In brief: Virginia budget, vaccine priorities, ALJ backlog

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Friday, November 20, 2020

RICHMOND, Va. – Virginia Gov. Ralph Northam has signed into law a state budget that includes an amendment requiring Medicaid managed care organizations to reimburse at no less than 90% of the state Medicaid fee schedule for DME.  

The Atlantic Coast Medical Equipment Services Assocation, VGM and AAHomecare worked on the effort for more than year. “Virginia providers stepped up to the plate when called upon to get the job done which is an illustration of the power of a state association at work,” said Beth Bowen, ACMESA executive director. “What a great win for Virginia’s DME community and the patients they serve.”  

It’s the latest win for providers across the country working to stabilize Medicaid rates, says David Chandler, director of payer relations for AAHomecare. 

"This win for DME in Virginia is another great example of what we can achieve when we develop a game plan and work together,” he said. 

LUCI named ‘Best Invention’ 

NASHVILLE – LUCI, a mobility technology platform, has been named to Time Magazine’s annual list of the 100 Best Inventions. “This is an incredible honor, and one we would have never considered when my brother Jered and I started tinkering with my daughter’s wheelchair in the kitchen three years ago,” said Barry Dean, CEO of LUCI. “The most exciting part of being included in this list is having the opportunity to bring more attention and, hopefully, more innovation to the world of power wheelchair users.” For 2020’s list, Time solicited nominations from its editors and correspondents around the world, and through an online application process. It then evaluated them on factors including originality, effectiveness, ambition and impact. LUCI’s hardware mounts onto a power wheelchair between the power base and the seat, and helps users avoid collisions and dangerous drop-offs while maintaining personalized driving control. The patented sensor-fusion system combines data from cameras, ultrasonic sensors and radar into a single, 360-degree view of the world, giving riders independence and safety. 

Study: Power mobility devices empower kids 

LEBANON, Tenn. – Power mobility devices can help young children with mobility impairments develop cognitive, reasoning and spatial skills, according to a new study published in “Physical & Occupational Therapy in Pediatrics.” The study, which was funded by Permobil, looked at 33 children aged between 6 months to 36 months who experience mobility limitations. It found that young children demonstrated self-initiated mobility through the use of a powered mobility device, in this case, the Explorer Mini from, Permobil, and that the device was instrumental in promoting exploratory behaviors. “The pediatric chair helps young children develop a sense ofs independence and the desire to explore, learn, and challenge their existing skill set,” said Dr. Teresa Plummer, lead author of the study.  “Once they discover that the world exists beyond their outstretched arm, they are set on a trajectory of rapid advancement of spatial skills, learning depth perception, directionality and laterality. These are all essential skills for visual development, reading and understanding how they fit into the world around them.” The Explorer Mini received 510k clearance from the U.S. Food and Drug Administration in February 2020.   

Dentists, sleep docs differ on HST 

YARMOUTH, Maine ­– The American Academy of Dental Sleep Medicine has issued a position statement that says dentists should be allowed to order or administer home sleep tests, something the American Academy of Sleep Medicine disagrees with, according to an article published in the Sleep Review. The AADSM states: “It is within the scope of practice for a qualified dentist, defined by the American Dental Association (ADA) as a dentist treating sleep-related breathing disorders who continually updates his or her knowledge and training of dental sleep medicine with related continuing education, to order or administer home sleep apnea tests (HSATs).” The AASM, for its part, states that a home sleep apnea test is used as a medical assessment and its use must be preceded by a comprehensive sleep evaluation by a medical provider. This medical evaluation should include an assessment for chronic diseases and conditions that are associated with increased risk for obstructive sleep apnea, including hypertension, stroke, and congestive heart failure. 

AAHomecare asks feds to prioritize DMEPOS suppliers 

WASHINGTON – AAHomecare is asking government officials to include DMEPOS suppliers in the first group of health care professionals to get vaccinated for COVID-19.        

