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by: Theresa Flaherty - Friday, January 17, 2014

In diabetes we have a rule: the rule of 15. What this means is, if you have a low blood sugar, you should consume 15 grams of carb, wait 15 minutes then test again. It's a good rule and it can work pretty well if you can stick with it.

I woke up this morning around 4 and according to the CGM, my blood sugar was an excellent 98, which I confirmed with my meter. However, since I was planning to roll over and go back to sleep for another 3.5 hours I decided to have a swig of OJ in case my numbers were trending down. I have noticed in recent months (years??) that I do not need 15 grams of juice. This was never more clear than this morning. I had some juice (maybe an ounce—3 carbs—at the most). I'd like go on the record here as saying that even at that dark hour, I used a glass, no carton chugging for me.

Fast forward some time (maybe an hour? I was too groggy to care) and the CGM woke up me to tell me my sugar had soared to at least 240. Could be overnight hormones, could have had a rebound from a low after all (I really don't think so), could have been the juice. But it was interesting all the same, and will be something I ask Erica about when I see her. That's the whole point of the device, to track trends, but also anomolies.

I think the rule of 15 could apply to a lot in life. Take this morning when I discovered that someone had burnt toast badly enough to scorch my brand new stainless steel toaster. It's less than a month old and it has a big black mark. Did I immediately text the likely suspects? Leave a passive-aggressive note? Nope, I waited a few minutes and the urge passed. I'm still ticked, but I am sure the offender will do their best to clean it up. It wasn't intentional, after all.

Theresa Flaherty


by: Theresa Flaherty - Thursday, January 16, 2014

I've been chipped and calibrated and am once again using a dexcom continuous glucose monitor (CGM). I think this is a newer model. It seems smaller and lighter and has a few more data input options. I still have to keep it within reach at all times and have quickly adjusted to picking it up every time I walk away from my desk.

Now, ordinarily, when I am tracking my numbers in this kind of detail (and with a nurse figuratively looking over my shoulder) I am on my best little person with diabetes behavior.

But last night felt like a tequila kinda Wednesday so I went out for margaritas as planned. I like 'em with rocks and salt. Lots of salt. Tequila of choice was Hornitos for those of you keeping track. Now, it's not that I think a margarita is good for my blood sugar, but watching the trend rise quickly and steadily upward was quite the eye-opener. Not only that, my numbers stayed consistently high all night. Too high. In other words, while it's OK to indulge in a rare treat, it's simply not worth it on a regular basis. Especially since I'll have to fess up that I drank two margaritas and they are loaded with sugary sour mix.

The meter only woke me once last night (well, this morning) to remind me my numbers were too high. Which is unfortunate, because the whole point of the great CGM experiment, 2.0, is to see if I am going low too often. Yesterday, I woke with a 60. Monday morning about 4 a.m. it was all the way down to 43! And yes, the lower it gets, the worse it feels and the more it just takes out of you. I was nearly an hour late for work because I needed to sleep in a bit longer to recover.

I also like to give credit where it's due: I arrived for my appt to get the CGM a full 24 hours early! Fortunately, the staff at Maine Medical Endocrinology and Diabetes managed to squeeze me in (thanks, Erica!). 

Stay tuned.

Theresa Flaherty

by: Theresa Flaherty - Monday, January 13, 2014

This week marks the 95th anniversary of the Boston Molasses Disaster. That's when a storage tank exploded sending a wave of the sticky stuff, sometimes reaching 25 feet in height, at 35 mph through the North End. Buildings were knocked off their foundations and crushed.

An excerpt from a Boston Post story at the time reads "Molasses, waist deep, covered the street and swirled and bubbled about the wreckage ... Here and there struggled a form—whether it was animal or human being was impossible to tell. Only an upheaval, a thrashing about in the sticky mass, showed where any life was ... Horses died like so many flies on sticky fly-paper. The more they struggled, the deeper in the mess they were ensnared. Human beings—men and women—suffered likewise."

OK, so the news story is a bit overwrought but doesn't all this make you think of competitive bidding and audits? Ensnaring HME providers in their evil wake? Knocking decades old businesses—indeed the very foundations of the industry—off its collective foundation?

This week we will start on the March issue. The first story I am tackling is the backlog of ALJ appeals (speaking of molasses). No fewer then three people so far have alerted us to a memo from the Office of Medicare Hearings and Appeals.

According to the memo, in January 2012, the OMHA central office received about 1,250 appeals each week. In December 2013, that number was—wait for it—15,000 per week. 15,000! The OMHA has a backlog of 357,000 claims and 65 ALJ judges. (I should note, these aren't just HME appeals). That's nearly 30,000 cases per judge. I guess we can all see why they have suspended assigning new hearing requests. 

I can think of one way to catch up on this backlog: suspend the damn audits. I mean, the fact that there are so many appeals only underscores that the auditors are denying claims based on, as one provider put it to me, being submitted on the wrong color paper. This comes as no surprise to the industry which has all along said that the practice of paying auditors for finding mistakes would create a bounty system in which they get their sticky little fingers into everybody's files. The system is broken and, to add insult to injury, people are being denied due process. I mean, last I checked, this is America, no?

