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by: Liz Beaulieu - Thursday, November 15, 2012

When we wrap up an issue, I always take the same issue for the previous year and dump it.

Before I dump it, I usually look at the front page to see what has changed, what hasn’t.

A few things about the cover of the December 2011 issue caught my eye (See image below).

The biggest: the top story about AAHomecare pushing unity on the market-pricing program (MPP). A year ago, there was a fear that providers would split hairs about the details of the program, particularly one provision that would maintain Round 1 until MPP was implemented.

I guess a year ago, the industry had the luxury of debating whether this was fair or not. Now, staring down the barrel of a Round 1 re-compete and a Round 2 that expands the program to 91 additional cities—not so much.

We haven’t heard a peep lately from any providers who think MPP isn’t a good idea. For the most part, I think AAHomecare got the unity it was pushing for.

Overall, what surprises me about this front page is how it really set the stage for 2012, a year that has been dominated by H.R. 6490, a bill that would replace competitive bidding with MPP; H.R. 4378, a bill that would create a separate benefit for complex rehab (of course, later on in 2012, a PMD demo requiring prior authorizations in seven states and attempts to create a clinical template would take over much of the industry’s attention); an Apria Healthcare-Humana preferred provider contract that got providers rethinking the importance of contracts and networks; and a good-sized acquisition (this year has to be some sort of record for those, both on the manufacturer and provider sides).

If my theory is true, looking at the December 2012 issue, some of the themes for next year will be MPP (can the industry get it done before Round 2 is scheduled to start July 2013?); more strenuous requirements, not only from Medicare but also private payers (especially in the growing sleep market); and providers doing what they do best (taking care of patients, come hell or high water).

by: Liz Beaulieu - Monday, November 12, 2012

Our HME Newspoll for the December issue takes a look at your net revenues for 2012—will they meet your expectations, will they be up or down for the year, how will they compare to last year?

We selected this topic for two reasons: 1.) With so few public companies in the HME industry, we thought this would be a god way to get a feel for the financial health of the industry; and 2.) it’s the end of year, so we thought it would be a good time to look back at 2012 and look forward at 2013.

So far, 59 providers have taken the poll, which is disappointing to say the least. (We grimace at any response below 100.)

But I hope more providers take the poll in the next two days (we kick the December issue out the door end of day on Tuesday), because what we are seeing so far is pretty interesting.

Here’s a peak at the results as of Monday morning:

Will your total net revenues for 2012 meet expectations?
Yes – 41%
No – 59%

How did your company perform this year compared to 2011?
Increased revenues – 37%
Decreased revenues – 43%
Stayed about the same – 20%

If revenues increased, by how much?
0-5% - 66%
6-10% - 20%
More than 10% - 14%

If revenues decreased, by how much?
0-5% - 68%
6-10% - 12%
More than 10% - 20%

What are your expectations for 2013?
Increased revenues – 37%
Decreased revenues – 37%
Stay about the same – 26%

I’m not going to deny that the fact that nearly 60% of respondents reporting that their net revenues for 2012 won’t meet expectations is pretty ugly, but 57% of respondents reported that their net revenues will increase or stay the same this year compared to last year. That’s a majority, albeit a slight one.

Also, for those providers who reported that they’re net revenues will decrease in 2012, 68% reported that they will decrease by only 0-5%.

Finally, 63% of respondents reported that they expect revenues to increase or stay the same in 2013. That’s an even healthier majority. And that’s in a year that the industry expects CMS to roll out Round 2 of competitive bidding in 91 cities.

With the U.S. economy, in general, having a tough year, I’d say the industry’s not doing all that bad.

Your thoughts? Chime in here.

by: Liz Beaulieu - Thursday, November 8, 2012

I love getting feedback from HME News readers, especially when they’re taking us to task.

I received an email this week from a reader who complained —very nicely, for the most part—that all of the most read stories in our Top 5 Respiratory for October were about CPAP and none were about oxygen. (We consider “respiratory” to cover both product categories.)

The reader wrote: “Could you possibly consider adding at least one non-CPAP story to the fold, as many of your readers provide more than just CPAP. We could use a story or two on O2 delivery models, innovative products and such articles that help us provide better outcomes to our oxygen patients.”

