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Andrea Stark
reimbursement consultant, MiraVista

Editor's note: In the wake of new market pressures, upgrades, non-assigned claims and cash sales are taking center stage, says industry consultant Andrea Stark. The market has changed and your business should contemplate the suitability of these options, but they are not appropriate in all cases, she says. This is the second in a series of mini-articles that break down the top myths of filing non-assigned claims and leveraging upgrades and cash sales.

Myth #3:  Every claim can be filed as non-assigned.

This is FALSE.

The most significant roadblock to filing non-assigned is a supplier’s participation status with Medicare. You must be non-participating to file a non-assigned claim. Your participation status with Medicare can be verified at www.medicare.gov using the “find a supplier” tool. Select a product you sell for a zip code located in your service area. If there is an “M” icon next to your company name, then you are a designated participating supplier and you must accept assignment on all your claims through the end of the year. This status can only be changed by sending a letter to the NSC in December that you no longer wish to participate. Participation status is governed at the tax ID level. If you multiple lines of business (hospital, home health, etc.), and any line participates, all lines must participate.

Another obstacle pertains to patients that are dual-eligible (meaning they have Medicare and Medicaid coverage). Medicare mandates assignment for these claims if you choose to service this group of beneficiaries. You do, however, have the right to refuse service.

Another barrier to filing non-assigned applies to pharmacies. Medicare mandates that all covered drugs be filed on an assignment basis. There are very few covered medications under Medicare Part B, but aerosol medications used with nebulizers, immunosuppressive medications for organ transplant patients, oral anti-emetic drugs for chemotherapy patients, and select medications infused through a pump are some of the medications subject to mandatory assignment.

If your company can clear the three hurdles listed above, filing non-assigned may help you cross the finish line.

Andrea Stark
reimbursement consultant, MiraVista

Editor's note: In the wake of new market pressures, upgrades, non-assigned claims and cash sales are taking center stage, says industry consultant Andrea Stark. The market has changed and your business should contemplate the suitability of these options, but they are not appropriate in all cases, she says. This is the second in a series of mini-articles that break down the top myths of filing non-assigned claims and leveraging upgrades and cash sales.

Myth #2:  DME suppliers are bound by a “limiting charge” when billing non-assigned, and beneficiaries cannot be charged more than a certain percentage over the Medicare fee schedule allowable.

This is FALSE.

The “limiting charge” concept applies to Part B services like physician visits, but does not apply to durable medical equipment. The limiting charge restricts physician collections to a maximum of 115% of the Medicare fee schedule when they file non-assigned. Physicians are further subject to a participation penalty when they do accept assignment (non-participating physicians receive a maximum of 95% of fee schedule amounts when they do accept assignment). Neither the participation penalty nor the limiting charge apply to durable medical equipment. The CMS publication titled “Medicare Coverage of Durable Medical Equipment and Other Devices” states, “If a DME supplier doesn’t accept assignment, there’s no limit to what they can charge you.”

Andrea Stark
reimbursement consultant, MiraVista

Editor's note: In the wake of new market pressures, upgrades, non-assigned claims and cash sales are taking center stage, says industry consultant Andrea Stark. The market has changed and your business should contemplate the suitability of these options, but they are not appropriate in all cases, she says. This is the first in a series of mini-articles that break down the top myths of filing non-assigned claims and leveraging upgrades and cash sales.

Myth #1:  If an item is not coded, it does not have to be billed.

This is FALSE.

First, every “potentially covered” item has to be billed as a result of federal guidelines in the Social Security Act. If Medicare ever pays for the item, then you have to file the claim, even if you do not expect it to be covered for a specific beneficiary. This is often referred to as mandatory submission of claims: “The Social Security Act (Section 1848(g)(4)) requires that claims be submitted for all Medicare patients for services rendered on or after September 1, 1990. This requirement applies to all physicians and suppliers who provide covered services to Medicare beneficiaries, and the requirement to submit Medicare claims does not mean physicians or suppliers must accept assignment.”