Back to the owners of that exploding molasses tank. They blamed it on anarchists (a claim never borne out).

Audits? Anarchy? You be the judge.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, December 31, 2013

People the world over are counting down the minutes and hours until the New Year arrives. Except perhaps for Jo in the next cube. She's singing "White Christmas."

I am personally counting the minutes until I get sprung from this joint today. No special reason, I just have holiday brain.

So let's talk resolutions. I make a few soft ones every year and don't beat myself up when they (inevitably) fall by the wayside. This year's have to do with fitness, both physical and fiscal.

One idea I got, just today, from the Internet. It's called "plank a day" and every day you do a plank, starting at 20 seconds and aiming just a little higher each day. Just a year ago, I couldn't have even considered this due to my shoulder problems but I have come a long way and while there are residual problems, I am grateful to be on the mend. The projected rock-hard abs will simply be a bonus ; )

This relates to my second resolution: pilates, where I believe they love the plank. I have been wanting to take a class for ages but they are hard to come by around these parts and when you do, they are expensive, the hours are sporadic and the hours are also geared toward folks that don't seem to have to work for a living (which cycles us back to expensive). My gym offers yoga—for free—but it doesn't appeal to me. Other excuses have included that if I am gonna do it, it should be twice a week, or, I'd like the class to be right after work. No more. I found a beginner's class, once a week, near my house at 6:30 in the evening. It's $15 bucks a class (ouch!) but it's time to reallocate funds (wine budget) and make the effort.

Speaking of $15 classes, the other Internet resolution I liked and plan to attempt was a 52 week savings challenge. You save $1 the first week, $2 the second week, $3 the third week and so on. If you keep it up, you have $1,378 by the end of the year.

Check back for updates and Happy New Year!

Theresa Flaherty

by: Theresa Flaherty - Friday, December 20, 2013

I can't be the only person in the industry who doesn't feel like doing any more work this afternoon. HME News will be closed until Dec. 26 and I don't plan on returning until Dec. 30 so really, I am in (festive) vacation mode at this hour.

I've been making cold calls this week (very cold calls, we had a couple of days of fffffrigid temps and nearly 20 inches of snow).

What can I report? Well, despite audits and competitive bidding (the Round 1 recompete is mere days away), there are still providers out there staying positive and staying strong. They are trying to add new products and services and opening new retail locations.

They are also, always, giving back to their communities. Whether it's continuing to supply them with enteral nutrition despite not being paid because it's the right thing to do or whether they are donating wheelchairs to veterans taking part in honor flights, they don't hesitate to lend a hand.

We had our company Christmas party last night. As part of it, we make a donation to the local food bank, because, while there are a million worthy endeavors to support, there is nothing so egregious as neighbors going hungry. I am proud to report that we raised what I believe is a record high $1,000, despite the pinch we have all felt from the economy.

Merry Christmas!

by: Theresa Flaherty - Friday, December 13, 2013

"What's the plural of armadillo?"

That's not typically a question I ask myself when proofing pages for HME News. But I am trying to write a snappier headline for one of associate editor Elizabeth Deprey's stories on mobility providers rethinking their business models as they run screaming from the Medicare program.

But it does kind of point to the larger trend we are seeing of providers doing what they can to diversify and move forward, while CMS and its auditing henchman continue to peck, peck, peck at providers for their perceived peccadillos (did you hear the one about the provider who was denied a claim for a wheelchair for a quadriplegic vent patient because the physician did not initial a date change? You will, it's in the January editorial pages of HME News).

But I digress. For all the horror stories we continue to hear—and I am sure I'll be hearing plenty more next week as I make a new round of cold calls (please, answer the phone, with the holidays we are pressed for story gathering time)—I still manage to speak with people who are trying new things and looking forward to the future. I talk to providers launching ad campaigns, ecommerce sites and new retail locations. They are trying new products and new markets.

As we stumble headlong into the New Year, I hope to hear more of these stories and perhaps, some better news on the bidding and auditing and fronts, as well.

As to the plural of armadillo? Just add an "s."

Theresa Flaherty

by: Theresa Flaherty - Tuesday, November 26, 2013

We've written stories in the past about how home medical equipment allows people to travel to visit friends and relatives for the holidays.

This year, I spoke with the folks at Pediatric Home Service about a photo contest they are holding that shows how vents and other HME allows medically fragile children to do just that. It was a nice contrast to the usual stuff about seniors and oxygen tanks (not that there's anything wrong with that). This allows the provider to not only highlight the services it provides but also showcases the advances that have been made in technology (lighter weight, longer battery).

I am so lucky all I have to do is haul along my glucometer (and strips, insulin, syringe and, if I am really on the ball, fast-acting glucose tabs). And maybe a bottle of wine.

Maybe the first or second year after I was diagnosed, I wound up eating by myself, simply because I was starving, my sugar was bottoming out and it seemed silly to eat extra food that I didn't want or need merely to prolong the turkey. Fortunately, experience has taught me how to better plan around unusual meal times. And carbs. And relatives in general.

