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by: Liz Beaulieu - Tuesday, November 19, 2013

It may not feel like it, but HME providers aren’t the only healthcare providers being audited like crazy by the government.

Hospitals are, too.

I was reminded of this last week when I saw a press release from a group called the American Coalition for Healthcare Claims Integrity (ACHCI).

Never heard of them?

According to the release, the ACHCI, founded in 2009, is a nonprofit “committed to working toward achieving 100% accuracy in payment claims submitted to public and private sector healthcare payors.”

It’s no surprise that among the group’s founding members are “partners in critical accountability initiatives, including the federal Recovery Audit Contractor (RAC), Zone Program Integrity Contractor (ZPIC) and Medicaid Integrity Contractor (MIC) programs.” Its mission: “educate policymakers and other stakeholders regarding the importance of healthcare integrity programs that help identify and correct improper payments.”

In other words, the ACHCI is a lobbying group for the auditors—a true sign that the business of auditing has become a big business.

Anyway, back to that press release. The ACHCI is decrying CMS’s recent—and quiet, according to the release—decision to suspend RAC reviews of short-stay inpatient hospital claims until March 31, 2014.

From the release: “The CMS Recovery Audit Program has successfully recovered more than $7 billion in improper payments since the program began in 2009. This new auditing interruption will amount to an estimated loss of nearly $2 billion for the Medicare Trust Fund, or more if the delay continues.”

ACHCI places the blame squarely on the American Hospital Association (AHA), whose complaints about the reviews, it says, have put increasing pressure on CMS to weaken the program. The group goes on to say that hospitals are responsible for 88% of the overbillings to Medicare.

I know an HME provider or two who would join the ACHCI in decrying the suspended reviews. Why should hospitals get what the group calls a “free pass” while HME providers continue to suffer?

Then again, the HME industry may be better off trying to ride the coattails of the AHA, which is working with Congress to reform the audit system.

by: Liz Beaulieu - Monday, November 11, 2013

Audits are as big an issue—if not bigger, for some providers—as competitive bidding.

So the latest news from the Office of Medicare Hearings and Appeals (OMHA) that it will defer assignments for ALJ hearings possibly up to 28 months has put some providers right over the edge.

And I don’t blame them.

For a story that will appear in our December issue, AAHomecare’s Kim Brummett told Managing Editor Theresa Flaherty: “If CMS wants to continue this ferocious cycle of audits, they need more ALJs.”

It’s unlikely that no one provider has felt the ferocious cycle of those audits more than Gordian Medical d/b/a American Medical Technologies. Michael Watson, vice president of government affairs and corporate compliance officer, wrote in HME News a year ago about how the company’s payments were suspended for 180 days based on a review of five of 14,000 beneficiaries being serviced. As a result, the company had to lay off 10% of its work force and it landed in bankruptcy court.

After reading in HME News about the significant delays in hearings at the ALJ level, Watson emailed me. He told me that the company has 46,000 claims pending at the OMHA, and it adds 5,000 per month to the pile.

“If this 28-month delay in assigning appeals is allowed to stand, it will be disastrous to many, many providers,” he wrote. “Give the timeline of each level of the appeals process (and including this 28-month delay) and the time it takes most ALJs to publish their decisions, it will be more than four years between the date of service and the receipt of the ALJ’s decision.”

That’s worst-case scenario, but still.

And all of this when, as we reported about a year ago, 56% of the time, the ALJ reverses the decisions made by the qualified independent contractor (QIC), the previous level of appeal.

We’ve made the delays at the ALJ the subject of the Newspoll for our December issue. Chime in here. I’m sure many of you will!

by: Liz Beaulieu - Tuesday, November 5, 2013

There’s just so much doom and gloom in the HME industry these days (competitive bidding, audits, face-to-face requirement, etc.) that I get really revved up when I read stories that Theresa and Elizabeth have written that feature providers that are doing smart things. (That, or I could still be on a high from the Boston Red Sox winning the World Series!)

There are at least two of these stories in the forthcoming December issue.

Avid readers of our HME Newswire on Monday got a sneak of one of those stories: Binson’s bets on partnerships with hospital systems. I think partnerships like these are one of the smartest moves in an HME provider’s playbook right now.

At this year’s HME News Business Summit, John Sphon, CEO of MedCare Equipment Company, had everyone’s attention when he gave a presentation on how these partnerships have allowed his company to not only grow (to the tune of net revenues of $70 million), but also meet the increasing demand for coordinated care and population management.

