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by: Theresa Flaherty - Tuesday, July 15, 2014

Did you know that if you laid the state of Alaska on top of the Lower 48 (as they refer to it from up there), it would cover an area stretching from Minnesota to Texas? And that there are only about eight DME providers in the whole state?

I had the unusual opportunity to talk to providers in both Alaska and Hawaii this week. It’s only unusual because, from our far east outpost here in Maine, the time difference between our beautiful states seems insurmountable (it’s not, only 4 and 5 hours, respectively).

I reached out to ProCare in Anchorage to see what they thought of CMS's latest ill-advised plan to expand competitive bidding pricing nationwide in 2016.

“Under no circumstances for Alaska would this be a workable scenario,” James McComas, COO, told me.

Not only is the sheer cost of doing business in the Last Frontier 30% higher, it’s a sparsely populated state with remote areas accessible only by plane—no UPS abilities here, says McComas.

What, I asked, would happen if providers from the lower 48 tried to service Alaska (because we’ve all seen what has happened in the Round 2 areas—servicing Hawaii from Florida? Please), he didn’t mince words. It’s a logistical nightmare.

“I came from the Lower 48,” he said. “You have to be here to appreciate and learn to adapt to this environment, its sheer size and the difficulty in getting accessibility to areas.”

In other words, if you think Mrs. Smith has trouble getting a Medicare walker in Nashville, don’t even bother in Fairbanks.

Theresa Flaherty

by: Theresa Flaherty - Friday, June 27, 2014

I'm not sure what Editor Liz Beaulieu thought when she perused the recent OIG reports on market share of mail order diabetes supplies but I took a look and thought, holy #@%*! It's not that a shift in market share was unexpected, but to see it in black and white was truly eye-opening.

The Prodigy AutoCode had captured nearly 25% of the market, while the so-called "Big Four" tumbled. It would, of course, be nice if the report had looked at the total diabetes market, but that was not the case (nor, apparently, was it the mandate). Obviously, if you are a beneficiary it's gotten a lot harder to find certain brands.

What, however, do the manufacturers think about all this, Liz asked me.

"How are the big companies with branded products not having a fit over this??? They're the ones losing all this market$hare!" (Jo, the $ is intentional. thx.).

It's a good question. Maybe they'll band together and raise hell with lawmakers (although, in the current no-spending environment, not sure it would do any good). They could also hustle (if you can call it a hustle after decades of expensive strips) to get cheaper products onto the market. Whatever happens, one can only keep their fingers crossed that Medicare pricing for ANY products doesn't go any lower.

It's appropriate that I am blogging about diabetes today. The online D community calls for people to wear blue on Fridays to raise awareness. By coincidence, I am.

In other diabetes news:

Thumbs up to Binsons Home Health Care Centers for providing 24 scholarships to diabetes camp.

Thumbs down to yet another media story that refers to a "diabetes sufferer." The "sufferer" in question plans to cycle 2,800 miles across America for charity. I don't "suffer" from diabetes. I do however, frequently find myself annoyed, confused or resigned to it. Personally, I think I'd suffer more from the bike ride.

Thumbs up/down

While I hate to perpetuate the stereotype that any type of diabetes (Type 1, Type 2 and, ahem, gestational) is caused simply  by poor eating habits, this graphic, posted earlier today on twitter, is pretty funny.

Theresa Flaherty, Type 1

by: Theresa Flaherty - Wednesday, June 25, 2014

I heard from Ed Grandi this week. You remember Ed. He was the executive director for the American Sleep Apnea Association for years until he stepped down this spring. He called about an article we recently published that would increase sleep apnea screening requirements for Medicare patients.

The providers in the story thought, by and large, that the idea was a positive, but pointed out that there are so many rules and regulations that come with getting the equipment to the patient that increasing screening doesn't translate automatically into testing and treatment.

And, of course, with any increase in diagnosis, there's an increase in utilization. In Medicare's eye, that means there's a problem. That strikes fear in the heart of providers who wake up screaming in the night over audits.

It's all part of a pattern of not seeing the big picture, Ed told me. The policy wonks (my words, not Ed's) don't grasp the concept of spending on the front end to save on the back end. That's especially true of a condition like sleep apnea, which has a host of a$$ociated co-morbiditie$$$.

Ed then asked for information about the binding bid bill that was introduced just last week. I explained that, while the industry would love to see the bidding program go away, that's simply not going to happen. Carving out a couple of bits from the bigger bill that are far more likely to pass is likely the best shot right now at making the program, if not disappeared, at least more palatable.

Until we get to the point where we have enough evidence that the program is causing problems for beneficiaries, smaller steps won't hurt, he said.

"This will allow us to nibble around the edges," Ed told me.

by: Theresa Flaherty - Tuesday, June 10, 2014

I went for coffee this afternoon at the very funky Cottonwood Canyon Coffee with Beth Cox, Kelly Turner, Lalaina Rabary and Emily van Harken—you'll know them either through People for Quality Care or The VGM Group, which is hosting its Heartland Conference this week.

