Subscribe to E–SP RSS Feed

E–SP

by: Theresa Flaherty - Tuesday, August 17, 2010

If you've read the Executive Session blog lately, perhaps you have an opinion on Mike Moran's suggestion that maybe certain items could be paid for—wait for it—with cash. By the consumer.

It's no accident that I say consumer, rather than beneficiary. No matter who is paying for the product or service, it is a "consumable."

I consume diabetes supplies and medications (and books, dinners out, theater tickets, a lighthouse bookmark and a fun set of bowls to give as a birthday gift, all just in the last week).

I willingly forked over the cash for everything but the strips and insulin, which, fortunately, are mostly covered by insurance. Still, the copay chips into my disposable income and I resent it. I have for 11 long finger-pricking years.

I think a lot of people hate paying for health care just on principle and I don't know why that is. For me, it's partially just diabetes fatigue, the knowing that I will continue to spend thousands annually for the privilege of a diagnosis.

Meanwhile, my mom rants and raves about having to pay certain health care costs, but does indeed own a flat screen TV, and a shiny red sports car. She's also a bit  jealous of my Dad's Medicare plan (the "Cadillac," I believe she called it.)

But, as provider Ron Frantz said in a phone call this morning: No matter how sick people are, they are going to do what they want. In his area, that seems to be vacationing, attending sporting events or gambling at the local casinos.

"If you've ever sat down and looked at the price of (football) tickets, it's unbelievable," he said. "But people will do it."

He's right, and Mike is right (frame this, Mikey). Most people—I said "most,"—can find the cash for what they need and often, for what they want. The trick is working health care products into that equation.

Theresa Flaherty

Tags:
by: Theresa Flaherty - Monday, August 16, 2010

Do you ever feel bad for the hardworking providers in South Florida? The ones that are aboveboard and honest who seem to spend as much time battling negative image as they do selling home medical equipment?

I mean, when Medicare contributes to the fraud problems in the area, what's a provider to do? In the latest fraud news from the sunshine state, Medicare paid out $28,600 in false claims for, uh, penis pumps. Yes, they are a covered item (at $395 at, ahem, a pop). But not for females. I mean, what's the diagnosis code for that?

As reported in the Miami Herald:

Emilio Felipe Lopez, 47, president of Charlie RX, and Orlando Hernandez Estevez, 25, president of Happy Trips, were indicted on charges of healthcare fraud in February. Last week, FBI agents arrested the two Hialeah businessmen.

Both defendants are accused of stealing Medicare patients' numbers and doctors' identifications to submit nearly $2 million in bogus bills to the healthcare program for the elderly and disabled between October and February.

Lopez's company, Charlie RX, billed Medicare a total of $689,853 in phony claims for medical equipment, including $41,000 for penis pumps for both male and female patients, according to authorities. Medicare reimbursed his business $370,853, including $24,000 for the pumps.

Hernandez's company, Happy Trips, submitted $1,188,956 in false claims for inhalation drugs and other medical services, including $22,000 for the erection systems, officials say. Medicare paid his business $364,120, including $4,600 for those systems.

Tags:
by: Theresa Flaherty - Friday, August 6, 2010

The MED Group's Kelly Riley wanted me to give her a call next week so she could bend my ear a bit on CPAP audits in region C.

As juicy as that sounds, I am going to be on vacation and really don't want to think about CPAP machines. (Note: I am staying with my parents who, at times, seem as though they are taking turns to see who can snore the loudest, so sleep apnea won't be completely out of mind).

I also don't want to think about home medical equipment while I sit on the beach overlooking Cape Cod Bay with a stack of fun reading material (I'll be leaving my copy of HME News in the office).

But of course, HME is everywhere. I'm sure I'll see it in the restaurants I eat in, during shopping excursions and anywhere else I go next week (a shout out here to Cape Medical Supply, which is probably responsible for the majority of HME I'll see next week).

But, I guess that's the point of HME isn't it? It's everywhere to make life more accessible for people and I hope while Congress is on recess, they too, will take note of how important HME is to many of their constituents.

