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by: Theresa Flaherty - Tuesday, May 18, 2010

I came across this story about a Medicare bennie who, well, the lead on this story sums it up better than I ever could:

Imagine coming home to find a brand new, $6,000 wheelchair sitting in your living room. That's what happened to Henry Harden of south Dallas. The problem: he didn’t order it, doesn't need it and had no idea where it came from.  Why should you care?

The story first details Harden's attempts to divest himself of the chair and then, when he still received a bill from Medicare, the attempts of his local Fox affiliate to follow "the paper trail."

As I read it I couldn't help but wonder how Medicare ever approved the thing. Why, when the agency continues to come up with ever increasing rules and regs to circumvent fraud, does something like this happen?

I will say that the article raised another question for me: How the heck would competitive bidding have prevented this particular instance?

The answer: It wouldn't.

Theresa Flaherty

by: Theresa Flaherty - Friday, April 23, 2010

There was a nugget of encouraging news at this week's MED Group Respiratory Summit in Jacksonville. There's a rumor floating around that CMS could take another look at its most recent set of rules for CPAP.
Patients who need an upgrade from a CPAP machine to a bi-level device must meet four--all four, the way it is written--of a set of metrics. That of course, must be documented by physicians.
"There is some movement to get CMS to (back away from this)," said Dan Brown, a healthcare attorney with Greenburg Traurig in Atlanta. "I think it will be revisited."
Simply re-evaluating the use of the word "and" with the use of the word "or" could make a big difference, providers say.
You can be sure the issue is top of the list for member of AAHomecare's new CPAP taskforce. Taskforce members are currently working to enlist the help of stakeholders among various industry groups as well as patients and physicians.
The taskforce plans to present its strategy at Medtrade Spring in Las Vegas.

Theresa Flaherty

by: Theresa Flaherty - Tuesday, April 20, 2010

At lunch today I was asked what topics I cover for HME News.  My main beat is, of course, specialty providers, including CPAP and sleep issues, hence my appearance at the respiratory spoke of the MED Group's Leadership conference here in Jacksonville.

"Specialty. That's the orange page, right?"

Well, yes, as a matter of fact it is the orange page (I also write for the green and blue pages, too).

That's the great thing about this event. It's designed with networking in mind. Round tables facilitate conversation just like the aforementioned. It's a big reason why providers make the trek to this event, to meet with fellow providers and learn what works and what doesn't for them. As one provider told me this afternoon, "These are the top (people) from these companies. Sitting down with them for 10 or 15 minutes and picking their brain is totally valuable."

For providers, it's also a good chance to know they are not alone (or crazy) when banging their head against the wall over trying to explain the latest CPAP LCD to physicians.

For me, its a chance to meet people in person and learn what's going on with their companies, good and bad. Like Bob O'Connor, who I featured about a year ago when Home MediService took several severely wounded Veterans hunting. This year, they did it again and also arranged a fishing trip and some other similar activities.

There's an old saying, "There's a million stories in the naked city." It's nice when people get to tell them to each other in person at an event like this and go away remembering why they stay in this business.

Theresa Flaherty

by: Theresa Flaherty - Monday, April 19, 2010

Despite cloudy skies over Jacksonville, the providers attending this year's MED Group National Respiratory Conference seem to have a somewhat sunny disposition. They are interested in what's going on and what they can do to stay viable.

Today's speakers included Phil Porte and Patrick Dunne, both of whom I am sure you've heard of.

Both made some interesting observations/comments today that got me thinking.

Phil compared the 36 month cap on oxygen to the Medicare Part D donut hole and, you know, he's right. It is a big gap for patients (and providers) to fall into after that 36 months is up, but before they hit that five-year mark.

He also had some straight talk for providers about health care reform. It's here to stay. For those of you lollygagging around and saying, "Maybe it'll get repealed," it's time to face the music.  It won't.

