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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.

by: Liz Beaulieu - Friday, August 16, 2013

I had two super interesting conference calls this week with the speakers for two panel discussions at the HME News Business Summit—one on big data; the other on life after the deal.

I’m really wowed by the experience and the knowledge of these speakers, and I think you will be, too.

A little bit of background, in case you haven’t poured over the education program for this year’s Summit like I have. The session on big data will address 1.) the trend of analytics in health care at large and 2.) how HME providers can use analytics to direct their businesses. The session on life after the deal will examine the opportunities—and challenges—of merging with or acquiring another company.

Big data

I think this session is going to challenge a lot of the providers in the audience.

Panelist Chris Kindard, formerly of QS/1 and now with Long’s Home Medical, pointed out that most providers are on top of activity-based costing by now (thanks in part due to competitive bidding). But he wants providers to think about where to go from there.

“How do we use historical data to really understand who our patients are?” he says. “It’s about more than just saying, ‘We have X number of oxygen patients.’ Who is the patient? What is their diagnosis? What’s their treatment of care? How do we keep them out of the hospital? That’s about more than just providing a piece of equipment.”

Panelist Steve Andrews of Brightree pointed out that analytics can help providers, whether they’re a contract supplier or a non-contract supplier, answer the questions that keep them up at night.

“If I’m in a competitive bidding area and I just lost half of my business, do I reinvent myself as a subcontractor, do I just focus on non-bid areas or non-Medicare payers?” he says.

In a nutshell: How can analytics and the information providers already likely have in their current software platform help them make data-driven decisions?

Life after the deal

I think this session is going to surprise a lot of the providers in the audience.

The one thing that each of the speakers for this panel discussion kept talking about was the people- and culture-related issues associated with merging or acquiring another company.

You may have crunched all the numbers there are to crunch financially during a due diligence process, but do your management and their management share the same business philosophy? Will the acquired company be able to transition to your corporate culture, to your systems and procedures, to your HR functions?

“Everything needs to be addressed,” says panelist Paul Bergantino of Numotion. “No matter how you wave your magic wand, it’s a process. You can’t rush it.”

Adds panelist Nathan Feltman of Home Health Depot, “The hard work really begins after the acquisition. You need to make sure you’re mindful of the resources that you may need to bring to bear to be successful.”

To register for the Summit, Sept. 8-10 at the Four Seasons in St. Louis, click here.

by: Liz Beaulieu - Wednesday, August 7, 2013

Invacare is placing its bets on HME providers that use fleet management principles to survive and thrive under competitive bidding.

“As the environment is restructured, what is the most optimal business model for providers?” asked Brian LeDuke, vice president of enterprise marketing, North America, during Invacare Media Day on Aug. 7. “Fleet management is the way to go.”

Invacare officials used Southwest Airlines as an example of how providers can become “breakout performers” by standardizing everything from the equipment they buy (for Southwest, Boeing 737s) to their turnaround times (for Southwest, 25 minutes).

Put simply, fleet management is all about “simplifying and optimizing your business,” says Joe Lewarski, vice president of clinical affairs.

“If I had a paint gun, I’d run out of paint balls shooting at all of the inefficiencies (that I see in the businesses of most providers),” he said.

Up and coming

Transitioning to a non-delivery model for home oxygen therapy is one way that providers can simplify and optimize their businesses, Lewarski says.

Data shows that more and more providers, amidst competitive bidding and punishing audits, are turning to portable oxygen concentrator (POC) and transfilling technology. In Round 1 areas, while overall utilization for oxygen products decreased, utilization for POCs and transfilling systems increased 76.8%, he said.

“We’re going to see exponential growth for K0738,” he said.

Practice what you preach

While a consent decree with the U.S. Food and Drug Administration has slowed down efforts, Invacare officials say they, too, have on their mind simplifying and optimizing their business.

A project kicked off in 2011 that will streamline Invacare’s products and reduce complexity on a global basis is expected to save the company $100 million annually starting in 2016, says Gerry Blouch, president and CEO.

“Would it have been better without the interruption—yes,” he said. “(The decree) is a temporary delay, but complimentary, (because it, too, will result in better customer satisfaction and better profitability).”

