In brief: Small Business Committee goes to bat for HME, CareCentrix partners with Performant

Friday, May 26, 2017

WASHINGTON – The House Small Business Committee is asking Health and Human Services Secretary Tom Price for relief for HME providers.

Committee member Rep. Blaine Luetkemeyer, R-Mo., is circulating a letter addressed to both Price and CMS Administrator Seema Verma, expressing concern with a 38% reduction in the number of HME suppliers since July 1, 2013.

The letter seeks: additional resources to speed up fee schedule adjustments required by the 21st Century Cures Act; a delay in cuts that went back into effect in non-bid areas on Jan. 1, 2017; and a restoration of payments for oxygen concentrators in rural areas based on adjusted fee schedules.

“We must provide relief for durable medical equipment suppliers before they are no longer able to help patients across America,” says the letter.

The letter is the result of grassroots efforts by Patrick Naeger, president of the Midwest Association for Medical Equipment Services.

“I am grateful to my friend, Congressman Blaine Luetkemeyer for recognizing the destruction small businesses like mine and thousands of others across the country are facing as a result of Medicare competitive bidding rural fee schedule cuts,” said Naeger, executive vice president of Healthcare Equipment & Supply in Perryville, Mo., in a press release.

Last week, Rep. Cathy McMorris-Rodgers, R-Wash., also began circulating a letter seeking changes to HME policy.

CareCentrix, Performant specialize fraud efforts

HARTFORD, Conn. – CareCentrix has teamed up with Performant Financial Corporation, the new national RAC for DME, home health and hospice, to deploy specialized analytics and algorithms to better identify and decrease waste and fraud, it announced May 23.

“You only need to look at recent headlines to know that the problems of fraud, waste and abuse are only increasing,” said John Driscoll, CareCentrix CEO, in a press release. “CareCentrix is committed to bending the cost curve in health care by working with payers to guide care for their members to the home. We are thrilled to expand our capabilities in identifying and decreasing waste and fraud insurance claims in home health care and DME, and look forward to working with Performant to stay on the cutting edge of curbing this trend for our clients.”

Home health and DME are known as high-risk areas for insurance abuse and error, representing more than $11.4 billion in improper payments each year for Medicare alone, according to the release.

Because home health and DME claims are often high volume, but low unit cost, traditional approaches to detecting waste and fraud often fall short, CareCentrix says.

“By leveraging their collective experience in home health care and cost-containment solutions, CareCentrix and Performant will deploy specialized analytics and algorithms to better detect the patterns that are often overlooked but add significant cost to health care payers,” the release states.

Performant says DME and home health have become a growing concern for healthcare payers.

“We are excited to leverage CareCentrix’s unmatched knowledge of home care management in pursuit of our mutual goal to curb improper payments,” said Simeon Kohl, senior vice president of healthcare at Performant, in the release.

SBA, CMS to attend Heartland session

WATERLOO, Iowa – Representatives from CMS and the Small Business Administration will participate in panel discussion at the VGM Heartland Conference in June. The discussion will focus on the future of the competitive bidding program, and provide an opportunity for audience members to ask questions and share feedback on the impacts to their businesses, according to a press release. “Providing platforms to share (provider) concerns and connecting VGM members with resources to navigate the regulatory environment helps strengthen and protect their businesses,” said John Gallagher, vice president of government relations for VGM. The SBA holds regular hearings across the country and HME providers have been making their case at every opportunity, including one held in Portland, Maine, in May 2016. The VGM Heartland Conference takes place June 12-15.

Clinicians speak out on bid program

WATERLOO, Iowa – People for Quality Care, the advocacy arm of The VGM Group, has released a video featuring damning testimony from clinicians on Medicare’s competitive bidding program. The clinicians provided the testimony at an annual conference recently hosted by Handi Medical Supply in Saint Paul, Minn. “Our goal is to empower the industry with the tools needed to continue the fight as we work together toward relief,” said Kelly Turner, executive director of PFQC. “This video reinforces the message shared by the industry and other stakeholders that the program is harming the very people it’s designed to protect and is in desperate need of reform.” Clinicians say the faulty program, combined with unsustainable reimbursement rates, has resulted in preventable hospital readmissions and reduced options. It has also resulted in patients either going without equipment or supplies, or paying for them out of pocket. “It may be great for Medicare; it’s not great for the patient,” says one clinician, who has been coordinating care for 45 years. “It is the worse thing that I’ve seen in my entire life.” PFQC encourages providers to share the video as part of their lobbying efforts.

