Subscribe to E–SP RSS Feed

E–SP

by: Theresa Flaherty - Wednesday, March 27, 2013

I recently (reluctantly) returned from vacationing on Vieques, a tiny island in Puerto Rico where horses roam free, on the beaches and in the twisty, winding narrow roads.

On Vieques it was easy to avoid all talk of competitive bidding, MPP or Medicare in general, mainly because internet access is so spotty, there are no local papers (and if there were, I suspect they'd be in Spanish) and I didn't travel all that way (3 airplanes and two rental cars) to watch my hosts' TV. They could have cancelled the bidding program and I wouldn't have had a clue!

While all that lack of access was welcome, I am, still, a reporter for HME News and at some point during my stay I realized what else I hadn't seen: home medical equipment ('cept for my own diabetes stuff). I saw no oxygen, no wheelchairs, no walkers, not even any canes. Is this because islanders don't need HME? Is it not readily available? Maybe those aforementioned twisty roads make it difficult to get around in a wheelchair (it was certainly difficult in our Jeep and I have the bruises to prove it). 

It's truly the first time I have gone a whole week without seeing some sort of HME. Even during my annual week in Cape Cod I have seen wheelchairs on the beach (I didn't however, get close enough to see if it sported an "I heart Cape Medical Supply" sticker). 

Where am I going with all this blather? I just wanted to post a vacay pic 

Theresa Flaherty

 

 

by: Theresa Flaherty - Thursday, March 7, 2013

As I edit the pages of the forthcoming April edition of HME News, I come across interesting tidbits. Take, for example, the Richard Barnes commentary on employee engagement.

Did you know that, according to a Gallup Poll, only 29% of employees are fully engaged in their work? And that 54% have mentally checked out (Hey you with the computer solitaire, we see you). Our fave stat here at HME News world HQ (which we share with a few other folks on a sister publication) was this one: 17% of employees are actively disengaged AND sabotaging the efforts of coworkers. With about 22 folks here in the office we estimate that four of us at any given time are saboteurs (smart money's on the new-ish guy).

As Round 2 continues to wreak havoc throughout the industry, I would imagine some of these numbers will rise among HME employees. After all, it's tough to work in an environment where folks are losing jobs, pay is being reduced and uncertainy is the only certainty.

For those employees left standing, here's a few signs that they are actively engaged: they are 26% more productive, twice as likely to be top performers, and miss 20% fewer days of work. Simply put, if you "bring it" to work and don't play hooky on a regular basis, your coworkers probably won't be giving you the fishy eyeball wondering if you are out to get them.

The commentary also says that constant complaining about the company is a bad sign, but I don't know. Isn't that just cubicle nature?

by: Theresa Flaherty - Tuesday, February 19, 2013

Providers are always talking about how beneficiaries have trouble learning new things or are resistant to new brands. I am no Medicare beneficiary (though I still can't get off the darn AARP mailing lists) and I have many times, while not scoffing at this notion, said of learning a new meter,  "it's not rocket science."

Well. A few weeks ago I picked up my new Freestyle meter and strips from my local pharmacy. The switch is solely because it's the preferred brand of the insurer's, but it's still a top brand with the features I demand (I sound like a commercial). I have twice opened up the box with the meter and twice stuffed it back into the box and back into the diabetes basket under my dresser (if only I could actually stuff my diabetes in that basket). It's not the meter, it's the stupid lancing device that has proved the sticking point. It has two separate pieces that look like they cover the lancet but I can't figure out how to make them fit.

Now granted, I haven't tried too hard, and it's not in my nature to read(yawn) instructions. The second time I tried it was because I realized I had left my meter at the office and needed to check my sugar. I was so irritated that this wasn't as simple as I thought it should be that I broke out the meter I inherited from Big Ed (alas, I only inherited one vial of strips from him).

But, I am getting near the end of my supply of One Touch strips and it's time to retire the meter and make the switch already.

I hate change.

Theresa Flaherty, Type 1

Tags:
diabetes, Type 1 diabetes
by: Theresa Flaherty - Friday, February 1, 2013

Did I really say, in my last blog, that expected payment amounts for Round 2 for diabetes test strips would about $15? Boy, was I (and, apparently, pretty much everyone else) wrong. The strips came in at $10.41. How did the price get so low, especially since Medicare implemented its 50% marketshare rule for Round 2. Did some bidders offer to supply them for free?

My first reaction was one of shock, quickly followed by dismay, not for myself but for all the wonderful providers I talk to that will be impacted by this. In fact, I had talked to several of my "sugar peeps" in the days before the announcement. I wanted to know what they thought of the plan to reimburse all Medicare diabetes supplies at the new mail order rate. While none of them were happy, they also weren't wailing and hand-wringing.

I have a feeling that's changed (if you are reading this and supply diabetes products, save me a dime and call me). CMS likes to spin the benefit to the bennies, but I think we'll find, you get what you pay (or in this case, don't pay) for.