Second, manufacturer product coding is generally voluntary unless mandated by the DME MAC. When coding is voluntary, the onus is on the supplier to make the best coding decision using existing codes and product characteristics. If it looks like a standard walker, acts like a standard walker and functions like a standard walker…then the claim should be filed using a standard walker HCPCS code (even if the vendor has not submitted the item for coding). However, a few items are subject to mandatory coding. Refer to the LCD for instructions and requirements for billing scenarios where mandatory coding is required by the MAC, but has not been secured by the manufacturer. Only in the event that the LCD provides for a statutory exclusion does claim filing become voluntary.

Wayne Merdinger
executive vice president & general manager, MK Battery

It is a sport played in 27 countries. Thousands of uniquely gifted athletes of all ages compete. Scores of spectators are amazed. It touches hearts and changes lives. Power Soccer, known internationally asPowerchair Football, enables power wheelchair users to pursue their dreams.

MK Battery showcased this exciting sport of skill at Medtrade 2014, where it was wholeheartedly embraced. The United States Power Soccer Association (USPSA), the not-for-profit governing body of the sport in the U.S., needs the help of the HME industry. MK Battery, now in its third year as the primary national sponsor of the organization, provides much-needed funding, public relations and other promotional support, but the USPSA has now taken on its greatest challenge yet as it prepares to host the largest scale international tournament ever.

The USPSA, in partnership with the Federation Internationale De Powerchair Football Association (FIPFA), which Invacare has been sponsoring for many years, is proud to bring the FIPFA World Cup of Power Soccer to the United States for the first time. The tournament, which will be streamed live over the Internet, will be held July 5-9, 2017, in Kissimmee, Fla., and will bring the 10 top-ranked teams from around the world to the largest stage they’ve ever competed on. In 2007, seven countries converged on Tokyo to compete in the first-ever World Cup of Power Soccer. Team USA was victorious and then, in 2011, they won their second consecutive World Cup, this time in Paris. The 2017 team has been training since October 2014 and is eager to defend its title on home turf.

There are approximately 60 organized teams competing in the U.S. at various skill levels. Athletes' disabilities include spinal cord injury, quadriplegia, multiple sclerosis, muscular dystrophy, cerebral palsy, and many others. Disabled military veterans are quite active in the sport, as well.

The look on a player’s face after a brilliant victory, or the emotional response of a parent watching a child compete, never fails to inspire and captivate all who witness the sport. Power Soccer affords those confined to power wheelchairs the opportunity to live their dreams of participating in a team sport, while enjoying the camaraderie and spirit of competition that had previously eluded them. The entire MK Battery organization has embraced our close association and sponsorship of the USPSA and Team USA as a truly inspirational and rewarding endeavor that we are extremely proud to be a part of. 

The World Cup will take a tremendous funding effort so I urge manufacturers and providers to step up and get involved at whatever sponsorship level makes sense for their business. I can assure you that the emotional reward and positive exposure for your company are well worth the investment. For the USPSA, grass roots engagement is also sought. For instance, providers can get involved by forming local teams or by providing “pit stop” facilities to charge batteries and make minor equipment repairs at local tournaments. No matter how you choose to participate, I can assure you that it will be a most meaningful experience for your organization.

To request a sponsorship package, please visit www.powersoccerusa.org, or contact MK Battery for more information.

I look forward to seeing you at World Cup 2017!

Todd Bryant
president and founder, Bryant Surety Bonds

On March 1, 2016, CMS published a proposed rule that seeks to address a growing number of abuses of the federal healthcare program by certain Medicare providers. The rule* titled “Medicare, Medicaid, and Children’s Health Insurance Programs; Program Integrity Enhancements to the Provider Enrollment Process” includes a number of provisions that directly concern providers and suppliers of Medicare.

