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In brief: CMS releases 2020 fee schedule, UnitedHealth Group buys specialty pharmacy

In brief: CMS releases 2020 fee schedule, UnitedHealth Group buys specialty pharmacy

WASHINGTON - The 2020 Medicare fee schedule grants 1.6% to 2.4% CPI-U increases in several categories, AAHomecare reports.

The fee schedule includes a 2.4% increase for former competitive bidding areas and a 2.4% increase for diabetes supplies in the national mail-order program. It also includes a 1.6% increase for non-rural areas.

The fee schedule for rural/non-contiguous areas will be 50% of the unadjusted fee schedule (2015) and 50% of the new adjusted fee schedule.

The fee schedule for oxygen equipment and contents varies, due to budget neutrality, but on average, it represents a 2% increase for former bid areas; a 3.5% increase for non-rural areas; and a 1.5% increase for rural areas.

AAHomecare says it is still reviewing the fee schedule.

See CMS's update on the CPI-U increase here. See the 2020 fee schedule here.

UnitedHealth Group buys specialty pharmacy

EDEN PRAIRIE, Minn., and FLINT, Mich. - UnitedHealth Group's Optum division will pay about $300 million to buy Diplomat, a provider of specialty pharmacy and infusion services, according to news reports.

Diplomat focuses on managing specialty medications, including oncology and immunology, and provides specialized infusion therapies in all 50 states and Washington, D.C.

“With its focus in specialty and infusion services, Diplomat has a proven track record of solving the unique challenges facing patients with complex health care needs,” said John Prince, CEO of OptumRx. “This combination will expand the innovative specialty pharmacy and infusion solutions OptumRx can offer to the consumers and clients we serve, helping ensure people get the right medications and services at the right time, in the right setting.”

Per terms of the deal, Optum's OptumRx will acquire Diplomat's outstanding stock for $4 per share through a cash tender offer and assumption of outstanding debt.

Diplomat was founded in 1975 and entered the PBM market in 2017, where it has had trouble maintaining clients, according to Modern Healthcare News. In August of this year, it said it was considering a sale or merger.

“Since co-founding the company in 1975 with my father, I have had the honor of helping to transform Diplomat into a specialty pharmacy services leader,” said Philip R. Hagerman, RPh, Diplomat co-founder and chairman emerituse. “This combination will create significant value for Diplomat's specialty pharmacy consumers and clients, and I look forward to the combined companies' future success.”

NCART rallies for support

WASHINGTON - NCART is calling on industry stakeholders to contact their members of Congress before their holiday break about supporting legislation to protect accessories for complex rehab manual wheelchairs. “Congress needs to hear from CRT advocates this week, as they are planning action on certain bills before they adjourn for the holidays,” wrote Don Clayback, executive director, in a bulletin. “We've been communicating with our congressional champions who are working behind the scenes on our behalf, but we need your help to elevate the collective 'CRT voice' this week.” Stakeholders can go to to contact members of Congress to support H.R. 2293, a bill to suspend bid pricing for accessories for complex rehab manual wheelchairs for 18 months and to permanently exempt complex rehab manual wheelchairs from the program; and S. 1223, a bill that would exempt complex rehab manual and power wheelchairs and any wheelchair accessory, cushion or back when furnished in connection with a wheelchair from bid pricing.

AAH: Give CMS feedback on bid survey

WASHINGTON - AAHomecare is encouraging providers to give CMS feedback on surveying beneficiaries, discharge planners and other stakeholders on the competitive bidding program. The agency is accepting comments on its survey until Dec. 20. “AAHomecare encourages suppliers to provide feedback on this rare opportunity,” the association stated in a bulletin. Key points that AAHomecare will highlight in its comments include: CMS should issue the same surveys before and after Round 2021 to develop a baseline: CMS should survey stakeholders twice a year: CMS should follow up on negative impacts with a root-cause analysis and develop a corrective plan of action; and CMS should publicize survey results within a reasonable timeframe. The association is also including in its comments a list of sample survey questions. Providers should submit their comments to [email protected], using the subject line  “Competitive Bidding Surveys.” CMS's initial announcement on the survey is here.

NSM deepens home access biz

NASHVILLE, Tenn. - National Seating & Mobility has expanded its home accessibility division with a pair of acquisitions: Promise HomeWorks in St. Louis, and Hart Medical Design in Buffalo, N.Y. “These new branches position us to bring NSM's full scope of solutions to more individuals who need them,” said Bill Mixon, NSM CEO. Both companies offer home accessibility products, as well as home modification services. NSM will also bring on board the owner of both companies, Charlie Felker, as director of business development for the home access division to manage the company's Veterans Affairs relationships. Felker, a West Point graduate and decorated combat veteran, will also be responsible for supporting NSM's growth in new and existing accessibility markets.