So yes, certain aspects of the new health care reform law are in play at this year's event, as well as discussions on the latest CPAP guidance and other common concerns of the respiratory provider.

As part of health care reform law, hospitals apparently have to reduce hospital readmissions, and Patrick talked about how providers can position themselves to help hospitals do just that. There's too much to get into right now, but HME News will take a closer look at this topic. Meanwhile, I leave you with this comment of Patrick's which seems to sum it all up nicely:

"If it looks like a barrel of lemons to you, get some sugar and learn to make lemonade."

Theresa Flaherty

by: Theresa Flaherty - Friday, April 16, 2010

Here's a shout out to a blog I stumbled across this morning. It's called a sweet life and it's about diabetes. It caught my eye because a recent posting contained a fascinating history lesson.

After wondering how people with Type 1 diabetes managed to survive the Holocaust, the blogger dug up a story about Eva Saxl, who, along with her husband, fled Nazi-occupied Prague for a Jewish ghetto in Shanghai, which was Japanese occupied at the time. The Japanese began shutting down pharmacies and insulin was impossible to get, except through the black market.

Eva and her husband, Victor, with the aid of a medical textbook, created their own insulin by, get this, extracting it from the pancreases of water buffaloes. Keep in mind that they also had to keep the insulin bacteria-free as well as at proper potency level and you start to realize just how crazy—and brave—this was.

But, it not only worked, Eva and Victor were able to make enough insulin for other diabetics living in the ghetto.

The Saxls eventually landed in the United States, where Eva became a spokeswoman for the American Diabetes Association at a time when most people with diabetes kept it hidden.

I guess I shouldn't complain about those expensive vials of insulin I get from CVS.

Theresa Flaherty

by: Theresa Flaherty - Thursday, April 15, 2010

Could this be competition for the negative pressure folks? An MIT doctoral student has invented a hand-powered suction healing system.

The kicker here: It costs about $3, a far cry from the $3,604 providers pay for new pumps.

According to an article in Fast Company Magazine:

The device, which has been field-tested in Haiti, is composed of an airtight wound dressing, connected by a plastic tube to a cylinder with accordion-like folds. Squeezing it creates the suction, which lasts as long as there's no air leak. What's more, where regular dressings need to be replaced up to three times a day--a painful ordeal--the new cuff can be left on for several days.

I realize I am comparing apples to oranges here folks, but still, you gotta admit, it's an interesting concept, not to mention an improvement over the leech treatments of yore.

Theresa Flaherty

by: Theresa Flaherty - Thursday, April 1, 2010

Unless you've been living under a rock (and I know some of you out there have), you probably know that the health care reform bill expanded Round 2 of competitive bidding to an additional 21 MSAs. There is no official list, but AAHomecare (if you haven't joined, you really should) has put together an unofficial list of potential areas. But, the bigger picture is, even if you are not in Round 1 or 2 of the dreaded program, competitive bidding is going to affect you.

I repeat, this is not an unofficial list.

Philadelphia-Camden-Wilmington, PA-NJ-DE-MD
Washington-Arlington-Alexandria, DC-VA-MD-WV
Boston-Cambridge-Quincy, MA-NH
Phoenix-Mesa-Scottsdale, AZ
Seattle-Tacoma-Bellevue, WA
St. Louis, MO-IL
Baltimore, MD
Portland-Vancouver-Beaverton, OR
Providence-New Bedford-Fall River, RI-MA
Buffalo-Niagara Falls, NY
Rochester, NY
Tucson, AZ
Honolulu, HI
Albany-Schenectady-Troy, NY
Oxnard-Thousand Oaks-Ventura, CA
Worcester, MA
Springfield, MA
Sarasota-Bradenton-Venice, FL
Stockton, CA
Poughkeepsie-Newburgh-Middletown, NY
Boise City, ID

Also, here are the next three beyond the 21-MSA cutoff:

Madison, WI
Des Moines-West Des Moines, IA
Harrisburg-Carlisle, PA

by: Theresa Flaherty - Wednesday, March 31, 2010

The call came in around 3 this afternoon.

