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by: Theresa Flaherty - Friday, August 23, 2019

I believe there's a saying that 5% of the people do 95% of the work.

It's a comment that's been made to me many times over the years on the HME legislative beat and one that was certainly born out by our September Newspoll in which 62% of respondents say they hadn’t set up a meeting with lawmakers or their staff in their district offices; 77% said they didn’t plan to host lawmakers at their location.

But, it's the all-important August recess!

“I’m just burnt out on trying to get the industry’s point across to anyone in Congress,” said one respondent. “I feel like I am shouting into a void.”

In other instances, the lack of scheduled meetings is not due to a lack of trying, providers say.

“I’ve asked my closest (geographically) Congresswoman for years to meet with me,” wrote on respondent. “She recently announced she is not seeking re-election, so it will never happen.”

I don't totally understand folks who do nothing but I certainly can't fault providers for being burned out by the whole prospect of advocacy. I hear ya! Confession time: There are days when the prospect of writing yet another story about competitive bidding makes me want to scream. But I refrain. Not only would it not solve anything, editor Liz would tell me "tough luck."

But all that burnout is balanced by the news in today's email inbox recounting visits that have taken place in the past week, including visits in Wisconsin, North Carolina, New York and New Mexico. Upcoming visits will span New England, thanks to the hardworking folks at HOMES.

Next weekend is Labor day and the unofficial end of summer. I'm kind of looking forward to getting back to work with a renewed focus and energy.

by: Theresa Flaherty - Tuesday, June 11, 2019

When last year’s Heartland Conference rolled around, I had just gotten my Freestyle Libre and was excited to take it on the road and see how much easier it was to check my blood sugar from the confines of a plane or during a session. Unfortunately, I knocked it off two days prior, courtesy of a doorframe that came at me out of nowhere (rookie mistake). Insurance policies being what they are, I had no way to replace before I took off, alas.

Fast forward to this year’s event and I can report that yes, living life in general and traveling in particular with Type 1 diabetes is So. Much. Easier. It’s a game changer.

And technology like that (and beyond) is coming ever faster. There’s a proliferation of devices aimed at managing chronic conditions, according to Jeff Cribbs, today’s keynote speaker during a dynamic session: “The Future of Digital Health is Centered in the Home.”

“We’ve gone from spot measurement to continuous event monitoring,” he said. “Real time signal processing.”

That, in turn, allows diabetics to make 200 decisions related to their diabetes daily, he said. 200! I’ve been busy counting carbs instead, but it sounds about right.

Libre aside, some things stay old school. I use syringes and toss them in a Folgers coffee can.

Bring home that bacon!

Speaking of Folgers coffee cans, Jennifer Leon is still trying to get you to collect those patient copays, 73% of which go past 30 days. Make it easier for them to pay. Set those expectations, now. Know that it’ll be harder with the existing patients but do it any how. They’ll try to tell you they don’t have a credit card, that they keep their cash in a Folgers can buried in the backyard.

Don’t fall for it.

As to your new patients?

“They don’t know you used to give away the equipment for free,” she said.

From the soapbox

As I move through sessions at this year’s conference, I am doing so with an eye on the future, the need to shake things up and the need to rethink business models, modes of thinking and just the same old, same old.

So, in that vein, I have two, oh so tiny, quibbles.

First minor quibble: Please stop labeling us diabetics. We are people who happen to have diabetes. I may make 200 decisions a day related to my diabetes, but I make a thousand more related to other stuff.

Second minor quibble: While I would never bite the hand that feeds me, literally or figuratively, it can be a challenge to eat at another’s table. Today, boxed lunches were served. I am fairly confident the boxes with the V on them were vegetarian. In the Midwest, I know, this is no small concession toward the non-meat eaters of America and it was nice to see. I’d like to see that go further, with a vegetarian option extended to the beloved hog roast. For the record, I am not a vegetarian myself, but even at the Heartland Conference's signature event, it’s time to set a place at the table for everyone.

(Jumps off soap box).