OIG pushes monthly rentals for all PMDs

WASHINGTON – Medicare could save millions if it sought legislation to shift from a lump-sum purchase option to a monthly rental payment for all power mobility devices, according to a report from the Office of Inspector General (OIG) published in May. In January 2011, Medicare eliminated the lump-sum purchase option for standard power wheelchairs, a move that saved $86 million from 2011 to 2014, according to the OIG. If legislation were in place to also eliminate this option for scooters and complex power wheelchairs—what the OIG calls “nonstandard PMDs”—Medicare would have saved an additional $10.2 million from 2011 to 2014, according to the report. The OIG conducted an audit that covered Medicare payments totaling $264,376,368 for PMDs obtained by 85,761 beneficiaries choosing the lump-sum purchase option during 2011through 2014. The PMDs were new and used nonstandard devices provided to Medicare beneficiaries during the four-year period. The agency calculated the potential savings to the Medicare program by comparing the lump-sum purchase to what the rental payments would have been over a 13-month rental period.

NHLBI introduces ‘COPD roadmap’

BETHESDA, Md. – The National Heart, Lung, and Blood Institute has released a COPD National Action Plan to offer a roadmap for addressing the third leading cause of death in the United States. The plan has five goals: empower patients and caregivers to recognize and reduce the burden of COPD; equip healthcare professionals to provide comprehensive care to COPD patients; collect, analyze and share COPD data; increase COPD research; and turn COPD recommendations into research and public health care actions. The plan was developed with the input of COPD stakeholders, including patients, healthcare providers and academics. “The enthusiasm of members from the COPD community in sharing insights has been invaluable throughout this process,” said James P. Kiley, Ph.D., director of NHLBI’s Division of Lung Diseases, in a press release. “The different perspectives brought by those who live these issues every day contributed to making this a clear, coordinated way forward for all stakeholders.” To learn more about the plan go to 

What do Medicare beneficiaries spend for care?

WASHINGTON – More than one-quarter of Medicare beneficiaries, or 15 million people, spend 20% or more of their incomes on premiums plus medical care, according to a new report from the Commonwealth Fund. Overall, beneficiaries spent an average of $3,024 on out-of-pocket costs. Of that, more than one-third was spent on cost-sharing for care, 25% on prescription drugs, and 39% on services not covered by Medicare, including dental and long-term care. The study also found that one-quarter of beneficiaries are underinsured, spending at least 10% of their total annual income on medical care, excluding premiums.

Medicaid Fraud Control Units recover about $36 million from DME in 2016

WASHINGTON – Medicaid Fraud Control Units made 29 criminal convictions and 56 civil settlements and judgments involving DMEPOS providers in fiscal year 2016, according to a report from the Office of Inspector General (OIG) published in May. On the criminal side, the units recovered more than $5 million; on the civil side, they recovered about $31 million. In all, the units reported 1,564 criminal convictions and 998 civil settlements and judgments, representing a total of almost $1.9 billion in recoveries. The OIG found that the units continued a trend of increasing the number of criminal convictions in 2016, and they hit a five-year high for the number of civil settlements and judgments. The OIG’s report was based on an analysis of 2012-2016 statistical data submitted by 50 units.

F&P Healthcare grew homecare revenues by 4% in 2017

AUCKLAND, New Zealand – Fisher & Paykel Healthcare reported net profit after tax of NZ$169.2 million for the fiscal year ended March 31, 2017, an increase of 18% over the previous year. Operating revenue was NZ$894.4 million, a 10% increase over the previous year, or 14% growth in constant currency. F&P says both were records for the company. By segment, the hospital product group grew revenues by 15% to NZ$500.4 million, or 19% growth in constant currency; and the homecare product group grew revenues 4% to NZ$381.5 million, or 8% growth in constant currency. “In the homecare product group, our masks continue to perform well, with 9% revenue growth or 13% in constant currency, compared to the previous year,” said CEO Lewis Gradon. “The new F&P Brevida nasal pillows mask, which was launched in August, is already showing great results in the markets where it is available. Our myAirvo home respiratory system is also growing strongly, building from our market-leading position in hospital humidification.” As part of its earnings, F&P also disclosed litigation-related expenses of $20.7 million in the 2017 fiscal year as part of its patent litigation proceedings* with ResMed. “We recognize that this is a significant cost and did not enter into litigation lightly,” Gradon said. “We have been providing unique solutions for patients for more than 45 years and we take pride in our proprietary technology. We also respect the valid intellectual property rights of others and we are confident in our position.”

