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by: Theresa Flaherty - Friday, December 18, 2009

It's bitterly cold here today in our little corner of New England, although today's weather is an improvement over yesterday when temps could most optimistically be described as bone-chilling.

As I scurried from my car, I thought of all the seniors who were probably staying inside, safe from icy walkways and blowing winds. Many of them, the ones providers are most familiar with, are homebound for health reasons as well. They have limited mobility or may be on oxygen and find it too cumbersome to be out and about. Some may have no nearby family to check on them. Who do they see on a regular basis? Quite often, it's their delivery tech, RT or other home health care provider who provides the only visitor some folks see.

While it may not be a reimbursable service, it's nice to think that someone, in this case, Joe Provider, checks in on patients, especially during this cold, dark and, for many, lonely time of year.

Unfortunately, as many of the providers I've talked to lamented this week, reimbursement cuts are  making it harder than ever to provide the service seniors have come to expect. Most expect the problem to get worse.

It's just one more hole in the safety net for a lot of these folks and Congress would do well to remember their constituents as they bicker over health care reform.

Theresa Flaherty

by: Theresa Flaherty - Thursday, December 17, 2009

I don't follow football but I do follow sleep apnea and I know that football players are as likely to suffer from the disease as anyone else. According to an article posted on the, Steeler Deshea Townsend took an apnea screening test at an area mall on Tuesday. He plans to take a sleep test after Pittsburgh's season ends.

Sleep screenings were held to give men a chance (and no excuse not to) to get tested while out shopping. It was organized by ESPN 1250 general manager Mike Thompson who suffers from sleep apnea.

"I get eight hours of sleep. I have more energy, more vitality. My blood pressure -- despite my size -- is normal, and since 1992, it changed my life," Thompson said in the article.

Theresa Flaherty

by: Theresa Flaherty - Monday, December 14, 2009

By sheer chance, I got the H1N1 vaccine today. I happened to be at the doc's and she happened to have it. With all the hype and hysteria around the virus, I should consider myself lucky to get it so easily (I was really looking for the seasonal flu vaccine).

For the record, it hurt less than the regular flu shot.

Provider Doug Mooradian, of Health System Services in New York, told me recently they played host to an H1N1 clinic. It drew 600 people and the local media to their location. Yes, 600 people, plus whoever saw any related media coverage, heard HSS's name, saw their location and will in the future have a positive association with the company (aren't those the guys who had the flu shots last year? Maybe they will have the HME we need).

To further his PR push, Doug had some pix taken and sent them to me. Check out page 19 in the January issue to see how the line (of potential future customers) wraps around the block.

Theresa Flaherty

by: Theresa Flaherty - Wednesday, December 9, 2009

Ohio lawmakers yesterday passed a bill that would require insurance coverage for diabetes. The state is one of a handful that do not currently require such coverage.

Think about it. There are (I believe) four states I could never live in for this one reason. What happened to the land of the free?

The proposal still has to pass the Ohio Senate and, according to news reports, passage is uncertain. The big concern for lawmakers: insurance mandates would burden small businesses.

I work for a small business. I understand the concern. Really.

However, when people with diabetes lack insurance and are unable to afford basic care, they risk ending up much sicker, and eventually disabled. That places an expensive burden on everyone, from businesses to Joe Taxpayer. When will lawmakers, either on the state or federal level, get the message: shelling out some dollars for preventive care is far more cost-effective than ignoring the long-term risks of not doing so?

Theresa Flaherty

by: Theresa Flaherty - Tuesday, December 8, 2009

It's been just over a year since Medicare's new compliance requirements went into effect for CPAP. Over the past year, I have checked in regularly with CPAP providers to see how its going. For the most part, providers take the good with the bad and simply try to take care of patients. However, I never fail to be amazed at the disconnect between Medicare/physicians/beneficiaries, with the provider stuck firmly in the middle.
Kelly Riley, director of the MED Group's National Respiratory Network forwarded me this latest example from a provider:
We have had patients that have not been compliant at the end of the 91 days. When presented with the available options at the end of the trial period we have had a local pulmonologist tell us that if we picked up the patient's equipment (they were unwilling to order a new sleep study, DC or change the patient to bilevel) that … we would never receive another referral from them again and become "blacklisted".  They did not care what the Medicare rules were. Keep in mind that the patient is unwilling to sign an ABN and refused to voluntarily return the equipment because she says the Dr wants her to have it. This is putting the dealer in a catch 22 situation.  Can we get guidance from the Medical directors on what to do when this happens?  I believe there needs to be some recourse to the physician in a case like this.
This provider raises some good points. Is it fair for physicians to, essentially, threaten providers with blacklisting? Is it legal for a beneficiary to hold CPAP equipment hostage? Isn't that ... stealing?

Providers, what else are you experiencing?

Theresa Flaherty

by: Theresa Flaherty - Monday, December 7, 2009

We hear a  lot about industry efforts to repeal competitive bidding, the oxygen cap, etc. But another effort continues to chug quietly along: getting Medicare to cover home infusion therapy. The most recent effort, The Medicare Home Infusion Therapy Coverage Act, continues to gain sponsors.