These include an increase in requirements for disclosure of affiliations by providers, greater CMS authority to deny Medicare enrollment, and changes to reenrollment and reapplication bars, as well as greater CMS authority in relation to approving or rejecting the Medicare surety bond of a provider.

Requirement to disclose affiliations and events

Under the new rule, providers who seek to enroll for Medicare or revalidate their enrollment will be required to disclose former or current affiliations with individuals who have or have had a "disclosable event". An affiliation is considered:

·      direct or indirect ownership interest of 5% or more in another organization

·      partnership interest in an organization;

·      role as officer or director in a corporation

·      any form of managerial or operational authority at another organization

·      a reassigned relationship as defined under 42 CFR § 424.80 (Code of Federal Regulations).

Events that prompt the need for providers to disclose affiliations with such individuals include:

·      individuals' uncollected debt to Medicaid, Medicare or the Children's Health Insurance Program (CHIP)

·      individuals' denial of participation in Medicare, Medicaid, or CHIP

·      cases of payment suspension under any federal health program at any time

·      revocation or termination of such indviduals' enrollment to any of the above programs.

Increased CMS authority over Medicare enrollment

The rule also provides for greater CMS authority when determining who should be allowed to enroll as a provider of these services. It lists a number of criteria that CMS will utilize in assessing enrollments and deciding whether something constitutes a serious risk.

If a provider does not disclose all such events and affiliations in their entirety, for example, CMS may deny them their enrollment or even revoke it. CMS may further do so if it considers that any of the affiliations or events pose a substantial risk to the integrity of federal health programs. A number of other instances in which CMS may deny, revoke or terminate an enrollment are also listed.

Changes to reenrollment and reapplication bars

As a further measure against system abuses, the rule also proposes a number of significant changes to Medicare reenrollment bars. One of them would be to increase the maximum amount of years of reenrollment bars from three to 10. CMS has said, though, that the maximum "would be reserved for egregious cases of fraudulent, dishonest or abusive behavior."

Under the rule an additional reenrollment bar of a further three years (even when exceeding the maximum) would be placed on those individuals who attempt to circumvent an already existing reenrollment bar that they are subject to.

Finally, a 20-year reenrollment bar is envisioned for those providers who have their enrollment revoked for a second time.

CMS also proposes an increase in reapplication bars to a maximum of three years in instances where applications include false or misleading information or provide information selectively.

Increased CMS authority to reject DMEPOS bonds

One of the important provisions of the rule is that it provides for greater CMS authority in rejecting providers' Medicare surety bonds. This would apply to instances in which a provider's surety has failed to submit a payment to the CMS as part of the surety bond requirement.

According to the proposal, in these instances the supplier would have to obtain a new DMEPOS bond by a different surety to keep their enrollment or to be able to apply for one.

Under the rule, CMS could also reject all bonds by a surety, even those supplied by an unrelated provider, if the surety fails to fulfill its obligations. A caveat to this rule does include that CMS may investigate the circumstances and the reason for failure to pay before rejecting a particular bond or all bonds issued by that surety.

Welcome amendments?

As a Medicare provider, what do you think of the proposed rule? Do you see it as a way to counter abuses to the program or do you think it places too heavy burdens on providers? Let us know in the comments, we'd love to hear your thoughts.

The entire world depends upon creative leadership in all walks of life, from the creative arts to better living. The world of health care is certainly no exception. Where would we be without the medical and scientific brilliance to save lives, prevent illness and find solutions to epidemics? However, those that thrive on creation, innovation and problem solving are often not the ones reaping the rewards of their endeavors. In this world of human beings, sometimes emotions like greed, jealousy, or just plain envy can drive us into unintended consequences.

Each of us is the sum of our environment, those who came before us, our teachers, our associates, and all those accumulated life experiences. It will serve us well to always remember that whatever we create, invent or innovate, it came from all those before and a healthy dose of gratitude can help carry us through frustrations.

