In brief: Premiums for Medicare Advantage remain stable, complex rehab stakeholders launch petition

Friday, September 25, 2015

WASHINGTON – There won’t be a cat-and-mouse game with premiums for Medicare Advantage plans this year.

CMS announced last week that premiums will decrease by about $0.31 next year, from $32.91 on average in 2015 to $32.60 on average in 2016. The agency says the majority of enrollees, 59%, will face no increase in premiums.

“Seniors and people with disabilities continue to experience stable premiums in Medicare health and drug plans,” said Sean Cavanaugh, CMS deputy administrator and director of the Center for Medicare. “Medicare Advantage and prescription drug plans remain affordable and provide high quality care.”

In past years, CMS has announced slight increases in the premiums for Medicare Advantage plans, only to reverse the increases.

CMS also announced that access to Medicare Advantage plans will remain strong, with 99% of beneficiaries having access to plans.

Additionally, CMS announced that in 2016, more plans will offer supplemental benefits for enrollees, such as dental, vision and hearing benefits.

Between 2010, when the Affordable Care Act was enacted, and 2016, premiums for Medicare Advantage plans are expected to decrease by nearly 10% and enrollment in those plans are projected to increase more than 50% to about 17.4 million enrollees, representing about 32% of the Medicare population.

The annual election period for Medicare health and drug plans begins Oct. 15, 2015, and ends Dec. 7, 2015.

Stakeholders launch petition in fight over pricing for accessories

WASHINGTON – Stakeholders are now petitioning the Obama Administration to step in and reverse CMS’s plans to apply competitive bidding pricing to accessories for complex rehab wheelchairs on Jan. 1. The petition had 765 signatures at press time, with a goal of 100,000 by Oct. 23. “This will have a devastating people across the U.S,” the petition reads. “To protect access for people with severe disabilities, this policy must be rescinded.” This is only the most recent effort to reverse CMS’s plan. Rep. Lee Zeldin, R-N.Y., introduced a bill in July to prevent the agency from adopting the pricing, which could mean a 20% to 50% cut for providers. H.R. 3229 had 11 co-sponsors at press time.

Epic Health moves into enteral nutrition

DALLAS – Epic Health Services has acquired Option 1 Healthcare Solutions, a move that positions the company, which provides pediatric nursing and therapy services, to enter the enteral nutrition market. The deal allows Epic Health to add Washington state, Oregon and Nevada to its coverage area. It now does business in a total of 15 states. It also allows the company to add 6,300 patients to its base across six Western states. It now serves more than 26,000 patients, according to the release. The Chandler, Ariz.-based Option 1 Healthcare will operate as a subsidiary of Epic Health, and retain its headquarters and management team. Epic Health is a portfolio company of Webster Capital, a private equity firm with a focus on consumer and healthcare services companies with EBITDA between $3 million to $15 million.

Grant funds new mobility training

ARLINGTON, Va. – The Craig H. Nielsen Foundation has awarded a one-year, $49,000 grant to Barbara Crane and Laura Cohen to develop and deploy a seating and wheeled mobility training curriculum for entry level physical therapists and physical therapy assistants, and for continuing education for practicing clinicians. “There are limited training opportunities for professionals to gain the skills needed to prescribe a wheelchair effectively, particularly at the pre-professional level,” a press release states. “This project aims to address the shortage of knowledgeable clinicians through development and dissemination of pre-professional training materials.” The “plug-and-play” curriculum will be made available for voluntary use by academic PT and PTA programs, decreasing curriculum variability and improving opportunities for PTs and PTAs to graduate with the requisite knowledge. Crane is an associate professor of physical therapy at the University of Hartford; Cohen is executive director of the Clinician Task Force.

Apria Healthcare doubles down on wound care

LAKE FOREST, Calif. – Apria Healthcare has extended its partnership with MoInlycke Health Care by taking fulfillment and support for the Avance Max negative pressure wound therapy system to acute facilities across the country. This complements Apria’s existing role as exclusive U.S. distributor of MoInlycke’s Avance Flex negative pressure wound therapy system for the home. “Transition planning upon admission with product continuity is now possible, benefitting patients and healthcare professionals alike,” said Dan Starck, CEO of Apria Healthcare, in a press release.

