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by: Theresa Flaherty - Monday, June 13, 2016

Waterloo, Iowa, is 1,366.9 miles from Portland, Maine, if you’re driving. I’m not sure how far it is as the crow (or in this case, Delta) flies, but two 2-hour plane flights, and an hour’s drive in a rental car with Siri’s help (she pronounces it water-LOO) and we made it to our hotel tired and hungry but relatively unscathed.

Then we got lost on the tiny drive to the Heartland hog roast. I’d like to blame Siri, but who knows how we wound up meandering through the local neighborhoods looking for something, anything, that looked like the downtown or the riverfront.

At the kwik mart where we stopped for directions:

Clerk: “It’s near the “Waterloo Library. Do you know where that is?” No.

Helpful customer: “Isn’t it near the library?” So we’ve heard.

The good news is, we now know where the apparently ever-popular Waterloo library is.

This year is the 15th year of the annual VGM Heartland Conference and Van Miller’s absence appears keenly felt. His dog, Daisy—soon to be a working dog with veterans, children with autism, and, ahem, people with diabetes—made the rounds tonight, as did several other pups.

They’ll be around all week and if you can, check out this important cause, Retrieving Freedom, which trains the dogs and matches them with families.

Another theme I’ve already noticed at this year’s event: wine.

There’s been a couple of networking events centered on wine, including the women and wine event (or wine, women and song, as Jo-Ellen insists on calling it) that’s on my calendar for Wednesday afternoon. Shocking, I know!

While I didn’t see any wine at the hog roast tonight, there was a special beer on tap: It’s called Thumbs Up and it was brewed specially in honor of Van.

I also got a hot tip for a special announcement happening on Wednesday. I’m sworn to secrecy, but I can tell you, I approve!

I’ve got my new Heartland app downloaded and am ready to get started tomorrow.

Cheers from the Heartland!

by: Theresa Flaherty - Monday, May 2, 2016

Well, it looks like I posted last week’s blog not a moment too soon. CMS released its highly anticipated list (and list upon list upon list) of the Round 2 re-compete contract suppliers.

I am sure you are all out there, busily poring over the list for you area of interest, both products and geography-wise.

And I know poor Kim Brummett and others like her will be poring over all of them.

So, in the interest of sanity, allow me to share initial thoughts on my area of interest: the diabetes category. Conveniently, it's also the only one that's a one-pager.

Last time around, CMS offered approximately 20 mail order contracts (I say approximately, because the number shifted a few times.)

This time around they offered only nine.

A quick comparison of this year’s list with the previous list, reveals that only three of the nine contract suppliers are repeaters. The new list also reveals that of the nine, four were among the top 10 providers in the category in the HME Databank in 2014.

So, first question, what kind of impact will reducing the number of mail-order suppliers by half have on a. beneficiary access and b. the suppliers themselves?

The second question is how these companies, will make any money off the new super low pricing?

It remains to be seen.

On a side note, scanning the websites of the new suppliers whose names I didn’t recognize, I stumbled across something I hadn’t seen before: a medical ID bracelet with a QR code. This way, emergency workers can scan the code and pull up what I would assume is a medical profile that’s a bit more comprehensive then a few engrave words can ever provide.

For all I know, this has been around since about the time I let my subscription to Diabetes Forecast expire (I renewed in February and got my first issue last week, it’s good to be back!).

by: Theresa Flaherty - Monday, April 25, 2016

“Hey, Theresa, any idea who won contracts?” asked more than a few providers in recent emails.

That, my friends, is the question of the day.

And the answer so far is no, for the most part. Two notable exceptions: Aeroflow Healthcare, which has received 645 contract offers for 108 CBAs; and Rotech Healthcare, which has received contract offers for general HME and standard mobility for all 117 CBAs and respiratory equipment in 116 CBAs.

Oh, and Inogen also made a big sweep—it got respiratory in 93 CBAs.

Rumor has it that CMS is having to extend additional contract offers because providers are rejecting them, and reaching out to nudge offer-ees to get those contracts signed and returned.

As in previous rounds of the bid program, it will be interesting to see who’s on the list. And, as the industry continues to scratch its collective head over the latest reduction—an average of 7%—that list of contract suppliers will be closely scrutinized because who the heck keeps lowering the limbo bar with lower bids?