That’s music to my ears.

The other story you’ll read about in the December issue is about Long’s HME. Through the course of this year, the provider has been transforming itself from a traditional HME provider-pharmacy combo to a traditional HME provider standalone with some serious benefits. Here’s a hint: Those benefits have to do with patient management services.

Long’s has also launched a parent company to oversee its HME and new services. The name: LifeH2H (Hospital to Home). That has a nice ring to it, doesn’t it?

OK, I’m done cheerleading…for now.

by: Liz Beaulieu - Tuesday, October 29, 2013

Managing Editor Theresa Flaherty and I couldn’t help but scoff at a quote from CMS Administrator Marilyn Tavenner in a press release this week touting major savings for Medicare beneficiaries.

You see, the standard monthly premium for Medicare Part B will stay the same in 2014 at $104.90.

Which is good news, as Tavenner points out, for not only beneficiaries but also for taxpayers.

But, in explaining why the premium will stay the same in 2014, Tavenner said:

“We continue to work hard to keep Medicare beneficiaries’ costs low by rewarding providers for producing better value for their patients, and fighting fraud and abuse.”

Are Theresa and I paranoid for thinking that when Tavenner says “keep…costs low by rewarding providers for producing better value for their patients” she’s referring to the competitive bidding program and its average reimbursement cuts of 32%, 45% and 37%, respectively, for Round 1, Round 2 and the Round 1 re-compete?

Probably not.

This reminds me of a conversation I had with provider Gene Sego at Medtrade. Sego and a coalition of other providers in Florida have had good success getting lawmakers to sign on to H.R. 1717, a bill that would replace the competitive bidding program with a market-pricing program (MPP). While CMS likes to brag about how beneficiaries are benefitting from reduced co-pays as part of the competitive bidding program, Sego says, in many cases, they end up paying more.

Why? Because beneficiaries get so frustrated with the program (having to start over with a new provider, being forced to use inferior products—it goes on and on and on), they end up throwing up their hands and paying out of pocket.

So instead of a $20 co-pay, beneficiaries end up footing an entire bill for hundreds of dollars.

Theresa, Gene and I aren’t the only ones scoffing.

Consultant Anna McDevitt emailed me recently after watching an interview with Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services (HHS), on CNN. Sebelius made a comment about a serious problem in health care of creating markets where there is none. McDevitt wrote:

“Though HME is just one corner of healthcare, there is certainly a market here and certainly an army of talented people working hard to problem-solve and provide service.”

It’s really sad that Tavenner and Sebelius don’t have kinder words for an area of health care that the government should be building up, not tearing down.

by: Liz Beaulieu - Wednesday, October 9, 2013

On face value, incontinence seems to be a pretty straightforward product category in the HME market.

After a trip to Medline’s booth at Medtrade, however, I’m not so sure.

I met Bill Bowser there, who’s the director of sales for the company’s Personal Care division.

He told me a story about a woman who combed the Internet to get his phone number at work, called him and told him her mother was using Medline’s briefs and they were awful. She said they were leaking all over the place.

Bowser asked the woman what size briefs her mother was wearing. The woman said XL. He then asked her the height and weight of her mother. She said five feet four inches tall and 140 pounds.

Apparently, the hospital sent the mother home with that size brief, so the woman assumed it was appropriate (It turns out hospitals could use a little education about incontinence products, too, but more on that later).

Bowser recommended a medium and gave the woman his cell phone number, so she could give him an update in a few days.

“She called and said, ‘This is awesome!’” he said.

Bowser was talking about this to begin with because Medline has put together a packet of educational materials for providers to use with their patients. There’s a sell sheet and a product guide. There’s also access to a 12-minute webcast (Providers can set up a laptop or TV in their showrooms, so patients can watch, too).

I wonder: Where did the woman get these briefs for her mother? From a trip to Walmart? If so, this story creates a strong case for why patients should buy products, even those that may seem straightforward, from educated HME providers.

Bowser had another story for me, one straight from the show floor. Two parents stopped by the booth to talk about their 19-year-old daughter, who is disabled. It turns out she is using a brief, when she could be using a bladder control pad, which is more comfortable and less expensive.

“I feel like, ‘I changed someone’s life today,’” he said.

by: Liz Beaulieu - Tuesday, October 1, 2013

At Medtrade next week, while the Maine-based editors of HME News run around putting together onsite newspapers (get your copy of the Show Dailies at the top of the elevators on Wednesday and Thursday mornings), Cleveland-based Contributing Editor Jennifer Keirn will be manning (womanning?) the HME News TV studio.