Senators want to review home infusion pricing with CMS

WASHINGTON – More than a dozen senators have written a letter to Senate Majority Leader Mitch McConnell and Minority Leader Harry Reid asking for time to review S. 275, the Medicare Home Infusion Site of Care Act, with CMS. “We urge that the average sales price pricing provisions from H.R. 6 or H.R. 2570 not be included in any legislation that does not recognize the services component of care that is included in S. 275,” stated the letter. The House of Representatives passed H.R. 6 and H.R. 2570, changing Medicare reimbursement of Part B DME infusion drugs to an ASP methodology. The senators argue, however, that without the inclusion of payment for required professional services patients are at risk of losing access to care. The 13 signers of the letter include Sen. Johnny Isakson, R-Ga., who sponsored S. 275

Speakers address ‘sleep tech boom’

ARLINGTON, Va. – Dr. David White, the former chief medical officer at Philips Respironics, will give the opening keynote at the inaugural Sleep Technology Summit & Expo Oct. 6-7 in Santa Clara, Calif. "Dr. White is widely regarded as one of the most influential experts in the world today when it comes to sleep," said David Cloud, CEO of the National Sleep Foundation, in a release. "His position at Harvard Medical School, as well as his relationship with Philips Respironics, put him on the front lines of the emerging sleep technology boom.” Philippe Kahn, CEO of Fullpower Technologies, will deliver a luncheon keynote and Dr. Michael Breus, better known as ‘The Sleep Doctor’ on the Dr. Oz Show, will serve as NSF's Sleep Technology Ambassador and Emcee. The Summit will bring together technology innovators, sleep experts, industry analysts and venture capitalists to share technologies and discuss the global investment landscape.

VGM retools government relations portal

WATERLOO, Iowa – The VGM DC Link page has a new look and a few new resources. In addition to staples like the Action Center and Resource Center, the updated site now features an event calendar and a designated page for state associations. The latter also features contact information for state associations, state licensure information, and speakers available for association events and conferences.

AOPA ‘salutes’ advocates

WASHINGTON – The American Orthotic & Prosthetic Association will recognize three individuals for their contributions to the O&P community next month. Rick Riley, CEO of Townsend Design; Teri Kuffel, vice president at Arise Orthotics; and Charles Kuffel, president and clinical director at Arise Orthotics will receive the Ralph R. “Ronney” Snell Legislative Advocacy Award at the 2015 AOPA National Assembly in October. The award is presented to individuals who advance legislative and regulatory goals for O&P. “Rick, Charles and Teri are O&P industry champions who consistently and unselfishly invest their personal time to inform and educate legislators, regulators, and other professionals with considerable impact,” said Charles Dankmeyer, AOPA president. “AOPA salutes their advocacy.”

ASP rises for several drugs

BALTIMORE – Fourth-quarter payments showed healthy increases for several respiratory drugs. Brand name drugs Brovana (J7605) rose 88 cents to $8.08 per dose and Perforomist (J7606) rose 40 cents to $8.88 per dose. Budesonide (J7626) was up 19 cents to $5.39 per dose. Ipratropium (J7644) was unchanged at just under 11 cents per dose. Albuterol (J7613) was down nearly 2 cents to just under 12 cents per dose.

RESNA seeks feedback on job analysis, education

ARLINGTON, Va. – RESNA is conducting a job analysis of work performed by assistive technology in schools. The goal is to identify core job responsibilities of ATPs in schools. Click here to participate in the survey. RESNA/NCART 2016 is accepting submissions for workshop and course proposals for its conference in July. Proposals are sought on several topics, including computer applications, emerging technology, and service delivery and outcomes. Proposal are due Nov. 19. For more information, click here.

People in the news: Henry Dale Smith, Todd Timbrook

H.D. Smith announced this week that Henry Dale Smith Sr., the company’s founder and chairman emeritus, has died at age 87. Smith founded H.D. Smith in 1954 with the mission of providing personalized service to local pharmacies in the Midwest. The Springfield, Ill.-based company has become the fourth largest national pharmaceutical wholesaler today…Continuum Rx, a Birmingham, Ala.-based provider of home infusion services, has added Todd Timbrook to its board of directors. Timbrook founded and was the CEO of Home Solutions, a provider of home infusion services that grew by more than 20% per year, on average. Continuum Rx operates joint ventures with six major health systems operating 25 hospitals.