But please, don’t take away my bacon.

by: Theresa Flaherty - Monday, June 3, 2019

Have you ever been in Best Buy, simply trying to purchase whatever electronic device and been forced to listen to *The Spiel? It’s been a few years for me, but I seem to recall it had to do with them trying to sell you some sort of warranty and now matter how politely or firmly you try to stop the cashier from wasting their breath (and your time), they are required by the Corporate Overlords to do it any way.

I was reminded of this recently while reporting a story about ongoing confusion regarding ABNs and when providers are required to educate beneficiaries on the use of ABNs.

The answer: Even if the provider is non-participating AND even if the beneficiary has every intention of paying for said item with cash, you must advice them that item may be covered by Medicare.

As Andrea Stark advised: It’s always best to err on the side of full and utter transparency if there’s even the slightest chance your customer looks like they might have Medicare.

Using my mom as an example: If my 70-year-old mother takes a **cane up to the front counter at CVS, in theory, they should be sending her back to the pharmacy where the pharmacist would presumably explain about Medicare.

I am pretty sure my mom would have been irritated to have to hobble back to the pharmacy and wait in line to hear the spiel when she has a credit card in hand, ready to pay.

That goes for the mom-and-pop providers as well as the CVS and Walgreens of the world, something I didn’t include in the story (space, my kingdom for a few more column inches). I should have however, as many providers, like the one who emailed today to ask that very question, probably still wonder if they are taking it on the chin while the big guys get away with it.

For an online like Amazon, they could have a disclaimer at say, the "checkout" point (or elsewhere) stating that Medicare may pay for the item.

Does all this mean the government is throwing out consumerism or the patient’s right to choose what products they want or the right to pay however they choose? Of course not, but it does serve as a reminder to providers everywhere not to take any chances that the DME item you sold for cash today won’t come back with someone wondering why they paid full price while someone else had Medicare pay for theirs and demanding a refund on the item.

*I have avoided Best Buy ever since and have no idea if this practice is still in effect.

**My mom actually did buy a cane at CVS when we visited Vegas. I suspect she paid cash right at the front counter. Fun fact: She proceeded to leave the cane behind all over the strip.

 

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by: Theresa Flaherty - Thursday, March 21, 2019

The latest news cycle certainly kicked off with a bang! First, the latest update on the competitive bidding program, which features an aggressive timeline and added certain orthotics and non-invasive vents (vents! I tell ya!).

Then, BioScrip and Option Care dropped a merger into my lap (side note: whenever I am having trouble finding stories I have been known to state: “I need a merger, a bill or a lawsuit.”). It’s been awhile since we had a heady home infusion merger story.

And the mail-order diabetes category is being tweaked so it’s not even up for bidding at the moment. Coincidentally, I had already been poking around (haha, get it?) in the diabetes arena after a few members of a Facebook diabetes group I belong to asked if the gap period meant they could get supplies everywhere. In theory, sure, in reality, not so much, which they had kind of noticed.

Speaking of diabetes, yesterday, Roche filed another lawsuit against yet another company, Alliance Medical Holdings, for insurance fraud involving test strips.

The stories for specialty are writing themselves this month.

by: Theresa Flaherty - Monday, January 21, 2019

So apparently, the New England Patriots won the AFC East (am I saying that right?) last night.

If my Facebook and Twitter feeds are anything to go by, it was a real heartstopper of a game, due to the myriad posts from people saying things like, “My heart just stopped,” and “My heart can’t take this anymore.”

My favorite? Karyn Estrella, of HOMES fame who is smack dab in the middle of Patriots country, who asked, “Where’s an oxygen tank when you need one?”

That’s an excellent question. My guess is, for many beneficiaries, that’s a question that will be asked very frequently if recent trends continue. The latest GAO report on supplier numbers showed a decrease of 11% for 2017. That’s on top of an 8% decrease in 2016.

It’s also in line with an AAHomecare analysis that shows a decrease of about 35% between 2010 and 2018.

The big question now is, with the industry just starting in on two years of any willing provider, will access problems worsen, less or stay about the same?

As the executive director of HOMES, Karyn presumably has an inside track on the best oxygen tank suppliers in her area, should she actually need one to watch the Superbowl.

If you are a beneficiary, or their caregiver, it might not be so easy.