Solara faces lawsuit over data breach

CHULA VISTA, Calif. - A patient has filed a class action lawsuit against Solara Medical Supplies, which recently disclosed a data breach that impacted about 114,000 patients.

The lawsuit, filed in the U.S. District Court of the Southern District of California, accuses Solara of failing to protect personal information, according to Health IT Security.

The lawsuit also accuses Solara of failing to notify patients in a timely manner. Per HIPAA, covered entities must report breaches impacting more than 500 patients within 60 days of discovering the breach.

Solara, a provider of diabetes testing supplies, says it discovered the breach on June 28 and notified patients in November. In its notice, the company stated that, between April 2, 2019, and June 20, 2019, an “unknown actor” used a phishing campaign to gain access to a limited number of employee Office 365 accounts.

Personal information that may have been present in the accounts at the time included first and last names and one or more data elements, including address, date of birth, Social Security number, Employee Identification Number and medical information.

Glooko receives ISO certification

MOUNTAIN VIEW, Calif. - Glooko has received joint ISO 13485 certification from Intertek Testing Services NA Ltd. for both its Mountain View, Calif., and Gothenburg, Sweden, sites. This certification demonstrates the company's commitment to establishing a compliant quality management system that meets customer, safety and regulatory requirements for medical devices. “Our certification to ISO 13485 is an important milestone that confirms our quality management system has met internationally-recognized requirements, and that Glooko is committed to ongoing compliance and improvement,” said Russ Johannesson, CEO. Glooko's product suite includes the Glooko and diasend diabetes management solutions.

Innovation in Motion expands distributorship

ANGOLA, Ind. - Innovation in Motion, the distributor for Magic Mobility and Ormesa, has added a third manufacturer to its product portfolio: Aalborg, Denmark-based VELA. Innovation in Motion will be the exclusive distributor of VELA Pediatric Activity Chairs in the United States. “Being one of the best known brands in Europe, we are very excited that our activity chairs for children will now be available in the U.S. as well,” said Klaus Eikhof, sales manager, VELA. “Partnering up with Innovation in Motion is a perfect match for us, as our chairs fit within their existing range of pediatric products, and we can utilize their expertise and existing sales and distribution channels.” Tampa, Fla.-based Enable Me distributes VELA Adult Chairs in the United States. The family owned VELA has designed and manufactured ergonomic chairs for the medical and private sectors since 1935.

Philips connects care for Humana

AMSTERDAM - Royal Philips is collaborating with Humana to improve care and health outcomes for select high-risk Medicare Advantage members. Humana has implemented two programs that leverage Philips' medical alert services and remote member monitoring solutions. “Our goal is to continue to find ways to help our Medicare Advantage members stay longer and safer in their homes,” said Susan Diamond, president of Humana's Home Business Segment. “We believe our work with Philips will help offer our members and their caregivers more in-home support and help them stay engaged and focused on prevention.” Humana is identifying members who are at-risk and offering them Philips Lifeline medical alert services, including AutoAlert, Lifeline's fall detection technology, supported by Philips' CareSage predictive analytics. The insurer has also deployed Philips' remote member monitoring solutions and its connected measurement devices to select congestive heart failure members, allowing care managers to monitor and understand meaningful changes in a member's condition. “Forward-thinking companies like Humana are realizing how deploying population health management can enable the industry to influence high-risk, high-cost populations at scale to help them lead healthier lives,” said Carla Kriwet, chief business leader, Connected Care, Philips. “As the industry moves beyond traditional care delivery in the hospital to health delivery that starts and ends in the home, Philips' population health management solutions can enable strong collaboration between care recipients, providers and payers, connecting care and empowering patients.”

People: John Sphon, Wayne Grau, Karissa Peffer

John Sphon has been named CEO of Greensburg, Pa.-based Excela Health, according to He had been serving as acting CEO since last spring after the abrupt departure of both the former CEO and COO. Sphon previously served as president of Excela's MedCare Equipment Company and has been with Excela and its predecessors for more than 35 years. “(Sphon) is highly skilled in such areas as business development and operations, establishing and nurturing effective physician relationships and employee engagement,” said Teresa Petric, chair of Excela's Board of Trustees�Anaheim, Calif.-based MK Battery has named Wayne Grau as HME category manager. Grau has extensive industry experience, holding leadership roles in sales management, legislative affairs and trade relations. “We are thrilled to have Wayne on board to lead our HME business and lend his 25-plus years of industry experience to help support our HME/Complex Rehab customers,” said Wayne Merdinger, president�ATF Medical has recently taped Karissa Peffer as senior coordinator of adaptive housing solutions. Peffer most recently served as senior project manager for National Seating & Mobility. "There are people who understand construction and others who understand workers' comp," said Erin Zablocki, executive director of rehab technology. "Karissa has experience in both, along with outstanding customer service skills." The Woodbridge, Va.-based ATF Medical is a provider of medical equipment and adaptive housing solutions to the workers' compensation market.





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