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by: Theresa Flaherty - Monday, August 7, 2017

When it comes to data in healthcare, nothing does it like diabetes. Tracking the who/what/where and when of glucose readings, carbs, insulin doses and phases of the moon.

In fact, I've spoken recently with companies like GlucoMe and CareCentrix about data and technology and how that’s shifting healthcare. Data, they tell me, can provide immediate, real-time feedback that allows patients and health professionals make treatment decisions.

So imagine my disappointment to learn I had arrived at my annual appointment with Dr. Emily the Endo (I don’t really call her this), only to learn that I Forgot. My. Meter.

Yes, I went to a place called the diabetes center without my glucometer. There was to be no downloading of numbers. And, because I am lazy, I had no old-fashioned paper logbook as a backup.

I could only answer in vague generalities about patterns and couldn’t pinpoint any specific issues. I had even, over the few weeks prior to the appointment carefully made notes regarding my numbers and outlier snacks like the chips and salsa (so worth it) and the donuts (so not worth it) that coworkers brought in.

Meanwhile, Dr. Emily and I discussed the outrageous costs of insulin and Why Is It so High??? (I don't know, she doesn't know). I made an appointment to see one of the nurses in three months and left resolved to be more diligent.

When I got home, I dug out an old unused logbook that came with a meter I haven’t used in years and got tracking. I must admit, in the past week, I’ve looked forward to diligently logging numbers, making adjustments (those patterns again) and feeling accomplished when said adjustments work. It’s also discouraging when they don’t. But, because I pinpoint those problems, I can try harder to resolve the problem. Failing that, I can fax pages over to the nurses at the diabetes center and get feedback.

 

by: Theresa Flaherty - Monday, July 24, 2017

In the game of life, it’s not uncommon to receive congratulations when someone learns you’ve bought a new house or car. This, despite the idea—at least to me—that I am also being congratulated on incurring debt that I will be making monthly payments on for (gulp) years.

It turns out, the same is true when one buys a new bed, or at least, when one buys a new bed and announces it on Facebook, proclaiming “It’s here! First brand new bed since forever.”

Which is true. I’ve dumped the platform bed/futon mattress combo that has served me well since 2001 in favor of an actual mattress and box spring, on a bed frame with—wait for it—headboard and footboard.

I’ve received many “congratulations,” been told “awesome,” asked how I slept on the new bed (quite well, I promise you) and been assured that investing in a good bed (therefore investing in good sleep for good health), is “worth every dime.”

I also got a “how did you sleep princess?” text from Mom, who provided partial funding for said bed. (Hopefully, she wasn’t being sarcastic).

Apparently, I am surrounded by people (not just CPAP providers) who get it: Sleep is essential.

I am already sleeping better, and the aches that came after balancing on a bed that had started to fall apart, have dissipated. Nothing that I had stored under the bed fits there any more, I can’t open the doors to the TV cabinet at the foot of my bed because the footboard takes up just that much space, and I can’t reach my very short nightstand because the new bed towers over it. If I were short, I'd need a running leap to get into it.

I don’t care.

Now, I just need to have the strength to not rush to Macy’s and buy all new bedding.

Sweet dreams!

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by: Theresa Flaherty - Thursday, June 15, 2017

James Rogers is not just here for the party. Oh yeah, he likes the parties: the hog roast, Fiesta in the Heartland.

“You’ve got to go, it’s lots of fun,” he tried to convince me (I do not like parties. There, I said it).

He’s also here for the education and to meet with fellow providers—and not just during the traditional networking stuff. He followed one such fellow provider out of the Washington Legislative Update Tuesday afternoon. During the session, she had expressed frustration that her efforts to connect with Senators—big wigs Dianne Feinstein and Harry Reid, so you know the deck was stacked against her—and that a trip to DC, when it turned out they weren’t even in town, was a big waste of time.

“I told her it’s not a waste of time and that I appreciated what she did,” said Rogers.

Then they got to chatting—West Coast provider to East Coast provider—and found themselves sharing ideas, which is what the good folks at VGM like to hear.