 

 

 

by: Theresa Flaherty - Monday, October 22, 2018

Among the first providers I bumped into at Medtrade last week: The Feiersteins.

You know Lisa and Steve of Active Healthcare fame. They sold their sleep business and now focus on nebulizers and certain diabetes supplies.

We stopped to chat for several minutes about the direction this industry is going in, what’s going to be the next big thing (retail? Probably not) and eventually, Medicaid.

Well! It so happens that the Maine-based HME News team had literally (literally!) just learned news that should strike terror into the hearts of pretty much everyone who isn’t healthy and wealthy.

So, pretty much everyone.

You see, we had just heard (literally!) that non other than Mary Mayhew (often referred to in these parts as Mary Mayhem), has, in true Trumpian, fox-meet-henhouse style, been appointed as the new director of the federal Medicaid program.

Oy!

Mayhew, former commissioner of the Maine Department of Health and Human Services, boasts a tenure that includes cutting, cutting and more cutting. Cutting programs, cutting services, cutting reimbursement rates. Cutting was all she cared about.

Her slash-and-burn approach to the programs meant to help our society’s most vulnerable has left disaster in her wake (in a fit of hubris worthy of, well many politicians, Mayhew left her post to run for governor, despite being a deeply unpopular figure in the state).

There's so much more I could say, but I think the best I can do for all my unsuspecting HME News readers is provide a link to a recent editorial summing up her utter failure at DHHS.

"Mary Mayhew brings Maine failures to Washington"

Consider yourselves warned.

by: Theresa Flaherty - Monday, September 24, 2018

As I was sitting down at my desk one recent morning my coworker, Cath, came to me and said, “Theresa, I guess I need to ask you about diabetes.”

Being short on coffee and a bit long on self-centeredness, I blinked in confusion, thinking she meant MY diabetes. But, since I’ve worked with her for years and already demoed my new-ish Freestyle Libre to the office (and my mom, my friends and my doctor), this made no sense.

She was actually trying to drum up the contact list for our November feature on diabetes, an assignment I find more challenging every year. The space has changed so much, especially in terms of reimbursement (dismal) and technology (amazing).

I have found myself doing more articles on diabetes technology, talking to companies like One Drop and Ascensia about patient self-management tools.

Technology like the aforementioned Libre, which I started using this spring—readers, it’s life-changing. After nearly 20 years of finger sticks, to wave a device at a sensor and get a number? Amazeballs. Sometimes I just keep scanning it, unlike with those precious test strips I daren’t waste.

The Libre also allows me to note if I am trending up or down (uh, my blood glucose, not my Twitter feed). It allows me to see patterns I never would have caught with traditional (less frequent) finger sticks.

But let me tell you, with technology advances, as with so much else in our on-demand society, users can be quite demanding and have very high expectations that it works conveniently and consistently (not me of course, I am as sweet as a sugar-free pie). Hopefully, that demand will push innovation further down the road.

As to the diabetes feature for November? If you get an email from me seeking product listings, please, send them along. If you get an email from our contributing editor, John Andrews, please weigh in for our story.

by: Theresa Flaherty - Tuesday, September 4, 2018

Every year around this time, HME News usually gets a small flurry of press releases from HME providers who have landed on Inc. Magazine’s annual 5000 list of the fastest growing privately held companies in the U.S.

This year: crickets. A quick, highly unscientific perusal of the 375 healthcare companies on this year’s list confirmed the notable absence of several past winners.

Where, we wondered, were such list stalwarts as Cape Medical Supply, Carolina’s Home Medical Equipment, Aeroflow Healthcare and Home Oxygen Company? Had growth leveled off? Has the list lost its luster?

Both, it turns out.

Home Oxygen Company hasn’t submitted for the last two years, says Todd Usher, co-founder of the Modesto, Calif.-based provider.

“We were in fact flat or a little behind because of the rural rollout,” he said. “This year, we are growing however, we are having trouble seeing the value in such a list to our company.”

The rural rollout also whacked reimbursement hard for Carolina’s HME, says Andrew Trammell, president of the Charlotte, N.C.-based provider.

“Inc. looks at revenue numbers over a three-year period,” he said. “We are selling a lot more but at significantly lower reimbursement. Therefore the unit growth is somewhat meaningless to Inc. so I did not even submit numbers.”  