At least, I hope you know them. They spend a lot of time getting the word out about competitive bidding, etc., to you, the provider, but also to lawmakers, the mainstream press and the beneficiaries. Uh, I also think Emily is responsible for wrangling John Gallagher.

But a big part of our chat today was about how to raise the noise level higher. It ain't easy, especially with social media. There are so many voices clamoring to be heard it's hard to rise above the chatter.

What does it take to get providers more involved? Beneficiaries? No one knows, but I know there are some interesting future projects in the works at P4QC and VGM.

I will say this: It looked like there were a lot of first-timers here at Heartland. That's always a good sign in these trying times. With providers pinching every dollar, they still see something of value in working in the industry. In fact, that's something keynote speaker David Wagner touched on today. (Yes, he's a hairdresser.) A former cancer patient, he gave a shot-out to our friends at Handi Medical Supply in Minnesota, where he hails from.

He told attendees:

"Know that what you do matters. There's negotiating and dramatic change in your industry. We understand that and we appreciate it. Don't take your eye off of what you do even though there is a lot of static in the way."

Another speaker touched on ditching non-value added services. More to come on that topic.

There were also a few providers here that have been to all 13 events. Is it the education? The networking? The hog roast? I don't know, but welcome back.

Needless to say, it's been a busy day here at Heartland and it's not over yet. Although I am hiding in my room during the exhibit hall opening (until I either recharge—both myself and my cell—or someone demands my presence), we have dinner with the capable Carolyn Cole on tap this evening.

 

by: Theresa Flaherty - Wednesday, June 4, 2014

Some ideas are so genious, you wonder why no one thought of it sooner. 

Monday, I stumbled across Jerry the Bear while trolling twitter (yes, social media works). Jerry the Bear has Type 1 diabetes and was created to help young children learn how to check blood sugar, count carbs and match insulin doses, and treat hypoglycemia.

I admit here to being a little jealous that Jerry checks his blood sugar simply by having a friend press a fingertip (no ouch factor)

 He's certainly a lot cuter than the doctors and nurses I dealt with when I was diagnosed (OK, so I wasn't technically a kid, but I might have like to have had a bear). He's also easier for kids to relate to, which is the whole point. I mean, who among us didn't consider our stuffed toys to have lives of their own? My brother would kill me if I posted a photo of him with his big Winnie the Pooh riding shotgun on his bike. Fortunately, he doesn't read my blog.

And imagine the show-and-tell possibilities (do they still do that?) of a bear like Jerry. Instead of being the odd kid out, you get to showyour classmates how cool your bear is. As we all agree, education and awareness is key to making life easier for all of us. The more people that understand how diabetes works, the fewer stupid questions people with diabetes are subject to (can you eat that? Yes. Are you gonna die? Yes, but so are you.) 

In a similar vein, there's an 11-year-old Wisconsin girl who has been campaigning for American Doll to create a diabetic doll, complete with supplies and an insulin pump.

"There are thousands of girls with diabetes and it's really hard for some of them getting diagnosed," Anja Busse told a local newspaper. "It's easier with a doll that looks just like you. You have someone to take care of."

Oh, and rumor has it that if you tickle Jerry behind the ears, he giggles.

Theresa Flaherty

by: Theresa Flaherty - Wednesday, June 4, 2014

Some ideas are so genious, you wonder why no one thought of it sooner. 

Monday, I stumbled across Jerry the Bear while trolling twitter (yes, social media works). Jerry the Bear has Type 1 diabetes and was created to help young children learn how to check blood sugar, count carbs and treat hypoglycemia.

I admit here to being a little jealous that Jerry checks his blood sugar simply by having a friend press a fingertip (no ouch factor).

 He's certainly a lot cuter than the doctors and nurses I dealt with when I was diagnosed (OK, so I wasn't technically a kid, but I might have like to have had a bear). He's also easier for kids to relate to, which is the whole point. I mean, who among us didn't consider our stuffed toys to have lives of their own? My brother would kill me if I posted a photo of him with his big Winnie the Pooh riding shotgun on his bike. Fortunately, he doesn't read my blog.

And imagine the show-and-tell possibilities (do they still do that?) of a bear like Jerry. Instead of being the odd kid out, you get to show your classmates your cool bear. As we all agree, education and awareness is key to making life easier for all of us. The more people that understand how diabetes works, the fewer stupid questions people with diabetes are subject to (can you eat that? Yes. Are you gonna die? Yes, but so are you.) 

In a similar vein, there's an 11-year-old Wisconsin girl who has been campaigning for American Doll to create a diabetic doll, complete with supplies and an insulin pump.

"There are thousands of girls with diabetes and it's really hard for some of them getting diagnosed," Anja Busse told a local newspaper. "It's easier with a doll that looks just like you. You have someone to take care of."

By the way, rumor has it, if you tickle Jerry behind the ears, he giggles.