I had also noticed that all of the most read stories for October were about CPAP.

But when we pull the most read stories from Google Analytics, we don’t cherry pick. We literally go down the list of most read stories for the month and pick the stories that have to do with CPAP or oxygen.

For October, there were five stories about CPAP before we could get to any stories about oxygen.

I have several thoughts about this:

Does this happen often, or is this just an anomaly? (In the Top 5 Respiratory for September, there were three stories about CPAP and two about oxygen; in June, there were, again, three stories about CPAP and two about oxygen.)

Are there more CPAP stories in the past few months because of a major change to how providers provide supplies? (I bet when the 36-month cap went into effect for oxygen, there were stories about oxygen than CPAP.)

Are more providers talking about CPAP, because more of them are moving into that business or trying to grow the supply side of that business? (At least 75% of the stories we write, we get from talking to people with boots on the ground, not from press releases and the like.)

The reason I love getting feedback like this: Now I have oxygen on the brain. What are providers doing in this area? Like the reader mentioned, how are providers changing their delivery models, how are they improving outcomes? These are questions we’ll be asking when we make our cold calls for the January issue. (The December issue, believe it or not, is out the door early next week!)

In the meantime, two oxygen-related items that have been posted to our website in the past few weeks include this interview with Todd Anzalone at Inova Labs on competitive bidding fueling adoption for portable oxygen concentrators (POCs) and this interview with Bob McCoy of Valley Inspired Products on the changing business model for respiratory providers.

While I’m thankful for this reader’s feedback, I’m not thankful for how he closed his email:

“I know you pull this from a readership ranking but, darn, it looks like either someone on your editing staff is a former CPAP therapist or your selection is biased to your full page ResMed and Respironics advertisements.”

No, and no.

by: Liz Beaulieu - Friday, November 2, 2012

As I was listening to the Nov. 1 call about waivers for Medicare, Medicaid and CHIP providers in New York and New Jersey, I couldn’t help but wonder how this all worked out the last time we had a hurricane that caused this much damage.

Hurricane Katrina in 2005?

I made a few calls to industry stakeholders in Alabama and Mississippi, where that hurricane hit hardest. I left a lot of voice mail messages, but I was able to get Michael Hamilton, the executive director of the Alabama DME Association, on the line.

I asked him whether or not these waivers made a big difference for providers that, then during Katrina and now during Sandy, are working 24/7 to make sure their patients have the products and services they need.

Where the waivers came in handy, Hamilton said: They allowed providers to file claims without paperwork that’s usually required in advance; and they allowed providers to service patients that had relocated temporarily.

Other than that, not so much, he said.

“The process is so convoluted and complicated,” Hamilton said. “I’m not sure anyone thought it was worth it.”

At the end of the day, “most of the work was done for free or for cash,” he said.

Hamilton noted that President Barack Obama, during a speech following Hurricane Sandy, promised “No bureaucracy, no red tape” in the government’s response. That’s nice in theory, he said.

“Once they start reading the regulations and figuring out which apply and which don’t, things always get bogged down,” Hamilton said. “That’s the nature of a bureaucracy I guess.”

by: Liz Beaulieu - Tuesday, October 30, 2012

I had an interesting conversation with Bob McCoy this week. McCoy is a respiratory therapist (RT) and the managing director of Valley Inspired Products.

It turns out he’ll be giving a presentation at the AARC Congress 2012 next month in New Orleans about how RTs need to be identifying opportunities to provide value-added care in this challenging environment.

Sounds like your standard fare, right? Opportunities and challenging environment have to be three of the most frequently written words by the HME News team.

As we continued talking, however, I learned that McCoy has a different take on how he thinks these opportunities should play out, at least in the respiratory space.

Let me back up: I hear a lot from HME providers that if only lawmakers and government officials knew and understood the services they provided and the impact those services can have on patient care and outcomes, they wouldn’t be pulling the rug from underneath their feet all the time.

This is true.

But instead of trying so hard to fight the image that some lawmakers and government officials have about HME providers as drop-shippers, McCoy believes the industry should move on.

