In brief: Two senators back bid bill, groups seek vent changes

Friday, April 8, 2016

WASHINGTON – HME stakeholders have added two co-sponsors to a bill in the Senate that would delay a second round of Medicare reimbursement cuts slated for July 1.

Sens. Debbie Stabenow, D-Mich., and James Lankford, R-Okla., signed on to S. 2736 on April 6. They join 15 other senators, a mix of Democrats and Republicans.

The bill, introduced by Sens. John Thune, R-S.D., and Heidi Heitkamp, D-N.C., on March 17, would delay the cuts slated for non-competitive bidding areas from July 1, 2016, to Oct. 1, 2017. A first round of cuts went into effect in these areas on Jan. 1.

A companion bill in the House of Representatives is still a work in progress, stakeholders say.

The bill also states: The ceiling for a bid submitted for applicable covered items may not be less than the fee schedule amount that would otherwise be determined for such items on Jan. 2, 2015.”

As a “pay for,” the Senate bill seeks to speed up plans to limit federal Medicaid reimbursement for DME to the Medicare payment rates from Jan. 1, 2019, to Oct. 1, 2018.

Respiratory groups seek changes to ventilator NCD

WASHINGTON – The American Association of Respiratory Care, the American College of Chest Physicians and the National Association for Medical Direction of Respiratory Care have submitted a request for a reconsideration of the current Medicare National Coverage Determination for home ventilators, including bi-level devices. The groups would like Medicare to establish specific definitions for chronic respiratory failure, as well as for mechanical ventilators/ventilation, and to create objective, consistent criteria for providing these products. Their suggested definition of respiratory failure is the inability of the respiratory system to maintain gas exchange within normal limits; oxygenation failure is the inability to maintain PaO2 of 60mmHg or greater on room air; and ventilatory failure is the inability to maintain PaCO2 of 45mmHg or below. Late last year, CMS overhauled the vent product category, reducing the number of codes from five to two, and reducing reimbursement by about 33%.

Program for joint conference announced

ARLINGTON, Va. – RESNA, NCART and NRRTS have announced the program for the first-ever Assistive Technology Collaborative Conference. The event, slated July 12-15 at the Hyatt Regency Crystal City in Arlington, Va., will include interactive exhibits; more than 50 workshops on best practices in assistive technology; research platforms and poster sessions; Capitol Hill visits; pre-conference instructional courses, including RESNA’s Fundamentals in Assistive Technology Course; networking events; and student competitions. For a list of events, sessions and workshops, click here.

Insulin prices increased threefold over 11-year period

YARMOUTH, Maine – The cost of insulin more than tripled—from $231 per year per patient in 2002 to $736 per year per patient in 2013, according to an analysis published in the Journal of the American Medical Association. The price for a milliliter of insulin increased 197%, from $4.34 to $12.92 during the same period. “Insulin is a life-saving medication,” said Dr. William Herman, a coauthor of the analysis and a professor of epidemiology at the University of Michigan School of Public Health. “While there have been incremental benefits in insulin products, prices have been rising.” 

ASP: Budesonide takes a dive

BALTIMORE – Second quarter payments for respiratory drugs are up in most cases, with the exception of Budesonide (J7626), which decreased sharply, down nearly 73 cents per dose. Perforomist (J7606) saw the biggest increase, up 41 cents to $9.82 per dose, according to the latest average sales price (ASP) figures. Brovana (J7605) increased 24 cents to $8.50 per dose. Albuterol (J7613) and ipratropium (J7644) stayed fairly flat, at 12.5 cents per dose and 10.5 cents per dose, respectively.

Feds tweak Medicare Advantage pricing for 2017

WASHINGTON – Payments to insurers that offer Medicare Advantage plans won’t be as high as initially expected. Medicare Advantage payments will increase 0.85%, on average, for 2017, and insurers will likely see overall revenue increases of 3.05%, according to news reports. Earlier this year, CMS had indicated that payments would increase 1.35% and that insurers would see overall revenue increases of 3.55%. As part of a final rule published this week, the Obama administration has also proposed several tweaks to the program, including changing the way the quality of plans is rated if they serve a large population of low income and disabled beneficiaries, and shifting the way plans are reimbursed if they take on sicker-than-expected beneficiaries, according to reports.

ResMed closes deal, promotes Price

SAN DIEGO – ResMed has completed its acquisition of Brightree. The $800 million cash transaction is expected to be immediately accretive to gross margins and non-GAAP diluted earnings per share, the company stated in a press release headlined “It’s a New Day for HME Business Efficiency.” In connection with the acquisition, ResMed has entered into a first amendment to its credit agreement, increasing the size of its senior unsecured revolving credit facility from $700 million to $1 billion, according to Reuters. The amendment includes an uncommitted option to increase its revolving credit facility by an additional $300 million. In other news, ResMed has appointed Andrew Price president of Innovation and Operations. Previously, he was the company’s senior vice president, Global Manufacturing and Logistics. Before that, Price was vice president of marketing for Asia Pacific, and vice president of product development and marketing for the company’s Sleep Disordered Breathing business unit.

Philips takes home awards

MURRYSVILLE, Pa. – Philips has received 37 “Red Dot Awards” for product design, including a “high design” award for its DreamWear CPAP mask. The DreamWear features an under-the-nose cushion and a hollow frame to allow airflow to pass through. The “Red Dot” jury comprises 41 independent designers, design professors and specialized journalists. They evaluate entries based on degree of innovation, functionality, ergonomics, quality, symbolic and emotional content, ecological compatibility and durability. The “Red Dot” award follows an iF Design Award for the DreamWear and a Providers’ Choice Gold Award at Medtrade Spring for the DreamStation CPAP machine. Philips has a team of more than 400 designers in 15 studios around the world, from the Netherlands to Asia.

Texas providers charged with healthcare fraud

MCALLEN, Texas – Federal charges have been filed against two DME owners for allegedly defrauding Texas Medicaid/Medicare through false billings, the Southern District of Texas U.S. Attorney’s Office has announced. Manuel Gomez, owner of two Illusion Medical Equipment locations, and Elva Santos, owner of Hope & Miracle DME, were charged separately in difference cases, but in similar schemes involving incontinence supplies and diabetic supplies. Both allegedly forged the signatures of physicians on the required DME prescription forms.Gomez submitted $2.3 million in claims to Texas Medicaid, while Santos allegedly submitted false and fraudulent claims for approximately $714,000.