In brief: Stakeholders rack up ‘impressive’ list, CMS details healthcare spend by state

Friday, June 16, 2017

WASHINGTON – The HME industry has met its goal of at least 150 co-signers for a letter calling on Health and Human Services Secretary Tom Price to provide relief from Medicare’s competitive bidding program.

Thanks to a few late additions, stakeholders were able to secure 154 co-signers for the letter, spearheaded by Reps. Cathy McMorris Rodgers, R-Wash., Dave Loebsack, D-Iowa, Lee Zeldin, R-N.Y., and Diana DeGette, D-Colo.

“This is an impressive number considering only two weeks were given to gain supporters and much of that time was when Congress was out of session,” VGM stated in a bulletin to members.

AAHomecare President and CEO Tom Ryan had called on stakeholders to secure at least 150 co-signers for the letter at the Washington Legislative Conference on May 24-25. The letter remained open through June 9.

The letter asks Price, along with CMS Administrator Seema Verma, to consider more long-term fixes to the competitive bidding program; to permanently protect accessories for complex wheelchairs from bid-related reimbursement cuts; and to reverse a recent “double dip” cut to oxygen concentrators.

A similar letter spearheaded by the House Small Business Committee and Rep Blaine Luetkemeyer, R-Miss., a committee member, has received support from four other members. That letter was to remain open until last Friday, June 16.

Both letters will be sent to Price and Verma, sending a clear message that they need to make DME policy reform a priority, stakeholders say.

VGM gave a shout-out to stakeholders in Alabama, Iowa, North Dakota, South Dakota, Maine, Vermont, Wyoming and Rhode Island, who were able to get all of their representatives to sign on to the Rodgers letter. Stakeholders in Missouri, Kentucky, Tennessee, Utah, Idaho, Minnesota, Mississippi, New Hampshire, Wisconsin, West Virginia, Colorado, Connecticut and Massachusetts were able to secure all but one or two of their representatives.

CMS details healthcare spending by state

WASHINGTON – While most states experienced faster growth in healthcare spending in 2014 due to Medicaid expansion and Health Insurance Exchange enrollment, per capita spending in Medicaid expansion and non-expansion states grew at similar rates, according to a CMS analysis of data from 1991-2014.

The data also shows that the most recent economic recession, which ended in 2009, and the modest recovery since then has had a sustained impact on healthcare spending and health insurance coverage. Every state experienced slower growth in per capita personal healthcare spending from 2010-13 vs. 2004-09, CMS says.

“Recent economic and health sector factors have had clear impacts by state, both by payer and in the rates of overall per capita personal healthcare expenditure growth; however, during the 2009-14 period, the variation in spending between the lowest and highest states was virtually unchanged,” said David Lassman, the lead author of a report on the data, published in Health Affairs.

Topline findings from the report include:

Considerable regional variation on personal health care spending

·      In 2014, the New England and Mideast regions had the highest levels of total per capita personal health care spending ($10,119 and $9,370, respectively), or 26% and 16% higher than the national average ($8,045).

·      In contrast, the Rocky Mountain and Southwest regions had the lowest levels of total personal health care spending per capita in 2014 ($6,814 and $6,978, respectively) with average spending roughly 15% lower than the national average. 

Similar growth in Medicaid expansion and non-expansion states

·      While most states experienced faster growth in 2014 compared to 2013 due to Medicaid expansion and enrollment in Health Insurance Exchange plans, per capita health spending in Medicaid expansion and non-expansion states grew at similar rates, 4.4% and 4.5% respectively. The similar growth in per capita spending for expansion and non-expansion states was due largely to two effects: Faster growth in the use of healthcare goods and services in expansion states relative to non-expansion states due to a larger increase in the percent of people insured in those states; and faster growth in spending per insured person in non-expansion states relative to expansion states.

Impact of recent economic recession and recovery

·      The most recent economic recession, which ended in 2009, and modest recovery since then, had a sustained impact on health spending and health insurance coverage.

·      For 2010-13, per capita personal health spending grew at a rate of 2.8 % per year on average, substantially slower than during 2004-09, when spending averaged 5.2% growth per year.