He explains:

“There’s going to be a model change. If we still have HME providers in the future, they’re going to be efficient UPS people. If you’re a typical HME provider and you’re still just doing the equipment model, you’re going to have to get real efficient at it. The models that are coming up spin off the service component. You spin off the service component, so it’s not bundled to the equipment, but it works in conjunction with your HME.”

McCoy says he’s putting his money where his mouth is with a new company called Valleyaire Respiratory Services dedicated to providing RT services to hospitals and healthcare systems to help them educate patients, improve outcomes and reduce re-admissions.

“They think hospital RTs are going to solve the problem, but it’s not going to work, because they don’t know the home,” he said. “The clinical issues and needs in the home haven’t been defined. There are no standardized procedures. There’s a wide-open opportunity to provide professional RT services in the home.”

As for reimbursement: McCoy has no problem with swapping Medicare reimbursement for hospital contracts, especially when he knows his services can help those hospitals save big money on patients with congestive heart failure and other chronic conditions.

“It’s the new frontier,” he said. “It has to happen.”

by: Liz Beaulieu - Friday, October 26, 2012

The amount of talk and activity around the market-pricing program (MPP) is really at a pitch and fever that I’ve never heard and seen before.

That’s a big deal.

I know I haven’t been around the HME industry as long as some of you, but I’ve been around long enough to remember the Hobson-Tanner bill, one of the first efforts to squash competitive bidding, which made the rounds in D.C. at least six years ago.

When it comes to the industry’s current efforts with MPP, I know there’s never too much talk and too much activity, but there was so much of it this week that we decided to do a separate roundup for our HME Newswire on Monday. (We posted it to the website today if you want to take an advance look.)

A few more things have come in post-press time, too, like another roundtable sponsored by a state association (MAMES), The VGM Group and PFQC to educate lawmakers on competitive bidding’s negative impact and on MPP as an appropriate solution.

Such as the way things are, MPP crept into a lot of the HME News TV interviews that we taped last week at Medtrade.

That’s why for the first three weeks in November, we’ll be playing interviews on HME News TV that focus on MPP and the industry’s efforts as part of an “MPP madness” special package:

Nov. 7: Tyler Wilson of AAHomecare, “Don’t leave any representative unapproached”

Nov. 14: Wayne Stanfield & Steve Ackerman, NAIMES, “Time to close the deal”

Nov. 21: Cara Bachenheimer, Invacare, “It’s crunch time”

In the days and weeks that follow, if you ever need some motivation to call your representative for the second, third or fourth time, watch one of these videos.

They’ll get you moving.

by: Liz Beaulieu - Wednesday, October 24, 2012

As users of our HME Databank very well know, we still don’t have 2011 data for Provider Share (top providers) and Product Share (product utilization), and I’m profusely sorry about this.

Believe me, I’m as upset about it as the Databank users that I’ve been talking to on a weekly, if not daily, basis.

I mean, it’s almost 2013.

Argh.

For what it’s worth, I made the request for this data in May, as I always have for the past several years. Typically, it takes the good folks at the PDAC (CMS’s Pricing, Data Analysis and Coding contractor) three months to fulfill the request, which allows us to update the Databank with new data late August/early September.

Not this year, apparently.

I’ve been calling the PDAC regularly since August to ask when we’ll get the data, and every time I’m told that my request is in QA (quality assurance). This week when I called, I asked: What’s taking so stinkin’ long?

I was told that the PDAC has seen a significant increase in the number of requests for data, that many of these requests have come from “stakeholders” and that said requests from “stakeholders” must be given priority.

Hmph.

(I feel the need to point out, here, that we pay the PDAC to fulfill these requests. They’re not free. In fact, for the requests we file for the Databank, we have to pay in full in advance due to the size of the requests. Can you imagine all transactions worked this way?)

When I was told that the request was still in QA, I didn’t have a clear enough mind (see second paragraph above where I talk about being upset) to ask the natural follow-up question: Who are these “stakeholders”?

CMS? The Office of Inspector General (OIG)? The Government Accountability Office (GAO)? We all know there’s an unsatiated appetite for data related to health care right now.