My goal herein is to share experience, and in doing so, pay it forward to the future leaders and entrepreneurs who are so vital to our human evolution. So, before you begin the journey of solving the world’s problems by presenting the next great business idea, product innovation or marketing breakthrough, beware! Beware of the scavengers of the creative, the ingenious, and the inventive. These may be companies, brands or just individuals with more resources than those held by the original innovators.

It saddens me to share, but market channels are full of low integrity firms and individuals that prey on bold entrepreneurs. Quality and function, to these scavengers of ideas, are often a low priority. Is it legal, maybe, but stealing an idea and making something cheaper or selling at a lower price usually does not best serve the consumer/patient or the HME channel.

No amount of intellectual property will guarantee protection from those waiting in the shadows. Of course, patents, trademarks, copyrights are all critical issues, but these can be small hurdles for companies who make a living off selling less functional look-a-likes. Unfortunately, many patients are not discerning enough to know they have been duped.

My first experience, as a young, naïve start-up entrepreneur/inventor, was in the business of diabetic care. My business partner, Dr. Douglas Richie, Jr., and I conceived the idea of making socks designed with more protective features for those with at-risk feet, specifically diabetics. Armed with research and considerable credentials, we began the process of convincing the diabetic health community that typical socks were dangerous to those with diabetes. Today the diabetic sock market is approximately $500M. More than 75% of these socks are made with inferior features that provide little or no protection to a diabetic and often even the reverse.

The advent of the Internet’s multi-product shopping sites allow and even invite scavengers to confuse the best deal for the best value. In reality, it is often the mass retailers that play out this unscrupulous strategy, or at least support the laggards who live off the new ideas of others.

The home health markets have stood as a barrier to design copiers, knock-off artists and the like. The HME retail channel has historically stood for offering the best or latest technology in products. I sincerely hope that this continues, even in the face of competitive challenges from the web or mass merchants.

To entrepreneurial creators, I say arm yourself! Arm yourself with knowledge, clear expectations, and a fearless drive to serve your end consumer. Arm yourself with all the intellectual property you can afford but remember that sometimes it is simply best to know how to keep a secret. Don't be afraid to make promises you can keep. The knock-off artists are afraid of knowledge and bold promises. Your new idea will be copied and most likely by much more powerful competitors. Plan your story of differentiation from the start.

To quality-focused health providers/retailers, I say stay true to the companies who innovate and create anew. Expand your knowledge: Know your products, conditions and categories better than anyone else and build into it your business strategy. Health products most often need associated service and education. This is not the strength of mass pharmacy or Amazon.

Making money is great and profit, after all, is the life-blood of creative success. But, long-term success comes from commitment to our consumer/patients and our shared vision.

Be fearless, but be aware! Get ready...then launch that next idea!

Dave Higgins has been in the technical textiles field for more than 35 years, educated in his home state of North Carolina as an undergrad and then at Stanford as a post-graduate. He has served as a top executive for many corporations in the field of health and sports products. Mr. Higgins has consulted with large vendors in product design, development and sourcing. He is known as the creator of the diabetic sock market. Most recently, he is the creator and CEO of a health and sports medicine products business with his patented innovations under the OrthoSleeve brand now widely distributed in the home health markets.

All of us at ResMed are excited about the Brightree acquisition. It supports our long-standing commitment to our home medical equipment customers with whom we have worked for 26-plus years to change the lives of millions of patients with serious respiratory conditions. Brightree’s expertise as a software provider in the post-acute care setting, when paired with ResMed’s therapy solutions and cloud-based infrastructure for respiratory care management, will mean greater efficiencies for our HME customers and improved experiences for the patients we serve together.

We understand that some providers may have questions about how this acquisition will affect them. We are happy to address those questions, and appreciate HME News giving us the opportunity to do so.

After the acquisition closes, Brightree will operate as a separate subsidiary, with a plan to develop robust software integrations that can dramatically increase business efficiencies for our customers. The exceptional service our joint customers have come to expect from both Brightree and ResMed will continue.