“Strike up a conversation. Speak with people,” Clint Geffert told attendees at the keynote on Tuesday morning. “We want to build a community.”

It’s easier to strike up those conversations at Heartland, both with providers and speakers, said Rick Wyche.

“The down home nature of Waterloo, Iowa, goes a long way,” he said. “It’s more personable. I don’t feel weird afterward talking to the presenter.”

But don’t let that folksy veneer fool you. There’s some serious education on tap here and providers who don’t get with the program as HME and health care evolves will not be attending Heartland in future years. With the world moving at the speed of light and technology moving even faster than that, older, slower and frankly less competitive attitudes won’t work.

Louis Feuer offered one succinct example during a session on sales.

“If you ever need to know time it is, call an HME provider at 4 o’clock,” he told attendees. “They’ll say, ‘it’s 4 o’clock!’ ‘I know it’s 4 o’clock, can you help me or not?’”

Clock’s ticking.

 

by: Theresa Flaherty - Wednesday, June 14, 2017

There’s an old saying: If you can’t take the heat, get out of the kitchen.

Here at the VGM Heartland Conference, where the temp has been hovering stubbornly in the 90s, attendees are being plied with food, bevvies and a solid slate of networking events to keep us from noticing those temps.

Speaking of heat, I found it oddly metaphorical that a panel discussion with CMS, the SBA, and contractors from Noridian and C2C, was held in a small, dark room that lacked both natural light and A/C. Let’s face it, many of the audits and other regulatory pressures that providers face have them hot, bothered and gasping for air.

“The claims process, the audits process, the appeals process. What are you not getting from us that you need to see?” implored one provider.

To be clear, these reps are not the cause of the problem, and they have indicated, and continue to indicate, a willingness to listen to providers and seek opportunities for improvements in the process.

As the first official day of the conference wrapped up yesterday, I would say attendees are on the whole, pleased. Despite thunderstorms, the hog roast went off without a hitch and I heard (literally) the fireworks were awesome.

As was the keynote speech, given by former Navy Seal Kevin Lacz. Lacz got a standing ovation for his talk on risk vs. reward, drawn from his experiences overseas. This is a man who has faced enemy fire and seen friends—teammates—killed, and can still empathize with providers who have to deal with Medicare.

by: Theresa Flaherty - Thursday, April 20, 2017

The United States is a vast and wonderous place. From our perch in Maine, high up on the eastern seaboard, we here at HME News get to talk to people all across the country, including—when we can get those pesky time zones aligned—Alaska and Hawaii (here’s looking at you, Paul Gammie!).

We also like to pay attention to trends. Which brings me to the small seaside town of Port Angeles, Washington, home to just under 20,000 people. In a very short span of time, about six weeks or so, the name Port Angeles popped up three times in relation to HME.

The first was a provider—whose individual name I did not catch, but the company was Jim’s Pharmacy & Health Care—who participated in the recent provider forum on competitive bidding. He minced no words.

"It’s unrealistic for Medicare to make a 50% cut and expect us to absorb that,” he said. “I cannot think of any other business that would do that.”

Adding insult to injury: audits.

“When you come back for a refund, boom you take it,” he said. “But, you expect us to wait 6,7,8 months to get reimbursed (for bid relief passed in The CUREs Act in December).”

Coincidentally, I recently spoke with Ryan French, also of Jim’s Pharmacy fame. Ryan was named as Brightree’s 2016 Ambassador Award from Brightree. The award is given to an individual with the greatest involvement and contributions to the Brightree Online Community. Ryan and I spoke about the importance of technology in HME (with about 2.5 years under his belt, he’s a relative newcomer to the industry). Look for my interview with him in the June issue.

Speaking of award winners, my third and final notice of Port Angeles is Michele Gunn of Browing's Pharmacy & Health Care, one of two inaugural Simon Margolis Fellows, who recently moved from Florida to Washington state. While I think the local weather and local customs are likely to be a shock, at least she’s in good company with other dedicated providers.

