In brief: Supplier numbers decline, Kansas Medicaid proposes rate cut

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Friday, January 11, 2019

WASHINGTON – The number of DMEPOS suppliers furnishing rate-adjusted items in non-bid areas decreased 11% in 2017, according to a new study from the Government Accountability Office.

That decrease follows an 8% decrease in 2016—the first year rates were adjusted—compared to 2015 and continued a trend of annual decreases in non-bid areas that averaged 8% each year going back to at least 2011, according to the report, “Medicare Fee-For-Service: Information on the Second Year of Nationwide Reduced Payment Rates for Durable Medical Equipment,” released Dec. 21.

The number of beneficiaries receiving at least one rate-adjusted item in non-bid areas in 2017 decreased 2 percent compared to 2016. This followed a decrease of less than half of 1 percent between 2015 and 2016.

Since 2010, the number of suppliers furnishing rate-adjusted items has decreased by almost 45% and suppliers furnishing non-adjusted items decreased by almost 25%. 

The GAO’s findings are in line with AAHomecare’s supplier analysis, which shows an estimated decrease of 35% in suppliers between 2010 and 2018.

Survey: Information on cost of sleep therapy needed

DARIEN, Ill. – Patients need better access to affordable sleep care, according to a new study from the American Alliance for Healthy Sleep.

Seventy eight percent of respondents reported that cost affects their decision to seek medical care; and 54% reported they were unaware of whether their insurance covered sleep services.

At the same time, 48% percent of respondents reported that their primary care physician never asked them about sleep.

“Millions of people in the U.S. have a sleep disorder that impairs their health, well-being, safety and performance,” said AAHS Chair Patti Van Landingham. “It is critical for people who have a sleep disorder to receive accurate health information, and they need convenient access to affordable, patient-centered medical care from knowledgeable health care professionals who understand the importance of healthy sleep.”

The survey included responses from 289 participants. Sixty-six percent were female; 43% indicated they have a diagnosed sleep disorder; and 17% of those with a sleep disorder reported being unable to afford medication or therapy.

Other findings from the survey: 75% of respondents said they have actively searched for sleep health information, but 59% reported that additional resources are needed, including more educational resources on sleep and improved education for medical professionals.

AAHS conducted the survey as part of its “Access to Information…Access to Care” awareness campaign, which seeks to establish how the organization can improve access to care.

An executive summary of the survey findings is available at www.sleepallies.org

Kansas proposes Medicaid rate cut

TOPEKA, Kan. – The Kansas Department of Health and Environment said in December it planned to submit an amendment to set the Medicaid fee schedule for DMEPOS items at 65% of the non-rural Medicare rates, effective Jan. 1. MAMES is working to set up a meeting with CMS to discuss the proposal, according to a bulletin. MAMES says that a legislative and regulatory approach may be needed to stop the cut from being implemented. Comments on the proposal are due Jan. 22.

CMS clarifies guidance on dual-eligibles

WASHINGTON – CMS has released updated guidance for state Medicaid programs on Medicare coverage for dual-eligible beneficiaries, clarifying that states do not need to require a Medicare denial for DMEPOS like incontinence supplies that the program routinely denies as non-covered, AAHomecare reports. The guidance also suggests that states consider creating a list of DMEPOS that are not covered by Medicare to expedite Medicaid coverage and payment for dual-eligibles. By doing so, states can avoid requiring providers to obtain a Medicare denial while still fulfilling their statutory requirement remaining the “payer of last resort.” Additionally, CMS suggests that states that develop such a list should also encourage their Medicaid managed care organizations to adopt the same list. “AAHomecare has been regularly engaging CMS over the last 18 months to help streamline the process for determining coverage for this patient population,” the association stated in a bulletin. “The new guidance has the potential to make it easier for suppliers to have claims processed for these services.”