Speaking of diabetes, I picked up my new brand of meter and strips the other day. The pharmacy billed it through as a 90-day supply, even though it was supposed to be 30. I hope that was an honest error but really, 200 strips to last a Type 1 90 days? I don't think it will last me 30 days. To give credit where it's due, my new insurer called the pharmacy right away and straightened it out.

It will be interesting to see how quickly I master the meter. Confession: The lancing device looks tricky already.

Theresa Flaherty
Type 1

Tags:
competitive bidding, diabetes, Type 1 diabetes, test strips
by: Theresa Flaherty - Wednesday, January 30, 2013

The other day, there was yet another article in which a person with diabetes experienced a low blood sugar while driving. The driver had a "diabetic attack," said the article. Which led to commenters posting how much they hated that phrase.

Diabetes doesn't "attack" and it's poorly written stuff like this that makes people with diabetes sound like we are walking around in imminent danger from ourselves. We are not and I think most of us have a sense of humor about the disease. Check out this picture I snapped this morning on the sidewalk in front of my house. I guess we know who lives here. 

You know what's under attack? The Medicare benefit for diabetes testing supplies. CMS not only has put the category out for its national mail order bid, but plans to lower pricing for testing supplies to mail order payment rates, no matter where they are obtained. 

Setting aside the argument that many folks don't even like mail order, I, and many of the providers I have been talking to this week, are concerned about the types of products that they will be able to offer, if they continue to do so at all. If beneficiaries have no choice but to go to mail order, will they lose that contact with the pharmacist, asks John Keegan.

"I see these people as a healthcare professional and I discuss their diabetes with them," said Keegan, a pharmacist. If there's a problem evident, that can "initiate a conversation between the pharmacist and the doctor if there needs to be a change in therapy."

I could go on, but I think you've heard it all before. And, to make it clear, I think mail order is great for those who want to use it. I talk to some great mail order providers as well. In theory, there's room for everybody, but not under an expected payment rate of about $15.

Stay tuned.

Theresa Flaherty
Type 1

 

Tags:
diabetes, Type 1 diabetes, low blood sugar, competitive bidding
by: Theresa Flaherty - Tuesday, January 22, 2013

Another day, another Medicare fraud story, this one from Ohio. While it involves fraud affecting physicians, it is, as always, the medical supply fraud that caught my eye. Apparently, Medicare issued licenses to some mailboxes at UPS stores.

Which begs the (tongue-in-cheek) question: Do said mailboxes meet the quality standards regulating a provider's physical space?

Let's take a look, shall we?

The site must measure at least 200 feet square. That's a pretty small actual DME store, but it'd be a damn large mailbox now, wouldn't it?

Be in a public, accessible location and not in a gated community or other restricted area. I am on the fence with this one, not having recently traipsed into a UPS store for either HME or packages. I suppose it's technically a public space but, you know, is just anyone allowed near the boxes? Keyholders only?

Be accessible and staffed during posted hours of operation. Well yes, any good mailbox needs to be accessible and staffed during posted hours. The bigger question for me is, how many staffers can you fit into a mailbox of any size? Do staffers have to take separate shifts?

Maintain a permanent and visible sign in plain view. This one has raised questions in the past. For instance, in plain view of what? The parking lot? Sarah Palin's house? My question: Does the little red flag in the "up" position, featured on so many mailboxes, count as an "open" sign?

Irreverently yours,

Theresa Flaherty

by: Theresa Flaherty - Tuesday, January 15, 2013

It always catches me by surprise when I am reading an article in a mainstream magazine (in other words, pretty much anything but my de riguer copy of HME News) and I happen upon a story featuring someone I've interviewed for HME News. 

The most recent case in point, an article in a women's health magazine about sleep in which Nancy Collop, formerly of the American Academy of Sleep Professionals, was quoted. Naturally, the article was about sleep: its importance to your overall health and well-being, how much do you need, etc.

Sleep, or the lack of it, as we all know, is big news. You may recall my recent short failed experiment with glucosebuddy. It simply won't work on my phone and they never responded to my inquiry. Well, in the same issue of Diabetes Forecast that included that app in its annual product guide, they also mentioned an app (I forget the name) that supposedly will track your sleep waves (or some such thing). You download it and place it near you while you sleep.

This I gotta see.

At no time are the arguments for getting better sleep more apparent than when I am sleep-deprived myself. Take this week, in which I have been having trouble staying asleep. The past two nights, I have fallen asleep around 11, only to wake up at 1:55 am (seriously, not 1:30 or 2 am but 1:55). I fall back to sleep only to wake up again (!) around 5 am and unable to get to sleep until around 7 am. Needless to say, I am quite tired this week, not to mention, late to work.

To be sure, it's not unusual for me to have problems sleeping (this week, I am hoping it's simply the cough medicine I have been taking). But maybe it's time to say, enough is (yawn!) enough. What's triggering these patterns of wakefulness? And, if I can figure that out, are there changes I can make to address them?

First, I have to see if the nap, I mean app, will work for me.