ResMed will not have access to individual Brightree customers’ patient data or pricing information. This is not a change, as Brightree will continue to respect the data protection provisions in the existing agreements with its customers. Similarly, Brightree’s pricing and promotional agreements will not change; those provisions will also remain in place. Instead, with input and focus from ResMed, our collective hope is that Brightree will be able to offer even more exciting new software products to make our customers more successful.   

Integrity is one of ResMed’s core values, and that’s also true at Brightree. Our customers can continue to rely on Brightree and ResMed to do what we say we’re going to do. ResMed has carefully guarded patient data in our AirView and U-Sleep data systems, and will continue to do so. Brightree has a similar track record of protecting patient and customer information.  And ResMed has a demonstrable track record protecting customer interests after acquiring the Caretouch and Jaysec resupply businesses. We think we’ve earned your trust and we intend to continue to earn it with how Brightree operates.

Regardless of the situation, at ResMed we firmly believe in and are committed to our core values of ethics and integrity, and it will be no different once Brightree joins the ResMed family.     

Of course, we encourage customers to contact us if they continue to have concerns.

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Clint Geffert
Clint Geffert is president of VGM & Associates

If you’re anything like my family, making a visit to the local cinema to watch the new Star Wars film was a must-do. My three boys were fascinated with the movie and characters, just as the original Star Wars had captured imaginations a generation ago. Based on the enormous box office numbers, it’s still a great time to be in the Star Wars business, just as it was when the original movie premiered in 1977.

The original Star Wars debut coincided with the beginning of the modern DME business. The Health Care Financing Administration launched a DME demonstration project in 1976 that helped lay the ground work for the evolutions in wheelchairs and home oxygen, among other assistive technology used outside institutional settings. 

The 38 years between Star Wars’ first and most recent editions brought tremendous growth in HME. There are some surprising statistics for this time period regarding demographic changes in the U.S. 

There were 24 million Americans 65 and older in 1977. Today there are 48 million. That’s an increase of 24 million seniors in a span of 38 years. But in the next 15 years, we’re going to add 26 million more seniors. There will be 3 million more people over 85 in 15 years, five times the number than when Star Wars originally debuted. 

In 1977, 13% of America was obese. Today 36% of Americans are obese and by 2030 that will likely reach to nearly half the U.S. population. Fourteen million more Americans have diabetes than in 1977. Sadly, on many measures of health, our society is much worse off today than back in 1977. 

Today, approximately 90% of our population has health insurance coverage of some type. Perhaps surprisingly, that’s about the same level of coverage as there was back in 1977. But in between, the insured rate dropped to less than 80%. There are 16 million more people with a third-party payer, as compared to a few years ago, which is a huge win for healthcare providers of all types. 

It’s also worth noting that seniors still are not asking, “How soon can I move to the nursing home?” There are very few markets with this type of growth built into the next two decades.

Just as Jedis must combat the forces from the dark side, we in HME face daunting challenges. Reimbursement rates continue to decline, payers are narrowing open panels, and restrictive regulatory requirements cut into our business. HME suppliers must make changes in order to thrive. New revenue sources are needed—from capturing more market share of key referral sources, to offering compelling solutions beyond equipment, to adopting new products and technologies, to implementing cash business, to targeting more cost-effective operations. Make no mistake: These required changes will involve more tough decisions and some pain. But there will be a payoff. Investors are actively buying up HME assets and operations; they see the long-term opportunity.

The Star Wars franchise is alive and well, with even more movies to come. Our HME industry is also alive and well. Sure we face immense challenges, but the future is bright for those willing to mimic Luke Skywalker and persevere, adjust and evolve to meet the needs of the rapidly growing market.

George Kucka
George Kucka is president and CEO of Fairmeadows Home Health Care.

