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In brief: 2021 fee schedule, health care spending, Medtrade West 

In brief: 2021 fee schedule, health care spending, Medtrade West 

WASHINGTON ­– Non-competitive bidding areas will see a slight decrease in Medicare reimbursement, based on the 2021 fee schedule CMS released last week. 

Rural areas will see a decrease of about 0.2% and non-rural areas will see a decrease of about 0.5%, according to an analysis of the top 25 HCPCS codes by AAHomecare. 

CMS will continue to apply the CARES Act relief rates in rural and non-rural areas, resulting in rates in non-rural areas that are, on average, 31% higher for January 2021 vs. January 2020. 

These relief rates have impacted the rates of other payers, as many non-Medicare payers and state Medicaid programs base their rates off of the Jan. 1 Medicare non-rural fee schedule each year.  

AAHomecare will be working with state and regional associations to notify the impacted Medicaid programs of the new fee schedule and will continue to work with the industry to ensure those relief rates are applied where appropriate. 

See the association’s region-by-region analysis for additional perspective:  

Far West – CA, OR, NV, WA 

Great Lakes – IL, IN, MI, OH, WI 

Mideast – DE, DC, MD, NJ, NY, PA 

New England – CT, ME, MA, NH, RI, VT 

Plains – IA, KS, MN, MO, NE, ND, SD 

Rocky Mountains – CO, ID, MT, UT, WY 

Southeast – AL, AR, FL, GA, KY, LA, MS, NC, SC, TN, VA, WV 

Southwest – AZ, NM, OK, TX 

Former CBAs 

National health care spending grows 

WASHINGTON ­– Total national health care spending in 2019 grew 4.6%, according to a study from the Office of the Actuary at CMS. 

That’s similar to the 4.7% growth in 2018 and the average annual growth of 4.5% since 2016, according the study, which was published Dec. 16.  

The share of the economy dedicated to health spending was 17.7%. 

The 4.6% in growth in health expenditures was faster than the overall economic growth of 4% as measured by the Gross Domestic Product. 

Growth in total national health care expenditures was $3.8 trillion in 2019 or $11,582 per person, up from $2.6 trillion or $11,129 per person. 

Also from the report: 

  • Spending for personal health care, including goods and services, accounted for 84% of total health care spending in 2019 and increased 5.2%, a faster rate than 4.1% in 2018. Offsetting the faster growth was a decline in the net cost of health insurance, which declined 3.8%. 

  • Private health insurance spending increased 3.7% to $1.2 trillion. Private health insurance enrollment increased by 0.5% in 2019, as enrollment in employer sponsored insurance increased by 0.7%. 

  • Medicare spending (21% of total health care spending) grew 6.7% to $799.4 billion in 2019, slightly faster than 6.3% growth in 2018. The accelerated growth reflected faster growth in private Medicare health plan spending (39% of total Medicare spending in 2019). Fee-for-service Medicare expenditures slowed, growing 2.2%, compared to 3% in 2018. Overall, Medicare enrollment was 2.6%, the same as 2018. 

  • Medicaid spending (16% of total health care spending) increased 2.9% to $613.5 billion in 2019, similar to 3.1% growth in 2018. 

  • Retail prescription drug spending (10% of total health care spending) increased 5.7% to $369.7 billion in 2019, up from 3.8% in 2018. 

The 2019 National Health Expenditures Data and supporting information will be posted here

Medtrade West rescheduled 

PHOENIX – Medtrade West has been pushed from April to July, in light of the ongoing COVID-19 pandemic. Originally scheduled for April 12-14, the show will now take place July 12-14 at the Phoenix Convention Center. “Our communities are incredibly eager to come together again in person,” said York Schwab, associate show director. “After consulting with key, long-standing exhibitors and attendees, we made the decision to secure dates in July to ensure maximum success for the event for all of our customers.” 

Guardia Medical donates PPE 

SAN DIEGO – Guardia Medical, a manufacturer of PPE, is donating 100,000 face masks to charities and foodbanks, including 36,000 to the Boys & Girls Club of America. As many states go into further lockdowns, Guardia Medical is prepared with sufficient inventory to help companies get back to work when businesses reopen, it says. "The U.S. economy has taken a mighty blow over the last eight months and our goal is to help it get back on its feet,” said David Lowe, director of marketing. "We are here to protect you, your family, your employees and customers so we can beat COVID-19 and get back to normal fast."  