"Theresa, do you remember me?" asked the caller. "I just got my billing number reinstated, but only to March 27. What about all those other months of rental on my equipment?"

That provider's lawmaker had written a letter on his behalf and within two weeks he had his number back, although he is still seeking to bill retroactively the date he relinquished it.

Meanwhile, the volume of calls to the National Supplier Clearinghouse Advisory Committee has dwindled, said Rose Schafhauser, operations administration for the committee.

"Hopefully--hopefully--the worst is over," she said. "I think the backlog was so large and you had so many people that were voluntarily suspending their number (they couldn't keep up)."

Well....the NSC should have planned better. I can imagine what would happen if I took five  months to write a story. Or pay a bill.

Needless to say, but I'll say it anyway, the whole experience has left a bitter taste in providers' mouths.

"Eth," who got her (his?) number today reinstated today, posted this comment to a blog I wrote in February.

"For the first five months, our application was in the mail room in a pile. In January, it was changed to a pile on someone's desk. Unbelievable! Sixty days as advertised turned into eight months--wish my creditors had the same timeline."

Congrats to these to providers on their perseverance. Shame on CMS and the NSC.

Theresa Flaherty

by: Theresa Flaherty - Monday, March 29, 2010

I was reading the latest issue of Newsweek yesterday and one article caught my eye. It had to do with how far, and not so far, women have come in the workplace over the last 40 years.

In 1970, 46 female employees ("dollies," they were called) sued Newsweek for gender discrimination. Fast-forward to 2010: Much has changed, says the article, titled "Are we there yet?" but sadly, women (everywhere, not just at the magazine) have not totally caught up. In 2010, women still earn only 77 cents on the dollar to men. In 2010, women who hold MBAs earn $4,600 less per year in their first job out of B-school then their male counterparts. In 2010, 43% of all women are employed as secretaries, nurses, teachers and cashiers, very little change from 1960. You get my drift.

Coincidentally, at HME News last week, we were trying to think of a few strong women leaders in the industry. We know you're out there. But, it is far easier to list a bunch of strong and, frankly, not-so-strong male executives in the HME world. And, I know from the many Medtrade shows I've attended, pen and notebook in hand, that I often have to seek out women when looking for a balanced variety of quotes. Why is that?

What is the make up of your company? Are there women in the upper ranks or are they answering phones and doing the billing? Whatever their job description, are their salaries on par with male colleagues doing the same work?

Theresa Flaherty

by: Theresa Flaherty - Tuesday, March 23, 2010

OK. I think a new food/obesity study making the rounds today is trying to compare, well, apples to oranges.

Brian Wasnik, a Cornell University food behavior scientist, and a team of researchers, used a computer to compare the size of the food depicted in 52 paintings of The Last Supper, including Da Vinci's famous rendering.

The size of the main dish grew 69 percent; the size of the plate, 66 percent, and the bread, 23 percent, between the years 1000 and 2000.

"I think people assume that increased serving sizes, or 'portion distortion,' is a recent phenomenon," said Brian Wansink, director of the Cornell University Food and Brand Lab and author of "Mindless Eating: Why We Eat More Than We Think." "But this research indicates that it's a general trend for at least the last millennium."

It's a painting. Paintings have as many meanings and interpretations as there are artists to paint them. Deconstructing a painting, as any art history student could tell you, is not about taking it literally and applying a modern context to it. In this case, I would wager  the large portions are meant simply to reflect bounty or abundance, not actual serving sizes. And yes, as people became more innovative, and wealthier, they had more food. Besides, who wants to look at a painting of the Last Supper and see bread and water (or, in this case, wine).

Still, I suppose it's a fun study, if not pure science. Here's an article for further reading, from the Los Angeles Times.

I just seriously hope a breakdown of body types a la Picasso isn't next.

Theresa Flaherty