Historically, items like hospital beds, oxygen tanks and concentrators, wheelchairs, commodes, ambulatory aids, compressors and other items that could be used to support a medical need on an ongoing basis were referred to as DME. This is clearly an accurate, but one-dimensional definition.

Health insurance carriers, Medicare included, covered these items as a “DME” benefit when a doctor indicated that there was medical necessity requiring the use of any of these items.

This one-dimensional view of DME never took into consideration that the item is DME, but providing these items is HME services. Providing medical equipment services to patients in their homes has never been one-dimensional.

From the beginning, HME services has always been multi-dimensional. In almost all cases, the patients needing DME required the following:

1.   Delivery

2.   A home assessment to verify the appropriateness and safety of the prescribed item.

3.   Set-up

4.   Instruction:

  • On use and operation with return demonstration.
  • Maintenance.
  • How to seek assistance in the case of operational failure.
  • How to report changes in medical conditions

5.   Assistance in verifying insurance coverage.

6.   Gathering needed documentation to support the medical necessity for such items.

7.   24/7 availability of assistance for emergency after hours and holiday service.

8.   Billing insurance carriers on behalf of the patients and caregivers.

9.   Advocating on behalf of the patient where reimbursement was challenged by the insurance carriers.

10.      Eventually, in most instances, the retrieval of such DME items where purchase was not met.

This is HME services. This is what has always been required, this is what patients and their insurance carriers were paying for, never was it only the DME.

For a provider to adequately support patients with HME services, the providers needed to do the following:

1.    Hire and train staff in the following disciplines:

  • All insurance carriers coverage criteria for all DME items
  • Communication with medical professionals
  • Communication with ailing patients and non-medical caregivers.
  • The operation and maintenance in all types of DME items.
  • Sanitation and reconditioning of returned DME items.
  • Safe vehicle practices and maintenance processes.

2.    Establish communication processes that make the provider available to patients 24/7 for emergency service.

3.   Establish processes for internal communication on handling patient needs

4.   Procure necessary transportation equipment

5.   Procure necessary communication equipment and services such as pagers, cell phones, computers, and answering services.

6.   Where required, become licensed and/or certified in their state to operate.

7.   Undergo elaborate, expensive accreditation preparation and surveys.

8.   FDA licensure for oxygen

9.   Have associates go through rigorous manufacturer training programs to become proficient in the operation and maintenance of all DME items.

DME is one-dimensional; it refers only to the items. HME services is multi-dimensional and specific to the home and everything that is necessary to help patients maintain themselves safely in their own places of residences.

A 1,000-bed hospital facility can operate with an economy of scale. They can inventory and staff accordingly, knowing that their patients are in a compact, defined area. HME providers run 1,000-bed hospitals in 1,000 different locations. They need to inventory, staff and maintain the logistics and communication procedures to service 1,000 patients in 1,000 different locations when needed, 24/7.

Since 1965, when Medicare was implemented, the array of medical equipment designed to maintain patients at home has exploded. Items have become more technical, more reliable, easier for patients and caregivers to use, and more accessible to patients in need in a timely manner.

In 1965, HME services were provided by delivery technicians and, occasionally, respiratory therapists. Today, HME services are more sophisticated and technical, and need to be provided by highly trained clinicians with multiple disciplinary backgrounds: pharmacists, nurses, dieticians, diabetic counselors, physical therapists, respiratory therapists, etc.

In 1985, the average length of stay in a hospital was 8.5 days.  Today, the average length of stay is less than 4.5 days. One of the main reasons for this drastic reduction in the length of stay is because of the development and availability of more sophisticated HME items to help get and maintain sicker patients back to their home environment sooner.

Healthcare costs are soaring out of control in the skilled environments. In such environments, patients incur costs for their health care, their healthcare items, their room and their board. At home, the only costs are the healthcare services that keep them safely at home.