I think we have a record number of interviews scheduled this year—32 over two-and-a-half days!

While you’re walking the show floor, swing by the studio at Booth 1367 to see your favorite industry stakeholder being interviewed (Although this booth doesn’t show up on the floor plan, show organizers assure me that it does, indeed, exist and will appear on the floor plan in the Show Directory onsite).

Here’s a look at the schedule for your planning purposes:

Tuesday, Oct. 8
9 – Randy Lutz, ThedaCare at Home (a 2013 HME Excellence Award winner)
9:30 – Miriam Lieber, Lieber Consulting (on leadership)
10 – Andrew Pyrih, Pride Mobility (on retail)
10:30 – Cliff Woolard, Home Med-Equip (on retail – hey, it’s a popular topic)
11 – Cara Bachenheimer, Invacare (on the legislative topic du jour – perhaps the new reimbursement rates for the Round 1 re-compete that were announced today)
11:30 – Kim Brummett, AAHomecare (on everyone’s favorite topic: the new face-to-face rule)
1:00 – Jim Greatorex, Black Bear Medical (on his top retail picks from the show floor)
1:30 – Sarah Hanna, ECS Billing & Consulting North (on audit activity from commercial payers)
2 – Jeff Mastej, Wright & Filippis (on audits – another favorite topic)
2:30 – Eric Kline, HME SalesPro (on his philanthropic efforts through Angle Flight)
3 – Eli Diacoupolis, Philips Respironics (on how technology can provide cost savings and efficiencies)
3:30 – Regis Farrell, Prius Healthcare USA (on turnarounds)

Wednesday, Oct. 9
9 – Anna McDevitt, Laboratory Marketing (on content marketing)
9:30 – Kathleen Gallivan, Renewal Technologies (on turning order takes into consumer educators)
10 – Brian LaDuke, Invacare (on a fleet management business model)
10:30 – Michael Sanderson, RemitData (on trending denial data)
11 – Greg Sims, DMEevalumate (on coaching referral sources on documentation)
11:30 – Gerald Sloan, MAMES (on critical decision making in stressful times)
1 – Weesie Walker, NRRTS (on being the group’s new executive director)
1:30 Kelly Franko, Advantage Training (on, you guessed it, training)
2 – Lisa Wells, Get Social Consulting (on marketing strategies for cash sales)
2:30 – Rob Boeye, Brightree
3 – Jeremy Kauten, VGM Forbin (on Internet use by the older population)
3:30 – Jonathan Sadock, Paragon Ventures (on developing M&A strategies under healthcare reform)

Thursday, Oct. 10
9 – Jeff Baird, Brown & Fortunato (on the legal issue du jour)
9:30 – Seth Johnson, Pride Mobility (on the power wheelchair issue due jour, possibly the PMD demo or the bill to create a separate benefit)
10 – Pat O’Brien, Golden Technologies (on driving traffic to your location)
10:30 – Tom Ryan, AAHomecare (on being the new president and CEO)
11 – Kevin Gaffney, Medtrade (a look at this year’s show and next year’s Medtrade Spring)
11:30 – Joe Kuehn, Genairex (on the company’s decision to manufacture all products in the US)
12 – Neil Caesar, Health Law Center (on structuring and operating competitive bidding contracts)

Safe travels everyone, and see you next week!

by: Liz Beaulieu - Monday, September 23, 2013

I finally watched the movie Amour over the weekend.

It had been on my list of movies to rent for some time, ever since it won Best Foreign Language Film at the 2013 Academy Awards earlier this year.

Amour centers around Georges and Anne, a couple in their 80s, both retired music teachers, living in Paris. When Anne has a stroke and becomes paralyzed on the right side of her body, their relationship—and their relationship with their adult daughter—is severely tested.

I don’t think I’ve ever seen a movie that depicts aging so soberingly and so bluntly, in moments both small and big. It moves slowly from scene to scene depicting everything from Anne trying to read in bed with only one working arm and hand, to a detached nurse tugging roughly at her hair while brushing it, to Georges feeding her food that has been pureed and helping her drink water through a sippy cup, to…well, I’m not going to give away any more.

A theme that pulses throughout Amour: Anne’s desire to stay in the apartment she shares with Georges. After being hospitalized following her first stroke, she asks him gravely to promise her that he will never, ever, take her to a hospital again.