It's not the first time the issue has come to the table, but industry stakeholders hope this time they achieve their goal. With all the focus on cost savings to the health care system, the home infusion message should be a winner, but it's hard to get lawmakers to understand that at times, says provider Kevin Nestrick, owner and founder of Altius.

"We've gotten very close but we can't seem to get them over the hump," he told me recently. "It would be a tremendous savings to Medicare but they don't (see) that."

The average cost to provide infusion therapy per day: $200 in the home; $300 in a skilled nursing facility (SNF); and $1,200 in a hospital, according to the National Home Infusion Association.

As of Dec. 1 32 senators and 102 representatives have signed onto the bills (S. 254 and H.R. 574). To see if your lawmaker has done the right thing, go here for a list.

Theresa Flaherty

by: Theresa Flaherty - Friday, December 4, 2009

CMS is circulating a reminder to pharmacists: If  you're not accredited, your time is almost up. In October, the deadline for accreditation was pushed to Jan. 1, 2010. We've seen a flurry of announcements in recent weeks from pharmacies who just received accreditation—those are the folks lawmakers and industry stakeholders had in mind when crafting the extension.

In the meantime, current health care reform includes a permanent exemption for pharmacies that bill Medicare for less than 5% of their DME revenues.

But pharmacists shouldn't wait around to see if that passes. The road to health care reform promises to be a long haul and there are no guarantees that pharmacists will ultimately escape accreditation.

And, don't forget about those surety bonds!

Theresa Flaherty

by: Theresa Flaherty - Thursday, December 3, 2009

This is kind of cool.

The Reggie White Sleep Disorders Research and Education Foundation has developed a free iPhone application that enables users to determine if they are at risk for obstructive sleep apnea. The "app," Sleep Well, combines three screening tools used by sleep specialists to determine an individual's risk of having or developing the sleep apnea.

The app also includes a feature that will list nearby sleep disorders centers for users. iPhone users can get the app at

Theresa Flaherty

by: Theresa Flaherty - Monday, November 30, 2009

There was a reader essay in my local Maine Sunday paper yesterday: a goodbye to a "much-loved" cat. The cat, a 16-year-old Siamese, was diagnosed with pancreatic cancer.

From diagnosis to death: a visit to the emergency vet; an ultrasound to reveal a grapefruit-sized tumor; a visit to a pet ultrasound specialist in New Hampshire; a visit to a veterinary cancer surgeon in Boston; scripts for kitty painkillers and appetite stimulants; a visit to a local veterinary cancer specialist; a holistic veterinarian acupuncturist; and finally a home visiting vet to put the poor thing to sleep—the cat, not its owner.

The cat, old and terminal (it's pancreatic cancer, for crying out loud) was hauled around New England in search of a happy ending that was never going to happen. Granted, it's the owner's right to spend her time and money on her pet however she wants, but honestly. Accept the inevitable already.

When it comes to people, I think many of us do the same thing. On 60 Minutes a few weeks ago there was a story about how patients, their families and the medical establishment just refuse to let people die. And, while those folks are in the process of trying not to die, they are subjected to numerous procedures, tests and specialists. I don't mean to sound heartless, but what a waste of money!

Earlier this year, there was a great hue and cry over "death panels." But, in the health care reform debate, there needs to be an honest discussion about when to let go. It helps no one to prolong pain and suffering and it certainly needs to be considered when talking about taxpayer dollars. Death happens everyday in the private insurance sector as well as for the uninsured. There's no reason the Medicare/Medicaid populations should get a reprieve.

If we are going to extend health care coverage—in any form—to a greater number of people, we have to start controlling costs across the board.

Stay healthy, Bruce.

Theresa Flaherty

by: Theresa Flaherty - Wednesday, November 25, 2009

So, I am reading some health care reform news today on Crain's New York and there is an article about how disease state management programs can reign in costs for diabetes patients. I don't belong to such a program, but I agree with the concept.

Apparently, UnitedHealthcare tested just such a plan this year with three national employers. What shocked me was that United says the average health care costs for an employee with diabetes (keep in mind, if they are employed, they aren't the blind, legless, dialysis patients) are $22,000 a year.

$22,000?! How is that possible? That's almost $500 a week. Does that seem high to anyone else?

I logged on my insurer's Web site to review my diabetes-related claims thus far for 2009. My total costs (both out-of-pocket and paid by the insurer) are roughly $4,586.71. That includes prescriptions (almost half), assorted bloodwork (standard for diabetes patients), one visit to the endo and two visits to the dietician.

Where on earth did the other $16,413,29 cents go? Am I just better than average at controlling costs? (Despite having insurance, I am always mindful of how much my insulin and test strips are if I paid retail). Do other people with insurance just say yes to everything cause someone else is paying for it? Do their doctors feel more free to order tests, etc? Are the costs just out of control?

Of course, I see the doc a little less frequently then others, stretch out my scripts longer than recommended, have skipped the eye exam so far this year and haven't gotten my $25 flu shot (Sorry Dr. B. they aren't available in Maine this season).

But I take care of myself, as recommended and try not to waste health care dollars—mine or the insurers. Isn't that what health care reform should be about?

Theresa Flaherty, Type 1, 10 years, 3 months