·      During 2010-13, every state experienced slower growth in per capita personal health care spending with an average deceleration of just over two percentage points compared to the 2004-09 period. 

Three major payers

·      Medicare: States with above average per enrollee Medicare spending were generally located in the eastern United States while states with the lowest spending were generally in the western United States. The state with the highest per enrollee Medicare spending in 2014 was New Jersey ($12,614) with spending levels roughly 15% above the national average ($10,986). In 2014, Montana was the state with the lowest per enrollee Medicare spending, at $8,238 per enrollee (25% below the national average per enrollee).

·      Medicaid: The recent trends in per enrollee spending were driven by the Medicaid coverage expansion, which increased the share of relatively less expensive enrollees relative to the previous Medicaid beneficiary population mix in expansion states. Total Medicaid spending increased 12.3% from 2013 to 2014 for states that expanded Medicaid, compared with 6.2% for states that did not expand Medicaid. However, on a per enrollee basis Medicaid spending declined considerably for the expansion states (-5.1%) in 2014, because of the enrollment of relatively less expensive enrollees, whereas per enrollee Medicaid spending in the non-expansion states increased 5.1%. 

·      Private Health Insurance: Per enrollee private health insurance spending was $4,551 in 2014, an average annual increase of 3.3% since 2009 ($3,872). Total private health insurance spending grew more rapidly in states that did not expand Medicaid eligibility by 2014 than in states that did expand eligibility, at rates of 6.8% and 4.6%, respectively.

CPAP withdrawal: It may foster diabetes, heart disease, study says

YARMOUTH, Maine – Not using CPAP therapy could have grave repercussions for patients with sleep apnea, according to a study published this month in the Journal of Clinical Endocrinology & Metabolism.

“OSA recurrence during CPAP withdrawal increases plasma free fatty acids (FFA) and glucose during sleep, associated with sympathetic and adrenocortical activation,” researchers concluded. “Recurring exposure to these metabolic changes may foster diabetes and cardiovascular disease.”

Researchers based their findings on a randomized crossover trail of CPAP vs. CPAP withdrawal. They used 31 patients with moderate to severe OSA acclimated to CPAP.

To conduct the study, patients underwent polysomnography while sleeping with CPAP or after CPAP withdrawal, in random order. Venous blood was sampled at about 20 minute intervals on both nights. In 11 patients, researchers assessed glucose kinetics with an infusion of 6,6-[2H2]glucose.

Researchers found CPAP withdrawal caused recurrence of OSA associated with hypoxemia, sleep disruption, and heart rate elevation. CPAP withdrawal dynamically increased nocturnal FFA (p = 0.007), glucose (p = 0.028), and cortisol (p = 0.037), in proportion to respiratory event frequency, heart rate elevation, or sleep fragmentation.

CPAP withdrawal also increased systolic blood pressure (p = 0.017) and augmentation index (p = 0.008), but did not affect insulin, triglycerides, glucose production, oral glucose tolerance, cholesterol, or hsCRP.

OIG finds savings increase from Senior Medicare Patrols

WASHINGTON – Senior Medicare Patrol projects achieved $163,904 in cost avoidance on behalf of Medicare and Medicaid in 2016, up from $21,533 in 2015, according to a study from the Office of Inspector General.

Savings to beneficiaries and others totaled $53,559, up from $35,059, the OIG says.

In 2016, 53 projects had a total of 6,126 active team members who conducted a total of 26,220 group outreach and education events, reaching an estimated 1.5 million people. The projects also had 195,386 individual interactions with, or on behalf of, a beneficiary, according to the OIG.

“We note that the projects may not be receiving full credit for recoveries, savings, and cost avoidance attributable to their work,” the report states. “It is not always possible to track referrals to Medicare contractors or law enforcement from beneficiaries who have learned to detect fraud, waste, and abuse from the projects. In addition, the projects are unable to track the potentially substantial savings derived from a sentinel effect, whereby Medicare beneficiaries' scrutiny of their bills reduces fraud and errors.”