Theresa Flaherty

Tags:
sleep, American Academy of Sleep Medicine, diabetes forecast
by: Theresa Flaherty - Thursday, January 3, 2013

This year, encouraged (dare I say, excited, even?) by Diabetes Forecast mag's annual product update, I decided to download an app, the GlucoseBuddy, so that I could log numbers and track patterns (when you have diabetes, it's all about the patterns). Typically, I just let my meter do the tracking.

It should be noted that I don't give a fig about apps in general. I don't play Words with Friends or Angry Birds. Don't get me wrong: I am no Luddite (or is that Philistine?). I love tech and what it does, but when I am done with work for the day, my idea of relaxation doesn't extend to staring at a tiny screen.

But, with my new insurance plan (the one in which my cost of test strips doubles), I may have to switch to a cheapo brand in which the meter can't be downloaded at the doc's office. If that happens I at least want to be able to bring the doc a readout of my latest readings. It's the only way to see what I am doing right. Or wrong. 

So, I downloaded the app, no problem. Figured out how to adjust the settings and the personal identifcation information, Piece of cake. Unfortunately, when it came to entering blood glucose numbers, or blood pressure or insulin doses or anything else, I couldn't do it. I can see where to do it. It simply won't let me. I am unsure if my phone wasn't quite compatible or if there was some unforseen glitch. What I do know is, without those logs, GlucoseBuddy is not my friend.

As with so much we discover with the net these days, you get what you pay for. The app is free. Great. Unfortunately, that seems to mean it comes with no instructions or customer support. I emailed customer support and haven't received a response. To be fair, I want to say that I have seen plenty of user testimony and this app gets rave reviews. However, I can't make it work for me.

I haven't given up on GlucoseBuddy, but isn't it discouraging when you attempt something for the first time and it's a big fail?

Theresa Flaherty

Tags:
diabetes, Type 1 diabetes
by: Theresa Flaherty - Monday, December 17, 2012

Things are tough all over. Between competitive bidding, the continued crap economy and the general cost of doing business, it's harder then ever to keep those doors open. Which is why, in my humble opinion, service counts. Every last bit of it.

I called a provider today who I used to speak with regularly. It's been a couple of years, mainly because his staff won't take messages—and that's when they can even be bothered to listen to me before hanging up on me.

Today, I took a deep breath and dialed. I pressed 0 for the operator, as instructed. I kid you not, the operator/receptionist/girl answered the phone with an impatient "Whatdoyouwant?!"

Naturally, I hesitated, wondering if I had misunderstood. So she snapped "What?!" At which point, I said "Excuse me?" (insert incredulity here). Then, I tried to ask for Mr. So-and-So. But she had already hung up.

I redialed and hit the number for the HME department. That person was more polite, but he wouldn't get any points for "phone face." He also couldn't be bothered with taking a message.

Well, if that's the way the staff treats people, I wouldn't want to leave a message. I'd be afraid every time I called to do business that someone would yell at me ( and rightly so, apparently). There's plenty of other providers in the sea and abusing customers is just plain wrong (even when some of them deserve it).

I did manage to get in touch with the owner, on his cell. (we reporters are a persistent lot). I debated telling him about my horrible phone experience with his staff, but in the end did not. On the one hand, if it were my company, I'd want to know. But I didn't want to be, ahem, impolite.

Theresa Flaherty
potential customer, but not for you

by: Theresa Flaherty - Tuesday, December 4, 2012

When you are immersed in a particular world long enough, you begin to see it everywhere. For example, I see home medical equipment in use everywhere I go. Prior to joining HME News, it might as well not have existed.

I got an email today asking if I "currently have T1..." Why yes, I do have Type 1 diabetes, but that's not what the email was about. The rest of the sentence was as follows: "...and up data services that have inconsistent speeds or blackout?"

It was an ad for AT&T, nothing to do with diabetes, although I could draw a parallel between blood sugar control (inconsistent speeds and blackouts) and data problems. The ad goes on to offer to help me "increase productivity and efficiency" which could arguably be a case for good diabetes managment.

I just finished writing a story on the OIG report that found bennies switching to retail from mail order in the Round 1 areas. In speaking with people about the report, we raised the old topic that having access to supplies is vitally important for diabetes patients. It's enough of a pain to test daily and calculate insulin dosages and carbs accordingly without a payer, be it Medicare or a private insurer stepping in with a bunch of hoops to jump through. In the case of competitive bidding, the biggest concern is that the artificially low payment amounts will make it difficult for suppliers to offer the supplies. They certainly won't be able to offer a lot of name brand stuff. That's likely to get worse when the national program kicks off in earnest next summer. Many of the folks I talk to think beneficiaries in many cases will simply cease to test as the doctor ordered.

That's not going to save money for anyone. As to whether AT&T could solve either my data transmission problems or improve my blood glucose levels, the jury is still out.

Theresa Flaherty
Type 1, 13 years

Tags:
Type 1 diabetes, competitive bidding

Pages