Not so wild cards

Arguably no one has spent more money trying to fight competitive bidding than Mal Mixon, chairman of the board of Invacare. While he continues to fight for fixes to the program, he says it’s probably here to stay in one form or another and it’s time to move on.

The question is: “How do we do it, not how do we not do it?” he said.

As for the consent decree that has handcuffed Invacare in several ways, including preventing it from releasing new products: “When we come out of this thing, we’re coming out like a caged animal,” Mixon said.

by: Liz Beaulieu - Tuesday, July 30, 2013

We had a great response to a webcast on how to snag private-pay contracts on July 25—a real testament to how many HME providers out there are trying to diversify their businesses away from traditional Medicare.

There’s nothing like a competitive bidding program hitting 91 cities and a reimbursement reduction of 45% to light a fire under you know what.

In an hour-long webcast with 13 slides, speaker Stephen Hodges, a strategic business development consultant for HME Solution, barely had time to scratch the surface on what can be a complicated and intimidating market. He said he once flew to Chicago to give a presentation to a group of providers that lasted six hours and had more than 70 slides.

But if you attended the webcast (if you didn’t, it’s still available on demand), you’re definitely off to a good start.

There were many things that Hodges shared in the webcast that I found useful, but none more useful than this: National providers don’t necessarily control the private-pay market.

Providers often tell me, how am I, a smaller provider, supposed to compete with a national provider to get a contract with a private-pay insurer?

Well, it ain’t easy, but it’s possible.

Hodges shared an anecdote about a provider that was able to get a private-pay contract after Round 1 of competitive bidding because a national provider turned all of its focus on the bidding program, dropping the ball on the private-pay contract. The private-pay insurer did not like this one bit and, in turn, dropped the national provider.

Hodges also shared an anecdote of another provider that provided such good service in a pinch to a private-pay insurer in a local market that the insurer gave it a contract in a larger market.

See—miracles do happen!

This webcast was a great primer for a session we’ll have at the HME News Business Summit, Sept. 8-10 at the Four Seasons in St. Louis. Speaker Mike Sperduti of Emerge Sales will take this whole idea of snagging a private-pay contract to the next level by sharing what you need to do once you do get a contract. How do you get the referrals? Even better, how do you become the preferred provider?

Sperduti is in the process of asking insurers and referral sources these questions on your behalf, and he’ll share the results during his presentation at the Summit.

So go on. Get a contract between now and Sept. 8, then attend the Summit to learn how to take advantage of it.

by: Liz Beaulieu - Wednesday, July 24, 2013

I’ve been working on a couple of stories this week that have required me to make a dozen or so calls to providers. Since I cover mostly the vendors in the industry, that’s usually Theresa and Elizabeth’s domain.

These are a few things that I heard that, while they didn’t quite fit into any of the stories I’m working on, resonated with me for one reason or another.

From Steve Nelson, who’s in a Round 1 bid area in Florida:

We’re forging ahead with cash customers. CMS in their wisdom has forgotten all about the patient. The patient is not getting served. We’re getting phone calls from areas that we used to take care of from patients needing help. It’s a crying shame. CMS is so blind to what they’re doing.
A lot of people are going cash because they’re tired of the game.

I’ve spoken to a lot of physicians and they’re going to get out. They don’t like what’s going on. They don’t like the audits. I said, ‘Welcome to the club.’

From Daryl Bowman, who’s in a Round 2 area in California:

I was offered support surfaces only. I had bid for beds and some other stuff. How can I do support surfaces but not beds? It’s like doing the clutches, but not the cars. I didn’t accept it.
Two years ago, Medicare was 70% of my revenue. I started moving that to retail and Medicare Advantage. Over the past two years, I’ve decreased it to below 50%. Still, I’m going to take a 40% hit on revenue. With me, that’s a lot. Because we’re a small company, we’ve downsized to only two employees. At my height, I had five.