Theresa Flaherty

by: Theresa Flaherty - Wednesday, August 4, 2010

Executive editor Mike wanted me to blog about a man with Type 2 diabetes whose dog ate his big, ulcerated toe. Turns out the man had blood sugars of over 500 (I assume he was undiagnosed, the article is unclear).

Yuck! Could you really every look at Fido the same way again? (I'd be sleeping with one eye open).

I would prefer to write about a study that targeted teens with diabetes and how text messages can lead to better self -management.  Dr. Jennifer Dyer, an assistant professor of pediatrics at The Ohio State University, sent specific treatment reminders and supportive messages to teen diabetes patients. Turns out, it was a great way to get their attention. The teens who received the texts were far more likely to stick to their treatment plans.

Practical. Inexpensive. Considerate of audience.

That's smart medicine. And smart business.

Theresa Flaherty

Tags:
by: Theresa Flaherty - Tuesday, July 27, 2010

Lots of people with diabetes, particularly the Type 1 crowd, pass along comments and, more often, criticism of incorrect or misleading information when they come across it. It can be exhausting to keep up with educating the world one misinformed (or sometimes, lazy) reporter at a time.

Others of us have a soapbox known as  "The Blog." Allow me to call your  attention to a badly written article posted today on the DaytonTribune.com, by an, I assume, young lady named Stephanie.

First, the headline: Diabetes supplies – do diabetics need to choose between dangerous drugs? Huh? Supplies are not drugs and drugs are not supplies. And, the rest of the piece doesn't back up this headline. (In all fairness, the writer may not have penned that clunker).

Second: Stephanie refers to the problems inherent in rushing "potential cures" out the door before they are properly tested.

True, but she uses Avandia as an example. Stephanie, a diabetes drug is not a cure. It is simply a treatment. And, apparently you haven't heard, but there is no cure for diabetes at this point in time. Maybe some day. But not today, probably not tomorrow either.

Third: "Insulin pens replace the need to inject insulin with needles." While I suppose technically the pens replace syringes, the pens themselves deliver the insulin via...a needle. And, while I have enjoyed the convenience of the pens in the past, the dosing has often been somewhat inaccurate. Oh, and the needle is sharp, no matter where it comes from.

Fourth: "Now technology has come up with battery power state of the art insulin pumps that when used in conjunction with glucose monitoring device can greatly improve the freedom a diabetic can now enjoy."

A little behind the 8-ball, here, Steph. Insulin pumps have been around for quite some time now and yes, they get better all the time. Glucose monitoring devices are not commonplace, though. And, quoting a study funded by a pump manufacturer, no matter how reputable, is kind of questionable. Of course, they are going to say their product is fantastic. It's called PR.

A little homework next time, please.

Theresa Flaherty

by: Theresa Flaherty - Friday, July 23, 2010

Editor Liz just sent me a link to an iPhone app (obviously, she is shopping instead of working this afternoon). It's called "FatBooth" and it allows users to add 100 pounds to their photos so they can see how they'd look if they partook of too many Luther Burgers.

The heck with calorie-counting or carb-tracking apps. This could be a true motivator to get or stay fit.

Gotta run. I need to find someone with an iPhone. Stay tuned.

http://itunes.apple.com/us/app/fatbooth/id372268904?mt=8

Theresa Flaherty

Tags:
by: Theresa Flaherty - Wednesday, July 21, 2010

"I'll call you back when I think of some good news," one provider told me yesterday when I called to see what's shakin' out there.

"Theresa, I just got word that Medicaid cut strips 26%," said another. "I can't talk now."

And so it goes, across the country.

These aren't folks in the round 1.2 bid area by the way. Just average providers in average towns. That's with the folks who answered the phone. Hopefully, the rest of you are just on vacation, not cowering under your desks.

Meanwhile, I shall continue to toil at my phone, looking for news stories (anyone?), and all I can say is stay cool everyone. You've survived this long. We all have.