And, once we see the names, we will have a clearer idea on how well various licensure laws, aimed at preventing things like someone in Florida bidding in Hawaii, have worked.

So much for a reporter to follow up on, and yet, I’m in limbo without that list.

Stay tuned.

by: Theresa Flaherty - Monday, April 18, 2016

Editor Liz and our marketing guru Heather (she’s very busy lately trying to drum up messaging to entice you to submit an HME Excellence application) both have very young children and therefore, like to compare notes on different stages of development, etc. Not coincidentally, they also use the same daycare so they also gossip about that.

I know all of this because Liz’s cube is on the other side of mine and I can’t help but hear. The convo is often fascinating to me.

Today’s topic was sleep. Apparently, even babies don’t always get enough. I also have a friend with a four-year-old struggling with sleep.

I suppose parents have always been concerned with how well their offspring are sleeping, but I’ve been thinking a lot lately about how the national conversation around sleep has grown. Especially since I sent an assignment to our contributing editor John Andrews today that featured—sleep.

Then I came across this article about the impact of sleep deprivation on employer’s wallets, to the tune of $63 billion a year in the U.S.

$63 billion! The tired mind boggles.

I have never been a good sleeper (sorry, Heather and Liz, that can happen), although I was an easy baby (unlike a certain brother of mine). I suspect this is because I’m a night owl by nature in a 9 to 5 world.

I'm also a light sleeper, which means precious sleep gets interrupted (why, oh why, is my roommate smashing around the kitchen at 6 am?! (Actually she's quiet as a mouse, I think every thing just sounds louder at that hour.)

Lately, I've gotten worse at sleeping.

But, I’ve also been slacking off on things like exercise and even just fresh air (since we are in Maine, I have an excuse for this; that fresh air is still pretty cold), both of which I firmly believe help with sleep. So, in an effort to sleep better, I am taking off extra early today to force myself to the gym and start building the habit again.

(Yawn). Wish me luck.

 

 

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by: Theresa Flaherty - Friday, April 8, 2016

I’ve written in the past about my obsession with Dear Prudence, an advice column on Slate.com.

I’ve discovered an advice blog that I now read regularly: AskAManager, and it’s all about work, from the benign (“How long can your resume be?”) to the bizarre (“Low performers in my office are paraded around and forced to wear dunce caps”).

This week, a reader wondered how best to navigate job interviews in a wheelchair.

In order to be out and about for eight to ten hours a day for a commute and job, I’m going to have to use my wheelchair. The thing is, I’m terrible at it. I bump into doorways. I have trouble getting lined up with desks properly. I’ve run into people accidentally — a lot. Plus, I sweat quite a bit while using it, probably a combination of muscles unused to the work of pushing it and nervous perspiration. I think time and practice will help me get better at it, but what do I do for job interviews now? 

Now, first of all, we all know job interviews are painful in any circumstance, but this is one of those things those of us who don’t use wheelchairs would never think of. While we talk a lot about wheelchair users (for example) leading as normal a life as possible, this points to how much effort "normal" can take.

I should mention this blog has has a passionate community of commentators and many of them not only had helpful suggestions, from making sure your interview suit allows you to maneuver, to practice, practice, practice, to wondering whether a rollator might be a more workable option.

Other commenters discussed things like insurance coverage (She doesn’t qualify for an electric power chair), Medicare issues, etc.

And, as most providers will appreciate: the wheelchair user had to travel an hour to buy her chair because she lives in—a rural area!

And now, just for fun, a few more headlines:

I punched a coworker at the office Christmas party

A vegan coworker is being aggressive toward me about food

My office wants us to chip in to send our CEO's family on a ski trip

I just hope I don’t come across this question on the blog:

"I recently asked if anyone needed anything from the grocery store and one of my direct reports had the nerve to ask me to pick her up a half gallon of milk. She even specified “skim.” Should I write her up?

Cheerio!

by: Theresa Flaherty - Friday, April 1, 2016

There's been a lot of chatter over the past two weeks about the new Round 2 re-compete payment amounts. With seemingly a gazillion different HCPCS codes with their corresponding prices (per region), folks have been burning up their calculators to crunch the numbers, I'm sure.

Except for one product category: mail-order diabetes, which was delightfully simple to parse, what with it being one national price for each of eight codes. 