In letters to officials at the Department of Health and Human Services and leadership at Operation Warp Speed, AAHomecare stressed the close contact that suppliers have with patients in home-based settings and highlighted the important role the industry plays in meeting the challenges posed by the pandemic.  

“DMEPOS suppliers are in patients’ homes every day and play a central role in helping individuals infected with COVID-19 manage their health care needs at home so that hospitals and acute care facilities have the capacity to handle those requiring more intensive care,” the letter states. “In addition to directly interfacing with infected individuals, many of the products and services provided by DMEPOS suppliers require their staff to enter homes with other caregivers or family present to set up the equipment for use.” 

AAHomecare pushes sequestration, budget neutrality 

WASHINGTON ­– AAHomecare is asking members to use its Action Center to register support for extending a moratorium on Medicare sequestration cuts, which is set to expire Dec. 31. AAHomecare is also urging them to register support for H.R. 8158, a bill introduced by Reps. Cathy McMorris Rodgers, R-Wash., and Dave Loebsack, D-Iowa that would remove the budget neutrality requirement for oxygen in rural areas. In September, the House Energy & Commerce Committee approved H.R. 8158. The association would like to see both measures advance before Congress adjourns in December. 

OMHA reduces ALJ backlog 

WASHINGTON – The Office of Medicare Hearings and Appeals is back to operating at full capacity and is making its way through a backlog of appeals at the Administrative Law Judge level, AAHomecare reports. As of Oct. 31, 2020, there are about 85,000 DMEPOS appeals pending at the ALJ, a decrease of 51% compared to nearly 173,000 in 2019. OMHA also reported that the average wait time for an ALJ hearing is still four years, but it believes that should decrease as judges work their way through the backlog. OMHA is required to eliminate the backlog by 2020. 

Quality Biomedical launches supply chain program 

BOULDER, Colo. – Quality Biomedical has developed an integrated supply chain management program for respiratory equipment across its eight warehouse facilities. Critical services available include pick-up and delivery, preventative and corrective maintenance, storage, cleaning, and same-day deployment using its web-based portal, Q-Connect. “Although this program has broad industry appeal in general, the benefits of maintaining and deploying patient-ready equipment via a national network of distributed service centers and warehouses has been highlighted due to COVID,” said Jim Worrell, chief commercial officer. “COVID underscored the need for rapid deployment of critical respiratory equipment getting to hot spots or other areas where demand for equipment is spiking.” 

What’s your financial score? 

WASHINGTON – HME providers that submitted bids for Round 2021 of competitive bidding now have the ability to view their financial score in Connexion. As part of the bid process, the competitive bidding implementation contractor evaluated a bidder’s financial health by reviewing financial documents and calculating a financial score. The financial score is available to all bidders, even those that bid on the 13 product categories that were recently removed from the bid program. AAHomecare encourages providers to review their financial score to see how they performed during the bid process. “The financial score will also be helpful for bidders in submitting bids in future rounds,” the association wrote in a recent bulletin. 

ATS makes recommendations on home oxygen therapy for COPD 

NEW YORK – The American Thoracic Society has posted online its latest clinical practice guideline on home oxygen therapy, addressing long-term and ambulatory therapy for adults with COPD. 

The guideline makes the following recommendations: 

  • In adults with COPD who have severe chronic resting room air hypoxemia, we recommend prescribing long-term oxygen therapy at least 15 hours per day. 

  • In adults with COPD who have moderate chronic resting room air hypoxemia, we suggest not prescribing LTOT. 

  • In adults with COPD who have severe exertional room air hypoxemia we suggest prescribing ambulatory oxygen. 

“Oxygen is a common, yet burdensome, equipment-laden therapy, so if we are going to prescribe it, there should be enough evidence that we can tell our patients what they should expect in terms of improving their symptoms, and the quality and quantity of their lives,” said Susan Jacobs, MS, RN, co-chair of the guideline committee and a research nurse manager in pulmonary, allergy and critical care medicine at Stanford University. 