Senior Medicare Patrol projects receive grants from the Administration for Community Living to recruit and train retired professionals and other senior citizens to recognize and report instances or patterns of healthcare fraud. The OIG has collected performance data on the projects since 1997.

OIG releases final report on test strip market share

WASHINGTON – Suppliers in Medicare’s national mail-order program provided 19 types of diabetes test strips to beneficiaries from October through December 2016, according to a new study from the Office of Inspector General. The top two strip types accounted for 53% of the Medicare mail-order market, and the top 10 strip types accounted for 97.5% of the market, the study says. To conduct the study, the OIG sampled 1,210 claims from a total population of 438,872 claims for diabetes test strips. The Medicare Improvements for Patients and Providers Act (MIPPA) requires the OIG to determine the market shares of the types of diabetes test strips before each round of competitive bidding. MIPPA prohibits CMS from awarding a contract to a supplier of diabetes test strips if the supplier’s bid does not cover at least 50%, by volume, of all types of diabetes test strips on the market, known as the “MIPPA 50 percent rule.” This is the third of three reports by the OIG. The agency released the results of a second study in February, and a first study in December.

MSD buys Attentus Medical

STOUGHTON, Mass. – MSD, a provider of products, distribution and biomedical services and technology solutions to the home infusion, HME and oncology markets, has completed its acquisition of Attentus Medical Sales, a distributor of medical, packaging and compliance products for the home infusion and specialty pharmacy markets. The acquisition allows the two companies to align complementary products and technologies to address the expanding needs of the post-acute care market, and leverage MSD’s nationwide infrastructure, according to a press release. “The combination will create a highly differentiated distribution, medical device and technology solutions company uniquely positioned to improve both the delivery and efficiency of care for healthcare providers and patients,” the release states.

Nunn’s HME boosts coverage in Syracuse

ROME, N.Y. – Nunn’s Home Medical Equipment has acquired Tri-County Home Care’s assets, excluding its Veterans Affairs customers, the company announced June 1. With a location in Syracuse, N.Y., the acquisition of Tri-County Home Care expands Nunn’s presence in the central New York region. “Acquiring Tri-County Home Care’s assets is another step forward for Nunn’s, as we expand and grow in the central New York region,” said Shawn Weiman, vice president. “Our geographic region now covers 22 counties.” Nunn’s will service Tri-County Home Care customers out of either its Rome or Syracuse location, depending on their home zip codes. The acquisition will also allow Nunn’s to expand its core business of respiratory products and services, including home oxygen and sleep therapy, into the Syracuse area and beyond, the company says. Nunn’s, which has been in business since 1942, celebrates its 75th anniversary this year. It is currently owned and operated by its original founder’s daughter and granddaughter, Sheila Nunn Murphy and Erin Weiman, as well as son-in-law Weiman.

Drive DeVilbiss steps up support for AAH

WASHINGTON – Drive DeVilbiss Healthcare has become a platinum level partner of AAHomecare, the highest corporate category. “Providing AAHomecare with additional resources is an investment that I am confident will pay significant dividends for our company, as well as the suppliers we serve,” said Harvey Diamond, CEO of Drive DeVilbiss. While AAHomecare’s budget is largely derived from membership dues, additional financial commitments from corporate sponsors allow the association to increase its work in areas like payer relations, value-based reimbursement models, and legislative and regulatory affairs. Drive DeVilbiss joins Medtrade at the platinum level. Other companies in leading corporate categories include Apria Healthcare, Brightree, Inogen, Lincare, Pride Mobility Products, ResMed and The VGM Group at the gold level; and Byram Healthcare, Philips Home Healthcare Solutions and Sunovion Pharmaceuticals at the silver level.