Theresa Flaherty

by: Theresa Flaherty - Friday, May 16, 2014

I don’t tend to blog about incontinence—or its related products—because, well, it’s just not sexy.

But I really can’t believe what Arizona (which surely has a large population of people who use these products) tried to do in an effort to save money. It wanted to deny briefs to adults.

This pees me off for two reasons.

The first is that, in trying to deny the products, Arizona said they were only medically necessary when needed to treat skin breakdown or infections. That’s right: instead of allowing the products to be used to PREVENT these health problems, Arizona wanted to treat after the fact. Which (correct me if I am wrong here) could drive a few other expenses. Not to mention, it just isn’t nice.

My second is this: Nobody, and I mean nobody, wants to wear adult diapers. So why make it more difficult and or demeaning for users?

Fortunately, an appeals court has (ahem) voided that bid.

by: Theresa Flaherty - Wednesday, May 7, 2014

The Omni Shoreham has hosted Frank Sinatra, U.S. presidents and other heads of state and, in 1964, The Beatles.

This year, it's HME providers with a lengthy to-do list.

In years past the focus has been on competitive bidding, but this year, while that's still on the menu, audits are in the spotlight. Rep. Renee Ellmers, R-N.C., has promised to sponsor audit legislation and providers here are tasked with asking their own reps to be an original co-sponsor.

I think lawmakers will be primed to hear that message. Kim Brandt told attendees that important reports on audits from the Senate Finance Committee and the Government Accountability Office (GAO) are the works, as is a possible hearing on the issue after July 4. AAHomecare is working on it, too. Officials have a meeting scheduled with Chief ALJ Nancy Griswold in June to discuss the two-year delay at the third level of appeals.

AAHomecare cookie tin

The first speaker today was none other than CMS's Laurence Wilson. The session was closed to the press (there's that CMS transparency again), but since it was held over the chicken and asparagus lunch, I was allowed in so long as I kept my reporter's notebook in my pocket and didn't live tweet. Still, I don't think I'll get anyone in trouble when I say that Wilson recounted a meeting with AAHomecare's Tom Ryan, saying that it had been awhile since he'd been visited by the association, which always brought him cookies.

As Ryan said, and others, too, providers and CMS ultimately have the same goal: to help the patient. The problem is that the agency goes at it at in different ways. Ryan told me he's determined to open dialogue with Wilson's office and, while Wilson's speech didn't break new ground, attendees were optimistic there is some sort of detente in the future.

Finally, there is renewed focus on the patient and how they are impacted by everything.

"The focus has been on the billing, on the rules, on the costs, the procedures, the audits," Dr. Elizabeth Vliet told attendees. "Bring the focus back to patient care. The patient is the ony person I have ever answered to."

Theresa Flaherty

 

 

 

 

by: Theresa Flaherty - Friday, May 2, 2014

My pharmacy robo-called my voicemail the other day to let me know that a prescription was ready. My voicemail has a voice-to-text feature that seems to work well, but like all technology (and human beings, for that matter), it has its limitations.

“Theresa Clarity, press 1 to continue,” it read.

Now, to be crystal clear, I am impressed as hell that the robot got the basic pronunciation correct, (except for that pesky first letter). You see, I find that many good folks west of the Mississippi—and quite a few to the east—cannot pronounce Irish names. (Common mangle: flagerty.)

I should interject here that I’ll likely get no sympathy from editor Liz Beaulieu. (Common mangle: beluga.)

People, please, if you are gonna pass around the Gs like candy, we’ll take it in crisp bills.

Clarity is the quality or condition of being clear, something I strive to do with every story I write. That’s easier said then done, some days. Take yesterday, when a legal story dropped into my lap. We always rely on attorneys to explain to us what we think we are reading, often with copius examples, and yesterday was no exception.

Also yesterday, in a moment of decided fog-headedness, I completely goofed on the time for a call I had set up with a provider. It’s in my book, and in my email correctly but I came to work with a different time in my head. Luckily, the provider took pity and carved out some time for me today.

If only achieving complete and utter clarity every day was as easy as pressing a button.

by: Theresa Flaherty - Friday, April 25, 2014

An ounce of prevention is worth a pound of cure, or so the old saying goes. Unfortunately, when it comes to healthcare dollars, money often gets spent on the more-costly cure. 

That needs to change, says Brian Pavlin.

“I think that the way that health care moves forward, we are going to want to prevent readmissions,” he said. “We need to focus on things that cause readmissions, whether it’s drug interactions or something else.”

HME providers are uniquely placed to help patients before something goes wrong—even in nursing homes.

“Some of the homes I go into, I can show you five patients ready to fall out of their chairs,” said Pavlin. “There’s nothing that allows for proper positioning so they are on the edge of the chair. We can prevent that through less expensive products.”

Less expensive is key thanks to ever-shrinking reimbursement.

“We used to get $10 to $15 dollars a day for a $1,200 air mattress,” said Pavlin. “That was great money. Now we are getting $3 or $4.”

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