Speaking of carbs—and prolonging dinner—have I ever introduced you to my brother and his deep fryer? (We are a little different from one another in all things food, needless to say).

Well, he got the bright idea to deep fry the damn bird (it was all the rage that year). Dinner was a little late. And later. Needless to say, as Russ futzed about with the turkey behind the garage (that's where the fryer was, he wasn't trying to catch the bird), the rest of us chatted, snacked, poured more wine.

Finally, it was time:

"Folks," said bro, "dinner's ready. And there's no turkey."

Did we really just hear that right?

Yes, yes we did. Apparently, he could never get the oil hot enough, so the bird never really cooked but it did get a good soaking in oil.

At least we had room for lots of side dishes and pie, needless to say.

Happy Thanksgiving and safe travels to you and yours.

by: Theresa Flaherty - Thursday, November 14, 2013

"What's the congratulations for?" my coworker, Jo, asked me this morning.

"What congratulations?"

"Didn't I just hear Heather say 'congratulations?'"

"She may have said 'congratulations' (personally, I don't think she did) but it wasn't to me," I said. "And now I feel bad. I want someone to congratulate me for something."

But as I was tooling around on twitter for blog inspiration, I did find a congratulations of sorts. Today is World Diabetes Day (insert awareness comments here). @gingerviera tweeted, from some sort of chat, I think: Are you aware of how AWESOME you are for simply waking up and facing diabetes every single day? Are YOU? Really? 

I never thought of it like that. Let me review my day so far. Got out of bed only slightly late after a restless night that had me checking my sugar at 3 am (it was fine).

Checked my sugar upon waking (too high). Healthy breakfast (oatmeal/skim milk). Remembered to grab my lunch (salad, homemade white bean chicken chili). I don't even like the chili but I made it and it's not inedible. Got gifted with dakon radishes (thanks, Liz!). Ate a tiny piece of "gooey" cinnamon square (uh, thanks, Liz?). Needless to say my numbers did not go down after that.

Dropped big, balsamic-coated lettuce leaf on the pants I just pulled out of the dryer this morning. Sigh.

In other words, a pretty normal day. So yeah, I guess I am pretty awesome just for waking up today. Thanks for the comments.

That's certainly balancing my horoscope by the way: 

Safety should be your primary concern today -- even more so than usual! It's a good time for you to check fire alarms, ask the right questions of landlords and others and just keep your eyes open.

If you are a Capricorn, proceed with caution.

Theresa Flaherty
Type 1

by: Theresa Flaherty - Friday, November 8, 2013

November gives me  an excuse to climb up on my diabetes soapbox and blog (as if I needed one, already!).

That's because November is Diabetes Awareness Month and I've seen countless posts, promotions and projects aimed at raising awareness. For the record, I find the "take the T1D for a day text challenge" the most intriguing. Hmmm, maybe I should take it and see how it compares to the real deal.

This week, we learned that Arriva had bought Diabetes Care Club. As one of the analysts I spoke with about the deal told me, the competitive bidding program has reduced diabetes supplies to such a commodity that, 1. mail order on a large scale is the only way to work with those prices, and 2. for providers who really like to work with people—and I'm not saying Arriva doesn't—it's no fun to just pack and ship.

That's too bad, because folks can always use a little encouragement along the way. If that goes away, it's a great disservice to the folks that depend on meter advice, or, for some folks, I imagine, a friendly voice on the phone. Stay tuned to see how much more this market condenses.

A final point to this disjointed blog: My favorite headline (actually, police blotter heading) this week: $2100 of Dental Whitestrips & Diabetic Supplies stolen.

Good health and a gleaming smile are important.

Theresa Flaherty

by: Theresa Flaherty - Monday, November 4, 2013

The announcement of the Round 2 contract winners earlier this year was quickly followed by the realization that many of those contracts went to companies that, for various reasons, did not meet state licensure requirements—something that should have been part of the process in awarding said contracts (this is where transparency would be helpful).

Full speed ahead to the Round 1 re-compete (not to be confused with Round 1 re-bid), and I have just heard, via email, from a licensed, family-owned provider (details have been omitted to protect the innocent), and holder of rRound 1 contracts that was not awarded contracts in its primary areas of business because, according the CBIC, they are not licensed in that state for those products. The only contract offer they received was for mobility (call me crazy, but it seems unlikely they would be meet any existing licensure requirements for this category, but not, say General HME).

"But because of some bureaucratic ineptitude‚—refusing us contracts on the false basis that we are not licensed—a significant portion of our ... business may very well vanish. And, though we can ask nicely for the review board to remedy their clear error, pleading is our only recourse. The MMA that created this foolishness precludes any judicial or administrative review remedies."

Adding insult to injury: out-of-state companies that were awarded contracts in the state in question.

Stop me if any of this is sounding familiar.

The provider is asking the CBIC to review the decision but asked to remain anonymous for fear of reprisal, which I find as disturbing as anything else about the whole bidding program. When Americans fear reprisal from government agencies (and, I am not talking about NSA spy tactics, here), well, I just don't know what to think.