ResMed’s Mobi now on the market

SAN DIEGO – ResMed’s Mobi portable oxygen concentrator is now widely available in the United States. The company says its POC offers an optimal balance of oxygen delivery, weight and battery life. “Simply put, Mobi keeps you mobile, which research shows is so important in terms of helping people with COPD lower their risk of hospitalization and early death,” said Richie McHale, president of ResMed Respiratory Care. “Mobi’s ideal balance of weight, battery life and oxygen output empowers people to stay active, and live their lives to the fullest.” ResMed is positioning its POC as one of a variety of solutions to help people manage their COPD at most stages: Mobi for people requiring oxygen therapy; and Astral and AirCurve 10 ST-A devices for cloud connected, in-home ventilation for people with severe COPD. The company plans to make Mobi available in other countries later this year, pending regulatory approval. ResMed first made a play to enter the oxygen therapy market in 2016, when it bought Austin, Texas-based Inova Labs. It introduced the Mobi in January of 2018, but the product has been under a controlled launch until now.

Ascensia partners with CGM maker

BASEL, Switzerland – Ascensia Diabetes Care is partnering with Zhejiang POCTech, Co., a manufacturer of continuous glucose monitoring systems, to serve as its exclusive distributor in 13 markets. As part of the agreement, Ascensia will commercialize a version of POCTech’s current CGM in these areas and will begin distributing product in the second half of 2019, according to a press release. The two companies have also entered into a development agreement to co-develop next generation products that build on POCTech’s existing technology. “This partnership will enable us to bring an approved CGM product to selected markets in 2019 and at the same time create novel CGM systems that build on POCTech’s existing technology to address some of the unmet needs of people with diabetes,” said Michael Kloss, CEO, Ascensia Diabetes Care.

Ritzman Pharmacies sells to CVS

MEDINA, Ohio – Ritzman Pharmacies will sell its 20 retail pharmacies serving primarily northeast Ohio to CVS Pharmacy, The Associated Press reports. CVS Pharmacy plans to operate in the same locations with the same staff in Ritzman’s Akron and Berlin stores, and close the remaining stores and transfer all files to nearby CVS Pharmacy stores, according to the AP. Ritzman will continue to manage Summa’s Home Infusion through a managing company called VAR. Eric Graf, president and CEO of Ritzman, told the AP that the company held out as long as it could. “This has been a lengthy process for Ritzman Pharmacy, including engaging the investment community, local and national chains, as well as private equity,” he said. “We have worked hard to sustain the independently operated community pharmacy model and are disappointed to bring it to a close, but it is time to pass our retail business to a company with more resources. While change is always difficult, especially after almost 70 years in business, customers and patients will benefit from having a wide range of products and services available and continued pharmacy care.” The deal is expected to be complete by the end of February.

Homecare nursing shortage leads to discharge delays

ST. PAUL, Minn. – A homecare nursing shortage is the primary cause of delayed hospital discharges for children being discharged to home care for the first time, according to a new study from Pediatric Home Service. Delayed discharge occurred in 68.5% of patients new to homecare with 46.3% due to not having available homecare nursing. The nursing shortage accounted for an average length of stay increase of more than 53 days for new patients. The study also shows that medical setbacks, not failed home care, account for 97% of 90-day readmissions. “Our findings clearly demonstrate the negative impact the shortage of home care nurses has on this population. Waiting for home care nurses to be hired prolongs hospitalization of technology dependent children,” said Dr. Roy Maynard, PHS medical director. “More must be done to attract caregivers to this profession, so these children have the opportunity to thrive at home with their family.”

NSM gets reaccredited

NASHVILLE, Tenn. – National Seating & Mobility has again earned The Joint Commission Gold Seal of Approval for Home Care Accreditation by demonstrating continuous compliance with performance standards. The Gold Seal of Approval is a symbol of quality that reflects an organization’s commitment to providing safe and effective care. NSM has been accredited by The Joint Commission since 2006, the only national complex rehab provider accredited by the organization. The company went through a month-long survey process at 20 locations across the country before receiving the reaccreditation. During the survey, its compliance with homecare standards reflecting key organization areas was evaluated, including the provision of care, treatment and services, emergency management, human resources, individual rights and responsibilities, and leadership.