"Good luck to us all," a West Coast provider said to me as we hung up. "If I don't last, neither will you. You won't have anything to write about."

Theresa Flaherty

by: Theresa Flaherty - Friday, July 16, 2010

I don't care to give this one-sided opinion piece in the Orlando Sun Sentinel any more press, but in case you've missed it, you should know how badly skewed the perception of the HME industry is, at least in areas where Medicare fraud is rampant.

There is so much to dislike about it, it's hard to decide where to start. I think, however, that my biggest issue with this piece is the way he keeps tying HME and competitive bidding in with fraud:

On the first full moon of the year, a group of medical-supply lobbyists and a group of Medicare bureaucrats meet at midnight. They put three pieces of folded paper in a hat -- 20 percent, 30 percent and 40 percent.

They pick one and add that to the cost of the wheelchair.

Then they put the paper back into the hat and move on to oxygen tanks and all the other equipment Medicare provides.

Meanwhile, down in Miami, the drug dealers who are out on parole get the updates. They set up medical-supply companies, submit the requisite fraudulent forms and open for business.

Pretty soon, dead people all over South Florida are buying wheelchairs. So are live people who don't even know it because their identities have been stolen.

Really? Where is he making the connection between someone like provider Rob Brant (sorry Rob, but I got to pick on someone) and drug dealers. Did I miss something?

Apparently, the writer has missed efforts to curb Medicare fraud, which the HME industry stands behind 100%. If Medicare is paying for a wheelchair for a dead man, that's a Medicare problem, not a provider problem. Hell, we've all heard stories of beneficiaries trying to report fraud or give back stuff they didn't order. But, Medicare don't want to know.

I close by saying that this piece (notice I have refused to call it an article, as there was no reporting involved) is so misinformed, so biased and so slanted (am I being repetitive) that I think even CMS would agree it's wrong.

Theresa Flaherty

Tags:
by: Theresa Flaherty - Wednesday, July 7, 2010

As a fun follow up to my previous blog on the fattest states, here's something from Health magazine called the "50 Fattiest Foods in the States." It's a menu of shame comprised of a dish from each state. My personal pick for the worst: Georgia's Luther Burger, which consists of a bacon cheeseburger on two glazed doughnuts. Paula Deen (rhymes with "butter queen") gave it her own twist by adding a fried egg. Did I mention this thing is named after Luther Vandross, who suffered from Type 2 diabetes? And died of a heart attack?

I do have a tiny quibble with the article. For Maine, it lists the lobster roll. But it takes the nutritional info for the crustaceous sandwich from a fast food chain, which requires me to delicately point this out: No self-respecting Mainer (pronounced "Maine-uh") would get a lobster roll from a fast food joint. Last I checked, we don't even have a Red Lobster restaurant here (there was one, briefly, but it didn't last).

Granted, with all the butter and mayonnaise on lobster rolls, this sandwich is never going to get a "heart healthy" award from anyone. But at least it isn't served on doughnuts.

http://www.health.com/health/gallery/0,,20393387_11,00.html

Theresa Flaherty

Tags:
by: Theresa Flaherty - Wednesday, June 30, 2010

What do all these states have in common (besides being Southern)? They are the current fattest states in the nation, with more than 30% of adults weighing in as obese. Mississippi, a frequent flyer on this list, tops it off at 33.8%. Are y'all trying for 40%?

Maine, where we live, isn't too much better, tied with Arizona at number 29 with a rate of 25.8% (ayuh). Sadly, only one state has less than 1/5 of its citizens classified as obese. Colorado, at 19.1%.

All this is included in the report, “F as in Fat: How Obesity Threatens America’s Future 2010," issued by the Trust for America’s Health (TFAH) and the Robert Wood Johnson Foundation.

I know, I know. Nutrition is hard. Fat/salt/sugar tastes good. All the diets are confusing. I'm gonna let you in on a little weight loss/control secret.

Eat less, move more.

Theresa Flaherty

Tags:

Pages