 

 

by: Theresa Flaherty - Friday, March 10, 2017

I always learn something new at Medtrade. This year, I learned new methods for greeting people without shaking hands, including the fist bump, the elbow tap and the air high five.

This was all in response to me being kind enough to warn everyone—hands up in front of me—that I had acquired a cold during my travels and had no wish to pass it on.

Unfortunately, despite my best efforts, I got both of my traveling companions sick and, I assume, the two passengers next to me on the first leg of the flight home from Vegas.

One of the great things about Medtrade, or any of the industry association events, is the opportunity to network and learn from one another, even apart from educational sessions.

We also do this with every month with our HME Newspoll. It’s a way to take the industry’s pulse on any number of issues.

So imagine our collective confusion today when Liz received an email, from a regular reader, who asked if, with our latest poll seeking input about overseas outsourcing, we were being merely inquisitive?

(Well, yes, we are always inquisitive.)

His response to our inquiry? “None of your business.”

He softened this with, “no harm, no foul, is OK.”

No harm taken or intended, Dear Reader. The poll idea came about, not out of the blue, but was gleaned from regular phone conversations with your fellow providers and some conversations on the show floor in Vegas.

I think we will be hearing more about outsourcing in the weeks and months to come.

 

by: Theresa Flaherty - Wednesday, March 1, 2017

At dinner Monday evening we had a great vantage point from which to people watch. It being Vegas, you’d think that meant watching a very…colorful parade.

Instead, our attention was drawn to a sunglass kiosk across from us, positioned against a wall act outside the tail end of a shopping corridor. There, the 22-year-old salesgirl (one of the few women I saw the entire trip with sensible shoes), engaged with customers fully, kept the shelving tidy and the glasses (2 pair for $30) polished. She never sat, she didn’t fiddle with her phone, she didn’t stare blankly off into space. She was, in essence, a case study of what to do in selling.

Earlier in the day, we had to chuckle in our skeleton booth: there was a card from the Medtrade powers that be with the basics of what I’ll call good booth behavior (re: selling). In essence, stay off your phones and engage with potential customers. Or, follow the lead of the above mentioned salesgirl.

About those "folks in Baltimore"

At the AAHomecare Washington Update Tuesday morning, there was a renewed energy.

"This year, 2017, is a year of opportunity," Tom Ryan told the crowd.

That opportunity seems to be mainly in the form of Tom Price who has taken the reins at HHS and who is known to be no fan of CMS. While the industry has made some small gains, there is much work to be done.

"There's still some folks in Baltimore that still think you are overpaid," said Jay Witter. “Keep fighting.”

See you over at the Mandalay Bay!

 

by: Theresa Flaherty - Tuesday, February 28, 2017

It’s a chilly today, here in Las Vegas, but here’s hoping things warm up with the official start of Medtrade Spring ’17 this morning.

I actually flew into Vegas on Saturday. I figured if I had to spend a whole day crammed onto a plane, anyway, I might as well take an extra today to enjoy some sun and relative warmth—two things that are often in limited supply in our neck of the woods.

On Sunday morning, before all the vacationing families could descend on the Shark Reef Aquarium (it’s just past the food court, which is just past registration for the show), I bought a ticket and headed in. While the aquarium was small by East Coast standards, it was oddly peaceful to wander around in cool dark rooms in the middle of *arid Nevada looking at sharks and other predatory sea creatures.

We’ve all heard the old adage, “swimming with the sharks,” which means to swim in uncharted, often dangerous waters. Well, that’s what HME providers often need to do these days to survive. They are dipping their toes into new markets or adding new products and services. That’s ostensibly why they are here.

During a session today led by Sarah Hanna on success stories, one audience member shared how he added companion services: that segment of his business is on track to surpass the DME portion next year.

Other means to survive include knowing when to walk away from something—a payer, a service—that just isn’t working any more. We get it. Change is scary.