The guideline, also published in the Nov. 15 issue of the American Journal of Respiratory and Critical Care Medicine, was borne out of an ATS workshop in 2017 on Optimizing Home Oxygen Therapy data, which “identified the lack of evidence-based clinical practice guidelines for appropriate use of home oxygen as a critical gap,” wrote the committee. 

The guideline also includes recommendations for liquid oxygen. In patients with chronic lung disease who are mobile outside of the home and require continuous oxygen flow rates of less than 3L/minute during exertion, the ATS suggests prescribing portable liquid oxygen. 

Additionally, the guideline makes recommendations for adults with interstitial lung disease. 

Gov’t takes down scheme involving kickbacks, straw companies 

NEWARK, N.J. – The ownhttps://oig.hhs.gov/oei/reports/OEI-03-21-00050.asper of a group of DME companies has admitted his role in a conspiracy to pay kickbacks in exchange for DME, the U.S. Attorney’s Office for the District of New Jersey has announced. Albert Davydov, 28, of Rego Park, N.Y., has pled guilty by videoconference before a U.S. district judge to an indictment charging him with conspiring to violate the Anti-Kickback statute. Davydov, the owner of nine DME companies, participated in a scheme to pay kickbacks in exchange for orders from doctors for medical unnecessary orthotic braces. Once Davydov and his conspirators received the completed orders, they billed Medicare and other federal and private health care benefit programs for the braces. Davydov concealed his ownership of the DME companies by falsely reporting to Medicare that various straw owners owned the companies. As part of his plea agreement, Davydov has agreed to pay back more than $16 million. 

OIG provides latest pricing update on Part B drugs 

WASHINGTON – Seven codes for Medicare Part B drugs met CMS’s price substitution criteria by exceeding the 5% threshold for two consecutive quarters or three of the previous four quarters, according to a new report from the Office of Inspector General. The OIG is providing the seven codes to CMS for its review. It says CMS should review this information to determine whether or not to pursue price substitutions that would limit excessive payments for Part B drugs. The OIG conducted its study by obtaining second quarter ASP and AMP data for Part B drugs, and calculating the volume-weighted AMP for each drug, consistent with CMS’s methodology for calculating volume-weighted ASPs. It then compared the volume-weighted ASPs and AMPs, and identified all drugs with complete data for which the ASPs exceeded the AMPs by at least 5%. The OIG also identified drugs that met CMS’s duration criteria for price substitution, meaning they exceeded the threshold in the two previous quarters or three of the previous four quarters. 

CMS touts decreased improper payment rate 

WASHINGTON – CMS says its aggressive corrective actions have led to an estimated $15 billion reduction in Medicare fee-for-service improper payments since 2016. 

The Medicare fee-for-service estimated improper rate decreased to 6.27% in fiscal year 2020, compared to 7.25% in FY 2019, the fourth consecutive year the rate has been below the 10% threshold for compliance established in the Payment Integrity Information Act of 2019. 

“We must ensure that fraud and abuse doesn’t rob the program of precious resources,” said CMS Administrator Seem Verma. “From the beginning, this administration has doubled down on our commitment to protect taxpayer dollars and this year’s continued reduction in Medicare improper payments is a direct result of those actions.” 

CMS says the reduction is the result of efforts to identify root causes of improper payments, implement action plans to reduce and prevent improper payments, and extend the agency’s capacity to address emerging areas of risk through work groups and interagency collaborations. 

One example of activities that have helped to reduce the improper payment rate: home health improvements, including clarifying documentation requirements and educating providers through the Targeted Probe and Educate program, which resulted in a $5.9 billion decrease in estimated improper payments from FY 2016 to FY 2020. 

CMS has developed a five-pillar program integrity strategy to modernize its approach to reducing improper payments, it says: 

  • Stop bad actors: CMS works with law enforcement agencies to crack down on “bad actors” who have defrauded federal health programs. 