Soleo Health helps to ramp up home infusion advocacy

MCKINNEY, Texas – Soleo Health, a national provider of specialty home and alternate-site infusion services, has joined Keep My Infusion Care at Home, an industry backed coalition that advocates for Medicare patients who are losing access to their treatment. Soleo Health has also authored a white paper that provides details on the impact of the 21st Century Cures Act on these patients. A provision in the act modifies the payment structure for certain infusion drugs under the Part B benefit, drastically reducing their reimbursement. The modification, which went into effect Jan. 1, essentially means that payments now cover only drug costs, not clinical services. “Home infusion has become a life-saving, cost-effective solution for more than 10 million Americans today,” said Drew Walk, CEO at Soleo Health. “Keeping care at home has sustained patients’ quality of life and better managed the costs associated with their respective conditions. With the new 21st Century Cures Act, these patients stand to be significantly compromised. Action must be taken immediately to help them remain at home, as this will benefit not only their health and wellbeing but our overall healthcare system, as well.” Another provision in the act provides payments for clinical services, but not until 2021, creating a four-year payment gap.

ResMed studies connect the dots on central sleep apnea

SAN DIEGO – People with treatment-emergent central sleep apnea (CSA) have a significantly greater risk of terminating CPAP therapy, according to a new ResMed-sponsored study presented on May 22 at the 2017 American Thoracic Society International Conference. Researchers found that 3.5% of patients had CSA during the first 90 days of therapy. ResMed says the study highlights the importance of regularly monitoring patients to support adherence to treatment, and diagnosing CSA early to minimize risk of therapy termination. The study builds on another study released earlier this year that showed patients with treatment-emergent CSA who switch treatment from CPAP therapy to adaptive servo-ventilation therapy use their therapy longer and have significantly fewer apneas during sleep. "This study provides the most robust view available on the prevalence of CSA in patients on PAP therapy,” said Dr. Carlos Nunez, ResMed’s chief medical officer. “The findings in this new research, combined with the research presented in April 2017, underscore the importance of keeping patients on therapy through regular monitoring, and rethinking the conventional wisdom on therapeutic options based on each patient's disease severity." Researchers found that patients with any form of CSA during CPAP therapy were at higher risk of terminating therapy in the first 90 days versus those who did not develop CSA, but patients with emergent CSA, whose condition only became apparent during therapy, were 1.7 times more likely to terminate their therapy than those without the condition. The study defined three groups among patients with CSA: emergency, persistent and transient.

Survey: Home oxygen therapy inadequate, say patients

BOSTON – Home oxygen patients say they are unable to access equipment to meet their needs, according to a new survey unveiled at ATS 2017 this week. The ATS Nursing Assembly Working Group surveyed 1,926 people and unearthed equipment issues like heaviness of tanks and portable oxygen concentrators that don’t meet their needs; and access issues like not being able to change suppliers, according to an article in RT Magazine. As a result, patients say they have lower quality of life. “Patients identify that they would benefit from equipment that is portable, lightweight and allows them to maintain activities of daily living,” said Kathleen Lindell, RN and Ph.D, of the University of Pittsburgh and lead study author. “Professional and patient organizations should develop processes to improve equipment supporting mobility and a better quality of life for oxygen dependent patients.” The American Thoracic Society has formed a workgroup to define optimal home oxygen therapy; identify barriers to therapy; and identify gaps and propose areas for future investigation and device development.

Tactile Systems launches system to treat head and neck lymphedema

MINNEAPOLIS – Tactile Systems Technology has launched Flexitouch, a pneumatic compression system to treat head and neck lymphedema at home. In a completed limited market release with more than 80 patients, 88% saw a reduction in head and neck swelling after an initial 32-minute session, according to a press release. “We are thrilled with these positive results demonstrating that the Flexitouch system can help head and neck lymphedema patients effectively reduce lymphedema swelling and improve their quality of life,” said Gerald Mattys, CEO of Tactile Medical.