Tonka Medical Supplies chases federal contracts

MINNEAPOLIS – Tonka Medical Supplies, an HME and supplies provider, plans to expand sales by applying for a GSA Schedule and actively pursuing federal contracts, it announced June 12. “The opportunity to service government accounts, specifically Veterans Affairs, opens up significantly more markets throughout the region as our goal continues to be expanded sales of our home care medical supplies,” stated Barbara Platten, general manager. “Getting our company on a GSA schedule will expand our reach not only to the federal level, but also to numerous state and county agencies throughout the region as they will be able to take advantage of our home care products at a set government pricing.” Tonka Medical Supplies, founded in 1995, carries a full line of DME and supplies. It also specializes in herbs, natural remedies, dietary supplements and natural cosmetics.

Bill seeks to clarify compounding provisions

ALEXANDRIA, Va. – Reps. Morgan Griffith, R-Va., and Henry Cuellar, D-Texas, have introduced a bill in the House of Representatives that would clarify congressional intent on several compounding provisions included in the Drug Quality and Security Act of 2013. Since the passage of DQSA, there has been a lack of understanding as to where federal regulatory oversight of traditional compounding pharmacies begins and ends, according to the National Home Infusion Association. Specifically, there are questions regarding the dispensing of compounded products across state lines, inspection standards, and several other DQSA provisions, the association says. In explaining the need for the bill, the NHIA stated in a press release: “It is important for home and specialty infusion providers to have clarification on application of a provision in the DQSA that calls for a Memorandum of Understanding (MOU) between the U.S. Food and Drug Administration (FDA) and states, specifically regarding the distribution of compounded products across state lines. NHIA has long maintained that dispensing a compounded product to an individual patient pursuant to a prescription is not commonly considered distribution of the product under state or federal law. The FDA, in its draft MOU released in 2015, included dispensing as an act of distribution and imposed strict limits that could negatively affect access to medications for a patient whose provider is based in another state. This would have serious implications, since the common business practice of dispensing medications for administration in a patient’s home can occur across a state line from the physical site where the drug is compounded.”

United Spinal logs 200 congressional visits with ROCH

WASHINGTON – United Spinal Association and more than 150 wheelchair users, clinicians, partners and disability advocates from 35 states gathered in Washington, D.C., June 11-14 for the 6th annual Roll on Capitol Hill to discuss improving disability policies with key congressional leaders. During the event, attendees took part in more than 200 congressional office visits, meeting face to face with their representatives and other key contacts to discuss their unique challenges living with a disability and to advocate for a number of issues, including improved access to the complex rehab technology that wheelchair users rely on to live active and healthy lifestyles. Among the speakers at the event was Don Clayback, executive director of NCART, who, along with Jose Hernandez, a program specialist with the association, and Rick Hayden, president of the association’s California chapter, provided an update on legislation to create a separate benefit for complex rehab technology.

VGM kicks off nominations for HME Woman of the Year

WATERLOO, Iowa – VGM is now accepting nominations for the 2017 HME Woman of the Year Award. The announcement was made during the “Women and Wine” event at VGM’s Heartland Conference last week. The event included a session on how to apply Sheryl Sandberg’s “Lean In” concepts and a moderated discussion on work-life balance. Also at the event, a video was shown promoting the award. Last year’s winner was Dr. Kirsten Davin, who has used the award as a platform to network with other women in the industry and share successes and obstacles that impact their businesses. Davin and the other finalists for last year’s award are not eligible for this year’s award, but they encourage their peers to nominate a deserving woman who has impacted the industry. Women are also encouraged to nominate themselves. “I would encourage everyone to take a minute to really think about what they do, what they’ve done, and who they’ve touched,” Davin said. “By really sitting down and reviewing your career, we often find out that we have a greater impact than we think we do.” Nominations are due Aug. 14.

NCD Homecare beefs up exec team in wake of acquisition

NASHVILLE – NDC Homecare, a division of NDC, has added Eugene Keane as director of category management. In this new role, Keane will work closely with NDC’s homecare distributor and manufacturer partners to build success in the homecare space. “I am looking forward to having Eugene join our homecare team,” said Doug Harper, president of NDC Homecare. “His experience and knowledge will be pivotal to analyzing competitive products and market profitability for homecare distribution and assisting us in becoming the partner of choice for the homecare provider.” Keane has more than 25 years of experience in home health care, including director of a regional independent pharmacy chain in New England, and territory manager for Sunrise Medical. NDC announced in May that it had acquired Dedicated Distribution. NDC stated at that time that it plans to use Dedicated Distribution, a wholesale supplier of HME and supplies, as a platform for its Home Care Division.