So, my scientific analysis (which consisted of printing off a hard copy of the new rates and comparing them to the hard copy of the previous mail-order rates tucked in a red file folder conveniently labeled "mail-order") tells me that the price for test strips has inexplicably gone down! 

The old rate: a draconian $10.41 per box. The new rate: a sub-draconian $8.32 per box—a difference of $2.09, which I believe calculates to a nearly 21% decrease. (Does it? I'm a wordsmith, not a math genius. Not even a math moderate.)

Can mail-order providers even ship for $8.32? And who's going to want to? CMS also announced that it was extending contract offers to nine providers, compared to the 18 or so last time. What will this do for access? What happens when we have a mail order or two fail because they can't make the numbers work? The numbers of people with diabetes ain't falling, folks.

And, will retail pharmacies want to offer the "big four" brands at these rates?

There's been a study, just published, making the rounds recently about the disruption in access for beneficiaries as a result of the bid program. People keep mentioning it to me, but frankly, I covered the study as story in June after it was presented at the American Diabetes Associations 75th Scientific Sessions.

I mentioned the radio silence on this lower pricing to Jonathan Sadock in passing. His guess was as good as any: "Perhaps it's just been so decimated that it doesn't even make the news any more."

by: Theresa Flaherty - Wednesday, March 2, 2016

Vegas is a Starbucks and Pepsi kind of town; I am a Dunkin Donuts and Diet Coke kind of girl.

So, I adapt, getting my morning caffeine fix from that Seattle brew (but eschewing Pepsi in favor of water—I do have my standards).

Adapt is a word that most providers are all too familiar with and it’s a recurring theme here at Medtrade Spring. As one provider told me Tuesday afternoon, “We’ve decided we’re not going to just give up.”

The folks at AAHomecare are also adapting, ready to roll out a plan B (OK, more like C, D or E) to soften the blow of the next round of reimbursement cuts. There’s another bill in the works folks—keep your eyes peeled and your lawmakers on speed dial in the coming weeks.

Still, the mood here on the show floor is optimistic. People are shopping, having great conversations and talking about the abundant opportunities in the HME industry.

It’s the baby boomers stupid.

As proof-positive that younger people see opportunity in HME, I’d like to offer the man bun. Yes, you read that right. For those not in the know, urbandictionary.com defines the man bun thusly: (n): A questionably sexy hairstyle in which a man with hair of the medium to long (and usually greasy) variety secures said hair into a firmly rounded bun.

I spotted my first ever HME man bun today on the show floor. Trust me when I say this is a hairstyle for the younger set—it’s not your traditional image of an HME provider.

(We now interrupt, while Theresa takes a sunrise break. A longtime night owl, this is a phenomenon she's not typically witness to back home).

Finally, speaking of old, I still haven’t mastered the selfie stick that Anna and Ryan McDevitt dropped off at the HME News booth yesterday. (There’s a contest you know). I’ve been wrestling with the selfie stick in my spare moments ever since. Stop by booth 142 today and show me how to work this damn thing and I’ll name drop you in a future blog.

 

by: Theresa Flaherty - Tuesday, February 23, 2016

In the end, it was nothing like I expected.

My dad has been declining slowly over the past year due to heart problems (yes, he was an incorrigible smoker). I’ve posted here about the grab bars and cane he began using (albeit reluctantly) over that same time period.

I always assumed he’d end up on oxygen (from Cape Medical Supply, of course), which occasionally kept me awake at night worrying he’d continue to smoke and therefore, set himself, the house or mom on fire.

In the end, all that overthinking was for naught. On Sunday, he watched the Super Bowl. On Monday, he had a heart attack; on Wednesday, they took him off the vent and he was awake and breathing on his own; by Friday, the cardiologist said it was time to talk about hospice.

The hospice nurse that afternoon began making arrangements for dad to be discharged, to come home, hopefully the next day. On Saturday morning, that same nurse called to tell us he had taken a turn for the worse. We agreed and so we left him where he was.

That afternoon, we called the hospital for an update before we headed in to visit with him. He was comfortable. We arrived 30 minutes later to find he had died quietly.

Almost…too quietly.

Me: Hi Dad.

Mom: We’re back!

(Several minutes pass, during which we settle in)

Me: I don’t think he’s breathing.