Today, HME services are still viewed by payers and legislators as DME, a one-dimensional line item, and reimbursement rates are shrinking to the point that the following is happening:

1.    There is almost no R&D to develop new technology to help even sicker patients get home sooner.

2.   The provider base has been reduced so that timely availability of services is more and more difficult to find.

3.   Patients are staying longer in skilled environments due to lack of accessibility.

4.   Providers that are still in business are forced to cut back staff and, therefore, services.

5.   The ill patients and caregivers are being forced to find ways to get to providers for services or go without.

6.   Providers are forced to buy equipment based upon cost, not reliability.

CMS can talk all they want about how the quality of care has not been affected by lower reimbursement rates, but the reality is that nowhere in the country where there is national competitive bidding are Medicare patients being cared for as well as areas not yet affected by NCB.

If Medicare wants to create a warehouse in each state where patients can go and take what they need off the shelf by themselves, take it home, learn how to safely use it, then you can talk about DME. By definition, ailing patients can’t do that and need individual and personal care to save money by keeping and maintaining safely in the cost effective environment of their home.

HME services is multi-dimensional and needs to be recognized and reimbursed as such to be effective. DME is a tool requiring HME services to make it work.  

Between 2007 and 2013, by Medicare’s own figures, the cost of Part A increased 70%. In that same time frame, Part B remained flat despite more people turning 65 daily. Contrary to the common wisdom, Part A and Part B are related. If HME services are not recognized and supported, Part A will continue to spiral out of control.

DME is what we use, HME services is what we do. HME services saves lives—and healthcare dollars.

George Kucka is president and CEO of Fairmeadows Home Health Care. He is a member of AAHomecare’s board of directors and chairs the association’s HME/Respiratory Therapy Council. He is also a member of AAHomecare’s Regulatory Council and its State Leaders Council. Additionally, Kucka is secretary for the Great Lakes Association of Home Medical Equipment Services and treasurer for the Indiana Pharmacist Alliance.

It is with great sadness and shock that I learned this morning of Van Miller's passing. Van Miller, the founder of the VGM Group passed away Sunday at his home. Van has indeed been a hero in our industry and the truest of friends! Regardless of whether you ever belonged to VGM or not, Van Miller was always there to help! Few people I have ever associated with in my life have ever left me with the impression Van Miller left with me. Van Miller was inspiring! One could not help but to be motivated when he was engaging you. Van Miller was an extraordinary figure to so many, but wanted most, to simply appear ordinary.

Van and I had our best talk ever about a year ago, at a great VGM event, as they are, always! Van and I talked about our past, and come to find out, we both had served in the United States Army, and we were both Combat Medics! This was a bond that brought us together in a special way and a conversation I will always cherish. A couple weeks after that, I sent him one of my old unit patches. About a week later, he sent me a note back, thanking me for the patch and ensured me it was going amongst other treasures that adorned his office! I recently had the good fortune just weeks ago to spend some quality time with him again, and I am grateful that I did. I even told my wife after my last visit with Van that if I had to work for someone, I could work for Van Miller!

To all my friends at The VGM Group, a big part of our MAMES family, I can't imagine the sadness you are feeling and the void you must be experiencing. I pray for your strength and perseverance through these very sad times. While there is no doubt VGM is strong, it has lost a great leader. But any of us who know the character of the VGM team, know you will continue to make Van proud as he looks down from heaven, because that is who each of you are, and you wouldn’t have it any other way.

To Christine, Vance, Dax, Christopher and the whole Miller family, words cannot begin to express the sadness we feel for the heart break you must be experiencing. You will remain in our prayers and know we are thinking of you. Thank you for sharing this amazing man with us, we are so blessed, as you are to have had him in our lives!

Van Miller, thank you for being in our lives and engaged so fiercely and so passionately in our industry. Because of you, we truly are better off! Van Miller will be sorely missed and never replaced.

May you rest in peace my friend!

Patrick Naeger is executive vice president of Healthcare Equipment & Supply Co., and president of the Midwest Association of Medical Equipment Services.

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