Cape Medical Supply, in Sandwich, Mass., has made a hard turn away from Medicare in recent years, but that hasn’t stopped the competitive bidding program from having an impact on revenues, despite an increase in business, says CEO Gary Sheehan.

“We didn't submit to Inc., he said. “For us, it was Medicare rates washing across other payers—growth on patient volume remains enormous, but that just keeps revenues flatish.”

So, were there any HME providers on this year’s list?

Yes, at least one: Charlotte, N.C.-based Portable Oxygen Solutions, at No. 1055. The online provider of POCs, which launched in 2013, had revenues of $3.2 million in 2017; its three-year growth rate was 467%.

by: Theresa Flaherty - Tuesday, July 24, 2018

When provider David Chase first submitted bids for the competitive bidding program, his team of seven armed themselves with pencils, calculators and coffee, working every night for three weeks to understand their costs and come up with—what he thought—were sensible bids.

“We did not win a single bid—not one,” said Chase.“We’re in the metro New York area, so we could easily bid on six or seven MSAs and we lost every single one.”

The second time around, they tossed aside their calculators and ended up winning most categories in most MSAs in which they bid.

“When I say, ‘winning,’ it’s in quotes,” he said.

Like other providers I spoke with in the wake of CMS’s announcement that it was hitting the reset button on the program, Chase was heartened to hear that at least someone at the agency might finally be waking up to the problems.

“Nobody wants to admit they implemented a program that was not well-thought out and had so many flaws,” he said “It will be interesting to see what they are going to propose on a permanent basis.”

Provider Andrew Trammell says the proposed changes, like using lead item pricing, will right some of the wrongs wrought by bidding.

“It’s certainly going to fix some of the very odd pricing fee schedules we’ve had,” he said. “For example, old manual crank beds are paid more than the newer, semi-electric beds—odd things from gaming the system.”

Still, while the proposed changes are a step in the right direction, the proposed timeline of 18 to 24 months is not. While CMS figures out how to retool the program, providers need a more immediate fix.

“There’s an easy fix and that is to acknowledge that the market clearing price is an appropriate price setting mechanism,” said provider Gary Sheehan. “They can go back to the 2016 auction, use the market clearing price and have that be the reimbursement reset for Jan. 1, 2019. I don’t think there’s any excuse for them do anything short of that, at the minimum.”

by: Theresa Flaherty - Tuesday, June 19, 2018

As I trudged from the Ramada Inn over the humid skywalk to the Sullivan Brothers Convention Center I swore, I could smell the bacon.

I was, after all, a weary traveller, in search of sustenance (and bacon) after a late check-in and a drive through the dark (very, very dark) Iowan countryside and some impressive rain to get HERE, the 2018 Heartland Conference.

We missed the hog roast, something we seem to manage every other trip.

However, once we get here, after all the sputtering and swearing and cursing (cussing, not actual, like, black magic hexes) we remember why we came.

We love the Heartland Conference. We can’t put a collective finger (all three of us from HME News) on why, but we do.

And I think the other attendees do, too. We met a newbie provider from the Chicago area over breakfast (and bacon) who drove fours hours through torrential downpours for her first Heartland. She’s so new to the industry she (gasp!) had no idea what HME News was. No offense to our friendly rival papers, but I quickly assured her we were THE HME industry publication, handed her a copy and told her where to sign up.

But, I think she, like the other attendees feel this show is as relevant as ever in these changing times.

This year's event kicked off with keynote speaker Jared Johnson who told the audience, “Thank you for showing up and making your community, company and the lives around you better.”

I attended sessions on telemedicine (and telehealth and telemonitoring) and CPAP resupply, broke bread at lunch with some other midwestern providers and hoisted a margarita with the folks from Contour Products at this evening’s community dinner (I got lumped into the marketing group dinner at a Mexican place—a sign if there ever was one).

The offer of a ride to the airport stands.

Tomorrow (or today, if you reading this on Wednesday), it’s a Washington update and a panel discussion with the SBA and CMS, serious stuff. And, I am not sure what else, but it will be good. 

I also hope there's bacon.

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