This pronouncement was followed by the two of us attempting to find a heartbeat or pulse. However, his heart function was so low and he was on morphine to boot, we thought maybe we just couldn’t detect it. We did everything short of holding a compact mirror to his mouth to see if we could catch a bit of fog.

Fortunately, his nurse arrived and save us from further embarrassing ourselves.

Now, some folks might find my relating the above scenario macabre. However, the visual of my quiet, long-suffering father trying—and failing—to get a moment’s peace, even in death, while the chatty (long-suffering) women in his life poked at him, pretty much says it all.

RIP

by: Theresa Flaherty - Wednesday, January 27, 2016

Those of you who’ve been around long enough have probably heard rumors of the HME News staff’s contact database, which contains the names and contact information of thousands of providers across the country.

You may have even have heard we have a ratings system by how much we like you and how quotable you are.

In both cases you’d be right.

Of course, thanks to everything thrown at providers over the past few years, I know that the database isn’t as accurate as it once was. For example, editor Liz is listed as former associate editor with a ranking of “very high” along with the comments: “workaholic” and “best writer I ever met.”

For the provider information, many have combined with other providers or closed up shop; others have moved to different positions or with different companies; and still others have added or dropped products and services as the market dictates. We make notes of all this in the database as we can.

I just got off the phone with provider Joel Gallion, the newly-minted president of Bellevue Healthcare in Bellevue, Washington. I’ve never spoken with Joel before, although we’ve spoken with the company in the past. Gallion told me he’s been with the company since 2004 (about a year longer than I’ve been with HME News).

Bellevue Healthcare (no affiliation with any other Bellevues but itself) is growing. It recently added a 17th retail location and rearranged some execs so that it could further focus on the business of growing.

Like me, Gallion lamented on how tough it’s getting for the independents out there, and he’s concerned that, down the road, the consolidation of the HME industry could be a bad thing.

After my conversation, I checked the database to see if he was listed. Sure enough, he was. His info was originally entered in 2004 and under title it said “sales and marketing,” with no ranking.

Today, the HME database promoted him to president with a ranking of “high.”

 

by: Theresa Flaherty - Monday, January 18, 2016

Now that you’ve fallen for my cheap, attention-grabbing ploy, let me clarify: after another year of white-knuckling it through “HR analyzes health coverage plans season,” a nightmare has come true.

It went something like this: I hit CVS to pick up my prescription for a three-month supply of Humalog, one of two insulins I must take.

Imagine my surprise to learn that the copay had jumped from $60 in October to $150—an increase of more than 100%.

I politely left without my insulin but filled with a faint cold fear that overshadowed the remainder of my weekend.

Turns out, although, ostensibly, my insurance coverage didn’t change (our HR, the capable Erika, thoroughly researches options every year), through some fancy footwork by the insurer, which shall remain nameless but rhymes with Barvard Milgrim, it did change things up some on the drug benefit.

That goes for my other insulin and apparently, everything else related to diabetes meds and supplies (even lancets for crying out loud). It looks like even their PREFERRED brand of test strips (which I had to switch to two years ago) will also be grouped in this third tier with the higher copay.

As I was moaning about this at the office, a coworker asked if there were other options for insulin (as in cheaper). However, all insulins are not created equal, except perhaps, in the eyes of the payer.

Even if I wanted to switch from a product I’ve used successfully since diagnosis, to one that works differently (and would greatly impact my quality of life)? Just, no.

And let me tell you, HME News coworkers, if you think I’m difficult to accommodate now when it comes to a communal work meal?

Plus, why is it that, in health care, we can be forced to change from an excellent product to one that is less excellent and have that be considered a reasonable option? If your cell phone plan for your iPhone6 is too rich for your budget, do you consider switching back to the iPhone4? Hell no!

All may not be lost: I think I can buy a cheaper syringe out-of-pocket at Walmart (I don’t shop at Walmart—ever—so this is an extra trip. And a moral outrage.)

It also looks like I can do the same with a CVS brand of strips and meter. The meter has a memory but I doubt it has download capabilities, which means the additional step of entering numbers into my Glucose Buddy app or old schooling it with paper logs. Really?

So, fingers crossed, it’ll all even out in the wash, but the impact is definitely a negative in this girl’s logbook.

 

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