God forbid we go into late November/early December without the new data, but if we do, the good news is that the 2012 State of the Industry Report will be included in the December issue. This will have data on the top providers across product categories and utilization for some of the most popular DME, diabetes, infusion, respiratory and mobility codes.

In the meantime, bear with me.

The HME News team got back from Medtrade last night via what turned out to be a fairly bumpy airplane ride. I felt better knowing, though, that Jim Greatorex (Black Bear Medical) was on the plane.

After helping to put together two Show Dailies in 48 hours, I'm pretty worded out.

Sooo, this blog is going to be all about some of my favorite scenes from Medtrade, like:

A tete a tete between these two HME powerhouses, Mal Mixon and Van Miller (thank you Carolyn Cole for sharing!)

A man known as the grandfather of HME, Shelly Prial, listening to the industry's newest champion, Rep. Tom Price

An exhibitor, Sky Med, taking advantage of Halloween to decorate its booth

That there were scantily clad men

To go along with the scantily clad women.

And on that note, I'm out.

by: Liz Beaulieu - Tuesday, October 9, 2012

I feel like I should apologize to many of you in advance for being missing-in-action from the HME News booth (2928) at Medtrade next week.

You see, the HME News team will be putting together the Show Dailies, which means we’ll be running around chasing stories (by we, I mean me, Managing Editor Theresa Flaherty, Associate Editor Elizabeth Deprey and Web Editor Leif Kothe), taking photos (that’ll be Production/Creative Director Glen Halliday) and polling attendees for the question of the day (that’ll most likely be Elizabeth and Glen).

When we’re not doing that, we’ll be chained to a desk in the Show Daily office, writing, laying out and proofing Show Dailies 2 and 3.

So be sure to wave hello when you see us zipping from a session like AAHomecare’s Washington Update (Wednesday, Oct. 17, from 1:30 to 3 p.m.) to an event like the welcome reception hosted by MK Battery for the consumer advocacy organizations (Tuesday, Oct. 16, Room 315, from 8 to 9:30) to the show floor (We hear Sky Med, booth 2625, will be giving out Halloween treats).

In any event, the HME News booth will be in the capable hands of Heather My-First-Name-Isn’t-Kelly Kelly, not to mention our publisher Rick Rector and our sales reps Jo-Ellen Reed and Steven Loerch.

We’ll also be taping HME News TV interviews, which will be in the capable hands of Jennifer Keirn, our contributing editor, and Shaun Clearie, our videographer. The TV studio will be at the top of the last set of escalators that you take to get down to the show floor. This year, we’re interviewing some new faces (Stephen Hodges from HME Solution) and some dynamic duos (not just Andrea Stark, but Andrea Stark and Derrick Stark).

Your best bet at finding me, Theresa, Elizabeth or Leif at the booth is on Thursday morning, when Show Daily 3 will be hot off the presses and that part of our Medtrade duties will be O-V-A.

See you next week (I hope)!

by: Liz Beaulieu - Monday, October 1, 2012

I don’t know about you, but I always have a mental checklist of things I need to worry about in my life.

This checklist runs from the mundane (did I lock the door when I left the house this morning?) to the more serious (will I get Chrone’s disease like my dad)?

I have a problem, I know.

What’s worse: I also have a mental checklist of things I need to worry about in the HME industry. I tend to think of this list more frequently on Friday afternoons—that’s when I fear those late announcements from CMS.

There are obvious things on my list right now:

What are the Round 2 single payment amounts (See note above about late announcements)?

But there are other things, too:

What’s the CBO score for H.R. 6490?

Will HME be exempted from the medical device tax?

Who will replace Phil Carter at Rotech Healthcare?

How am I going to get earnings data for Lincare now that it’s owned by Linde?

This one will be appreciated by those of you who subscribe to our HME Databank:

When will I get the 2011 data for top providers and top products? (For what it’s worth, I made my request to the PDAC at the same time I always do.)

The list goes on.

After covering the HME industry for going on eight years now, it’s more a part of my psyche than I’d like to admit—not as much as yours, perhaps, but a part nonetheless.

Let me know if there’s anything huge that I should add to my list.

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