for the item; including sufficient medical information in the medical record to demonstrate that applicable coverage criteria are met; and providing a copy of the exam and prescription to the provider before the item can be delivered. The bulletin also notes that the treating practitioner that conducted the face-to-face exam doesn’t need to be the prescriber for the DME, but the prescriber must verify that the visit occurred within the six months prior to the date of his or her prescription and that he or she has documentation the exam was conducted.

OIG report finds jump in redeterminations

WASHINGTON – Medicare contractors processed 2.9 million redeterminations in 2012, an increase of 33% since 2008, according to the Office of Inspector General (OIG) semi-annual report to Congress. As a result, the OIG calls on CMS to use the Medicare Appeals Process to monitor contractor performance, share information and keep an eye on the quality of redeterminations data. Also in the report: the OIG says it expects more than $3.1 billion in recoveries—$295 million from audits and $2.83 from investigations. It cites 465 criminal actions and 266 civil actions, as well as the exclusion of 1,720 individuals from participation in federal health care programs. Additionally, the OIG identified $91.6 million in Part B improper payments to “unlawfully present beneficiaries” from 2009-2011; $33.6 million in uncollected Part A and B improper payments for incarcerated beneficiaries from 2009-2011; and $23 million in improper payments for dead beneficiaries in 2011.

MetroStar obtains government contract

NEW YORK – Metropolitan Home Health Products (MetroStar) has been awarded a Schedule 65 II A medical equipment contract by the General Services Administration (GSA). The GAS establishes long-term, government-wide contracts to streamline the process of obtaining products for the federal government. Contracts are awarded to companies that are evaluated for proficiency and suitability for providing products and/or services to the federal government. The assessment covers a wide selection of a corporation's capabilities, such as customer satisfaction, organizational structure, performance history and other criteria.

CMS updates O&P edits

BALTIMORE – CMS has instructed the DME MACs to update programming edits that deny claims for prosthetics and certain custom orthotics when they are furnished by personnel who are not certified orthotists or prosthetists in states where that is a requirement, according to a MLN Matters article. At the time of the original edit, in 2005, nine states had the requirement. Since then, eight additional states—North Dakota, Iowa, Pennsylvania, Arkansas, Georgia, Kentucky, Mississippi and Tennessee—have implemented the requirement. If a supplier is located in one of the 17 states with the requirement, it must be properly enrolled with the National Supplier Clearinghouse to ensure the correct specialty code(s) is on file. To view the official instruction, go here.

People for Quality Care launches ‘Dear Medicare’ website

WATERLOO, Iowa – People for Quality Care (P4QC) has launched “Dear Medicare,” a website that features the stories of seniors and people with disabilities who are being negatively impacted by healthcare policies. “Our mission with Dear Medicare is to lift up the voices of Medicare beneficiaries and move readers to action through their powerful stories,” stated Kelly Turner, director of advocacy, in a press release. P4QC also has a Medicare Beneficiary Complaint Hotline that has received more than 3,000 calls since launching in June 2013.

Invacare, VGM extend agreement

ELYRIA, Ohio, and WATERLOO, Iowa – Invacare and The VGM Group have signed a new multi-year agreement, the companies announced May 27. Mal Mixon, chairman of the board at Invacare, said, “Supporting providers has always been a top priority for Invacare, and with the challenges that continue to face the HME industry, fighting for the rights of independent providers and the beneficiaries they serve is as important as it’s ever been.” Van Miller, CEO of VGM, said, “Working together makes us stronger and more effective.” No additional details were provided.

Booth space at Medtrade going fast

ATLANTA – Medtrade has already booked most of its booth space for the Oct. 20-23 event in Atlanta, according to show organizers. As of May 29, 93% of space has been booked, and show organizers say they expect the remaining 7% to be sold in the coming months. In other news, show sponsor Emerald Expositions has teamed up with CloserStill Media and LiveMed to provide Medtrade exhibitors with an opportunity to reach new international markets through two new events: Trade Days in Birmingham, England, Oct. 5-6; and ExpoMed in Mexico City June 18-20.

DME MAC releases oxygen, CPAP review data

HINGHAM, Mass. – NHIC found a 44% denial rate for oxygen and oxygen equipment as part of a review of claims filed between Jan. 1, 2014, and March 31, 2014. The Jurisdiction A DME MAC reports responses to additional documentation requests were not received for 59% of the claims. For the same time period, the NHIC found a 64.3% denial rate for CPAP devices. Oxygen claims were most frequently denied for missing documentation; failing to meet written order prior to delivery requirements; and failing to establish medical necessity, according to the statement. CPAP claims were denied primarily for problems with face-to-face documentation, the detailed written order prior to delivery, sleep study documentation, training documentation or deliveries.

Sleep apnea: It’s better managed at home, study says

SAN DIEGO – Testing for obstructive sleep apnea (OSA) and initiating treatment with an APAP device at home vs. in a lab reduces costs and doesn’t negatively impact clinical outcomes, according to a new study. The study, presented at the American Thoracic Society International Conference, May 16-21, in San Diego, enrolled 296 subjects, with roughly half beginning CPAP at home and the other half in a lab. Researchers found the cost of home testing was significantly lower than the cost of lab testing ($4,057 vs. $4,621) over 2.75 years. Additionally, assessment with the Functional Outcomes of Sleep Questionnaire showed no significant difference in outcomes between groups. “While the use of home testing and initiation of CPAP therapy is increasingly common, studies of its cost-effectiveness are scarce,” stated lead author Charles Atwood, associate professor of medicine at the University of Pittsburgh School of Medicine and director of the Sleep Disorders Program of the VA Pittsburgh Healthcare System. “These results support the continued use of home management of these disorders.”

People news

American HomePatient has appointed Barbara Stark senior vice president of business development. Stark has more that 30 years of healthcare sales and leadership experience, including stints at Apria, Gentiva Specialty Pharmacy Services, Coram and, most recently, as senior vice president of sales at Univita Health.