Keeping Anne at home, as you can imagine, takes a good amount of home medical equipment. A manual wheelchair and then, when her condition deteriorates further, a power wheelchair. A bath bench for showering. An adjustable bed. Diapers.

When Anne asks Georges to promise her that he won’t take her to the hospital, he doesn’t answer her—he can’t. But it ends up being a promise that he accepts and keeps at all odds, despite the fatigue of being her main caregiver and despite the ill will it creates between him and his daughter.

This all makes me think of a special report in the October issue that discusses the need for the HME industry to better communicate its value to lawmakers and the public. Stakeholders believe home care is the trifecta of health care: it’s clinically sound, it’s patient-preferred and it’s cost-effective.

A movie like Amour helps give meaning to patient-preferred.

by: Liz Beaulieu - Friday, September 13, 2013

So last time I left you, I had given you a little taste of the data that will appear in the 2013 State of the Industry Report.

To be honest with you: Every year, I put some of this data together prematurely right around the HME News Business Summit in September in case a speaker doesn’t show up and I have to pinch hit (This is what former Editor Mike Moran used to do and so this is what I do).

In the three years now that I have been programming the Summit, I’ve never had to use this “emergency presentation.” And anyone who knows me, knows I am very thankful for that.

Still, it would be a shame for all of that prep work to go to waste, so below you’ll find a few more nuggets of data from the forthcoming 2013 State of the Industry Report (again, it will be an insert in the December issue).

Medicare utilization for 2012 vs. 2011 by allowed charges

Biggest gains:

A4253, blood glucose strips, up 20.54% to $1.3B

A7032, replacement nasal cushion, up 29.06% to $57.8M

K0825, PWC Group 2 HD Captain, up 44.57% to $37.9M

L1832, knee orthosis adjustable knee joints, up 55.58% to $47.2M

Biggest losses:

A6021, collagen dressing size 16 inches or less, down 19.65% to $33.7M

E0439, stationary liquid oxygen, down 20.33% to $46.9M

E2365, U1 sealed lead acid battery, down 19.32% to $29.9M

E0277, powered pressure reducing air mattress, down 13.57% to $55.1M

by: Liz Beaulieu - Friday, August 30, 2013

Since it’s Friday, and since I’m pulling together some data for our 2013 State of the Industry Report, I thought I’d share a Top 10 list with you.

Here are the Top 10 providers for 2012 by amount allowed by Medicare:

1.) Lincare ($746,211,087)
2.) Accredo Health Group ($375,246,527)
3.) Apria Healthcare ($361,719,649)
4.) Liberty Medical Supply ($302,675,152)
5.) Lincare Pharmacy Services ($209,024,041)
6.) Walgreen Co. ($195,218,374)
7.) KCI USA ($172,178,074)
8.) DEGC Enterprise ($120,823,881)
9.) Hanger Prosthetics & Orthotics ($95,753,997)
10.) MED4HOME ($90,268,447)

When you compare this list with the Top 10 for 2011, you’ll see, among other things, that Apria has dropped from #2 to #3, that Braden Partners has moved off the list (down to #17), that Walgreen has moved up to #6 from #7, that Hangar has moved up to #9 from #10.

We get this data, by the way, from CMS via a Freedom of Information Action (FOIA) request.

Have a great long weekend!

by: Liz Beaulieu - Friday, August 23, 2013

Attendees tell us time and time again that one of the things they like most about the HME News Business Summit is the opportunity to network with their peers. The event provides several opportunities to do this—attendees each lunch together, go to the same social functions and participate in small group workshops.

This year, there’ll be one more opportunity.

The winners of the 2013 HME Excellence Awards have graciously agreed to sit on a panel to discuss not only their successes but also their frustrations.

These three providers, like you, live in a world of competitive bidding and audits. Amidst all of that that, they, like you, are trying to grow their top line and manage their bottom line.

How do they do it?

I had a call this week with these three providers and moderator Miriam Lieber. Here’s a sneak peek of what will likely be up for discussion:

What are the top three initiatives that you’ve undertaken in the past year?

When it comes to Medicare, what are you doing to offset losses in revenue due to reduced reimbursement?

How are you retooling your expense structure?

What non-Medicare/Medicaid revenue sources are you seeking? When it comes to third-party payers, how do you go after this business? How do you determine whether to accept a contract?

How do you use software in your business?

What is your strategy for dealing with audits?

How do you manage costs but still give back to the community?

This panel brings networking—provider to provider—to a whole new level.

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