Software vendors in the news: Brightree, QS/1, Mediware, Encore Healthcare

Brightreehas released its new Patient Financial Services solution, providing HME providers with enhanced live-call resources to streamline their patient payment process, including payment plan options, progress reporting and enrollment opportunities. The solution allows providers to, among other things, remind patients of balances owed and use live-call agents to procure one-time or incremental payments, and enroll patients in Brightree Patient Collections automated payment services, eliminating manual processes and delays…QS/1 has added another certification through Elavon to process transactions for Europay, MasterCard and Visa compliant cars. “Being certified by Elavon allows QS/1 to process EMV payments through its system,” said Sonny Anderson, vice president of systems and technology…Mediware has added FreshAire CPAP & Supplies to its roster of HME providers using CareTend software to manage operations, improving their productivity and compliance…Encore Healthcare has released a new respiratory patient management software for non-invasive ventilation and oxygen patients. Nexus Home Silver is an application that fuses a software-based ventilation and oxygen therapy equipment setup/maintenance protocol with its clinical risk assessments and plan of care protocols. The web-based application can be used on a smartphone, tablet or PC, guiding respiratory therapists through a comprehensive ventilation and/or oxygen therapy protocol and enabling them to document initial setup, home safety and vent check visits.

People in the news: Sarah Hanna, Greg Boucher, Lena Jouran, Dr. Jose Llana

Sarah Hanna, CEO of ECS North, has been nominated by an employee for a Patriot Award. To make a nomination, an employee must serve in the National Guard or Reserve, or have a spouse who is a guard or reserve member. The award reflects the efforts made to support members through a wide-range of measures, including flexible schedules, time off prior to and after deployment, caring for families and granting leaves of absence if needed. Award winners receive a certificate and accompanying lapel pin…The Braff Group has announced that Greg Boucher has joined the firm as managing director of health care information technology in its Washington, D.C., office. Boucher has extensive experience working with middle-market businesses in M&A advisory, strategic planning, and business development. Prior to joining The Braff Group, he was a managing director at Bengur Bryan and The McLean Group, two highly regarded mid-Atlantic investment banks…Smith Drug Company has named Lena Jouran divisional vice president, finance. She will support both Smith Drug Company and Burlington Drug Company in her new role. Jouran replaces Kyle Waltz, who has accepted the position of vice president corporate controller at J M Smith. Jouran comes to Smith Drug Company from Walgreens, where she was finance director of pharmacy procurement, supply chain and Rx insights…3B Medical has named Dr. Jose Llana national director of sales. Previously, he was a territory manager for Philips Healthcare, where he regularly received “Territory Manager of the Year.” Dr. Llana left private practice to enter the medical device and pharmaceutical industry.

Short takes: ROVI, Convaid | R82

Carson, Calif.-based ROVI Mobility Products has named Jacob Titus, a junior at Burlington County Institute of Technology in Medford and Westampton, N.J., as the recipient of its 2017 Design Innovation Award Scholarship. Titus won the award based on his concept for an elevator built into an existing staircase. He will receive $1,500 to put toward continuing his education. ROVI’s connection to BCIT goes back to 2015, when students at the school helped the manufacturer create a test track for a launch party for its ROVI X3 power mobility system…Convaid | R82 will return to the Cure SMA National Conference as a platinum exhibitor. Charles Larose, western region sales manager, and Steve Ricker, eastern region sales manager, will join Matt Abrahams, business development representative, to attend the event, June 29-July 2 at Disneyworld in Orlando, Fla. They will highlight the Convaid Carrot car seat, Convaid Trekker, the R82 Flamingo High-Low and the R82 Stingray. Last year, Convaid | R82 expanded its program of planned giving to Cure SMA by donating Convaid Trekkers to the organization’s Chicago-based loaner pool. The companies have also participated in Cure Walk-n-Rolls throughout the United States.