For retail, we have a Costco approach. We have a warehouse set up that you can walk in and the shelving is set up as retail. A person can come in and browse, but we’re still meeting the customer one on one. We sell a lot of wound care and incontinence retail.

by: Liz Beaulieu - Tuesday, July 16, 2013

A few weeks ago, a provider tipped me off that CMS had started recouping payments for Medicare beneficiaries who were in prison at the time of dates of service. This provider was dumbfounded: How could these beneficiaries be in prison when they had received equipment and services in their home and signed delivery tickets, he wanted to know.

“This goes to a new low in my eyes,” the provider said.

I hadn’t heard of this type of recoupment from other providers, so I saved his email to my file of stories to look into.

Fast forward to this week.

CMS has put out a bulletin detailing the recoupments—“A large number of overpayments have been identified,” it states—and advising providers on how to respond to demand letters. The agency notes:

“There may be instances where providers believe that the beneficiary was not incarcerated when the services was provided. However, a beneficiary may be incarcerated even when the individual is not confined within a penal facility. For example, a beneficiary who is on a supervised release, on medical furlough, residing in a halfway house or other similar situation may, nevertheless, be in the custody of authorities under a penal statute. In such cases, Medicare payment may be barred.”

I forwarded the bulletin to the provider. His response?

“Now we need to ask them to pull up their pant leg to see if they are on in-home incarceration? When does it get to a point that we are asking and doing things totally outside of what we are in business for (taking care of ill people in need)? Guess when my driver gets shot for asking about a person being in prison they will not require us to get involved with someone's personal business outside of healthcare?”

CMS doesn’t go that far, but it advises providers that are receiving demand letters for denial of claims because the beneficiary’s Social Security record indicates incarceration on the date of service to contact the beneficiary to gather as much information as possible.

That sounds like a fun conversation, huh?

I wonder how these things even get this far. Shouldn’t the doc or whoever the referral source is know that an incarcerated Medicare beneficiary doesn’t meet the coverage criteria for the equipment and services? If not, shouldn’t CMS focus its efforts on educating them about this and, therefore, nipping the whole thing in the bud, not to mention saving providers from, at the very least, awkward conversations, and, at the very worst, the possibility of physical harm?

But I guess this is typical of the backward way that CMS tends to deal with fraud and abuse.

Unfortunately, the last person holding the hot potato is often the provider.

by: Liz Beaulieu - Wednesday, July 10, 2013

I’m not saying the U.S. Department of Veterans Affairs (VA) is perfect in the way it provides patient care and federal benefits to veterans and their dependents.

Do a Google News Search for Veterans Affairs (or its former name, Veterans Administration) and you’ll find stories about a huge backlog in disability claims and, just today, a story about seven veterans who are accused of dealing drugs to patients being treated at its facilities, some of them for addiction issues.

But it does a lot of things right.

For example, I’ve long admired the VA’s use of health informatics, disease management and telehealth technologies to improve and extend access to care.

Today, in a story in Pharmacy Practice News about how comprehensive discharge plans help to reduce hospital readmissions for COPD patients (a story that also quoted Invacare’s Joe Lewarski, by the way), I learned about this little gem:

One pilot program being tested by his VA system to improve patient health and reduce readmissions is shared medical appointments for veterans with diabetes. Six to eight patients with diabetes and a high risk for cardiovascular complications are brought in for quarterly outpatient appointments with a nurse educator, a health psychologist, a dietitian, a physician and a clinical pharmacist with prescriptive authority. Patients receive joint education but individual medication management by the pharmacist. The VA also plans to pair similar patients as “health buddies” to encourage each other to stay healthy, with the goal of improved health outcomes.

Dr. Sean Jeffery, a clinical pharmacist in geriatrics for the VA Connecticut Healthcare System in West Haven, told Pharmacy Practice News:

“I absolutely think this model could work for HF and COPD patients. We need to catch COPD patients early, make sure they’re on the right medications, they stop smoking and have training on the use of inhalers, diet and exercise.”

There are so many things that are right about this pilot program: the reinforced messaging of having quarterly meetings, the cost savings of having clinicians meet with more than one patient a time, the support and camaraderie of “health buddies.”

I know this program isn’t dissimilar to HME providers doing things like hosting A.W.A.K.E. support group meetings, but it’s more intentional and focused, in terms of improving outcomes.

In this healthcare environment, that’s a necessity.

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