But if you are here, you are looking for new ideas and opportunities. You are looking for change, either ready to embrace it full force or get dragged toward it kicking and screaming.
I mean, what’s the other option? Better to swim with the sharks then sleep with the fishes.

Stop by the HME News booth at 606 and let us know what you hope to get out of this year’s show (warning: I take names and notes).

*Fun fact: 90% of the facility’s water is recycled monthly, resulting in an estimated 2.1 million gallons of reclaimed water each year.

by: Theresa Flaherty - Thursday, February 2, 2017

CGMs are all around me. Ads for the Dexcom G5, in particular, keep popping up on websites. I am guessing this is because I Googled it while writing a story about Medicare’s recent decision to start paying for certain CGMs (the Dexcom currently being the only one that meets the criteria at this time).

I also met with a new CDE at the diabetes center this week. “Have you ever considered getting an insulin pump?” asked Sarah the CDE.

(Syringes are so 1980s.)

I get asked this every year or so. My reasons so far for deciding against the technology have been that I didn’t want to be tethered to it constantly; I wanted to wait a generation or so and see how much the technology improved (re: how much smaller the devices would get), and the costs.

Guess what? The devices are getting smaller and the technology has improved—most now seem to come with integrated CGM technology. Alas, I have a feeling the pricing for the device (hello, high deductible!) and the ongoing supplies would still be cost prohibitive for me.

I told all this to Sarah the CDE, but then we somehow (I may have brought it up) got on the topic of how Medicare is looking to cover CGMs, which could (possibly, maybe) ultimately lead to lower pricing across the board for diabetes tech.

When I got into the office, I Googled OmniPod because that’s what has interested me most in the past, and now I am getting pop-ups for that, too.

Unless Big Brother really is watching and somehow knows what I am thinking.

In the meantime, there are lots of details to be worked out for the Dexcom to get paid by Medicare. One interesting point (and correction, we transposed some numbers here) came to light today, from Greg at Applied Policy who has been working with Dexcom on this.

CMS has proposed a one-time payment of $236 - $277 for the CGM receiver.

I emailed him back to ensure I had understood correctly, and added that seems like an extremely low payment.

“That was our impression as well,” he told me.

Greg said it seems that CMS may have used historical data (they do love that historical data, don’t they?) for traditional glucose monitors. Those monitors cost far less than the thousands a CGM costs. For that matter, they also cost far less than $236 - $277, but I’ll save my rant about insurance pricing for another day.

As Greg told me, it’s a curious pricing mechanism, to say the least.

Finally, a story to put a smile on the face of anyone who uses insulin: a lawsuit was filed this week against the manufacturers accusing them of price fixing.

Stay tuned on all of the above.

by: Theresa Flaherty - Tuesday, January 3, 2017

I’m back in the office after two (glorious!) weeks away. For Christmas, Mom, I and Aunt Patti went to a little burg known to many as Sin City.

As an HME provider, you more likely know it as the site of Medtrade Spring.

Now, Las Vegas tends to mean a lot of walking around (I broke my daily walking goal of 60 minutes every day by many minutes and many steps). At the conclusion of our first full day traipsing the strip (The Bellagio, Caesars Palace), Mom realized if she and her bad knee were gonna keep up with me, she’d better get a cane.

Not only did the cane, indeed, make it easier for her to get around, this simple stick wielded an unexpected power: everybody and their brother offered her their seat. On the tram. On the bus. On the monorail. It was funny to me because mom is one of the most active people I know and really isn’t the proverbial little old lady. 

She may get that attitude from her mother, whose biggest complaint upon Grampy backing over her in the driveway with the big beige Buick was that the local newspaper referred to her as “elderly.” She was in her 80s.

Exploring Vegas with a person that is slightly mobility challenged opens the eyes to how difficult it must be for some people to get around. The walking distances, the sheer volume of people and the broken escalators everywhere highlighted this for me. 

The cane also let Mom get thisclosetotheedge at the Grand Canyon. 

I had to look away.

Here's to a healthy, mobile and Happy New Year!

 

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