  • Prevent fraud: Rather than the expensive and inefficient “pay and chase” model, CMS prevents and eliminates fraud, waste and abuse on the front end by proactively strengthening vulnerabilities before they are a problem. 

  • Mitigate emerging programming risks: CMS is exploring ways to identify and reduce program integrity risks related to value-based payment programs by looking to experts in the health care community for lessons learned and best practices. 

  • Reduce provider burden: To assist rather than punish providers who make good faith claim errors, CMS is reducing the burden on providers by making coverage and payment rules more easily accessible to them, educating them on CMS programs and reducing documentation requirements that are duplicative or unnecessary. 

  • Leverage new technology: CMS is working to modernize its program integrity efforts by exploring innovative technologies like artificial intelligence and machine learning, which could allow the Medicare program to review compliance on more claims with less burden on providers and less cost to taxpayers. 

Great Elm shows improvement 

WALTHAM, Mass. – Great Elm Capital Group has reported first quarter revenue for DME grew 10.4% year over year and 5% sequentially, results that show the company’s ability to grow despite the negative impact of the COVID-19 pandemic, officials say. Great Elm reported a net loss for DME of $500,000 vs. $800,000 year over year, and an adjusted EBITDA of $2.8 million vs. $3 million year over year. “We made significant progress toward achievement of our strategic goals for both our DME and Investment Management businesses during the quarter,” said Peter Reed, CEO. “DME added key management talent, continued to improve operationally and is actively pursuing attractive add-on acquisition opportunities.” During the first quarter, Great Elm’s PAP supply rates remained strong, while rental revenues continued to be negatively impacted by suppressed referral pipelines for new equipment setups during the pandemic. Looking forward, company officials remain focused on exploring ways to lower the cost of capital and obtaining additional funds for potential future acquisitions. 

Philips survey shows respiratory health is more of a priority 

AMSTERDAM, the Netherlands – The COVID-19 pandemic has created unique challenges for the COPD community, but it has also increased awareness of the condition and pushed patients to pursue alternative care options, according to the first ever World COPD Day survey by Royal Philips. “Despite impacting millions of people around the world, COPD isn’t talked about as often as other chronic conditions like heart disease,” said Huiling Zhang, head of medical office for connected care at Philips. “We conducted this survey to shed light on the unique burdens and stresses that COPD patients face every day, intensified during this time. The survey results show that more than ever, respiratory health – and taking action to improve it – is a priority, but that the impacts of the pandemic have been especially felt by the COPD community, whom we work so hard to support with our respiratory solutions.” Philips surveyed more than 4,000 adults in China, India, Russia and the U.S. Fifty six percent of COPD patients report COVID-19 has made it difficult for them to get treatment, 58% report that managing their COPD during the pandemic has been completely overwhelming, and 68% report they worry much more than they used to about their chronic condition because of the pandemic, according to the survey. The number of respondents familiar with COPD increased from 52% prior to the pandemic to 72% today, according to the survey. Other highlights: The willingness for telehealth visits has been on the rise due to the pandemic, particularly for wellness visits (56% to 62%), regular check-ins for chronic health issues (57% to 64%) and new health issue (57% to 63%); and COPD patients have looked for better ways to manage their condition due to the pandemic (75%). 

York Schwab to lead Medtrade shows 

ATLANTA – Medtrade officials have named York Schwab their new show director. Schwab, who was formerly an account executive, replaces Mark Lind, who left to pursue another opportunity. Schwab says he is hopeful about the opportunities in the HME industry, including for Medtrade’s two flagship events, Medtrade East and Medtrade West. “Coming out of COVID, face-to-face trade shows have never been more important,” he said. “You don’t know what you’ve got ‘til it’s gone. Ultimately, showing is always more powerful than telling.” Schwab has served major clients like Pride Mobility and VGM as an account executive for Medtrade for the past four years. He has a bachelor’s degree in political science from East Carolina University, and an extensive background in manufacturing and distribution.