MobilityWorks expands assessment options 

RICHFIELD, Ohio – MobilityWorks is offering private needs analysis at its locations, in addition to its virtual and home-based assessments. During an in-store analysis, the client will be the only one in the showroom and will have the benefit of seeing its large selection of accessible vehicles. MobilityWorks is also, for a limited time, deferring payments for up to 90 days on new or qualifying pre-owned vehicles when financed through the company. 

Predictive analytics maximize CPAP adherence, study finds 

AMSTERDAM, the Netherlands – Automatic telemonitoring algorithms like the Philips Adherence Profiler are relevant tools for early prediction of CPAP therapy adherence, according to a recently published study in the journal Sleep and Breathing. They also may make it possible to focus therapeutic follow-up efforts on patients who are at risk of non-adherence, the study says. The study, which involved 457 patients in France, tested the predictive value at day 14 of the Philips Adherence Profiler algorithm for adherence at three months. The algorithm uses CPAP machine data hosted in the Philips EncoreAnywhere database. In a multivariate analysis, researchers found only older age and the Adherence Profiler prediction at day 14 were significant predictors of adherence. Researchers noted that about 40% of patients treated with CPAP are at risk of discontinuation or insufficient use. 

CQRC fights estimated 5% cut to stationary oxygen 

WASHINGTON – CMS’s “meager” 0.6% CPI-U adjustment escalates the need to pass H.R. 8158, says the Council for Quality Respiratory Care. The lack of a larger adjustment, combined with the budget neutrality requirement, means a reimbursement cut of about 5% for stationary oxygen in non-bid areas, though the impact varies by region, according to the council. “We remain hopeful that Congress will implement a technical fix to this issue through bipartisan end-of-year legislation,” said Crispin Teufel, chairman of the CQRC. “With the COVID-19 public health emergency accelerating, it is increasingly important to preserve patient access to home respiratory care. H.R. 8158 would eliminate the budget neutrality requirement for stationary oxygen in non-bid areas.”  

Tandem names ResMed exec to board 

SAN DIEGO – Tandem Diabetes Care has named Raj Sodhi, president of the software as a service (SaaS) business at ResMed, as an independent member of its board of directors effective Jan. 1. He brings to Tandem more than 25 years of digital strategy experience, SaaS commercialization and operations across multiple industries, including health care, financial services and telecom. “We are pleased to welcome Raj to our board of directors at this important next stage of Tandem’s evolution,” said John Sheridan, president and CEO. “Raj’s deep experience in driving innovation through software technologies will be invaluable to Tandem as we grow our business and advance our ecosystem of data-driven products and services in support of improving the lives of people with diabetes.” Sodhi joined ResMed in 2012 through the company’s acquisition of Umbian, where he was co-founder and president. Since 2016, he has led a series of health care IT acquisitions focused on software platforms serving providers outside of the hospital and building a new segment of growth for ResMed that represents 12% of the company’s global revenues. Sodhi succeeds Edward Cahill, who served as a board member for the company since May 2009. Tandem’s flagship product, the t:slim X2 insulin pump, is capable of remote software updates using a personal computer and features integrated continuous glucose monitoring. 

LCT pharmacists concerned about big chain vaccine program, survey finds 

ALEXANDRIA, Va. – A majority of pharmacists that specialize in long-term care worry that CVS and Walgreens don’t understand the nursing home environment and aren’t prepared to deliver the COVID-19 vaccine without major challenges, according to a new survey from the National Community Pharmacists Association and the American Society of Consultant Pharmacists. Long-term care facilities like nursing homes require specialized services that cater to the unique needs of older adults in those settings, which are almost always provided by service-oriented, independent, LTC pharmacies, the organizations say. “CVS and Walgreens were chosen to administer the program in nursing homes mainly because they have the systematic and technological capacity to handle a lot of volume,” said Chad Worz, ASCP chief executive. “But that shouldn’t be the only consideration. Many residents in assisted living and skilled nursing facilities need help – they can’t get in line or walk down to a room for the vaccination. We need to accommodate them and if that is not recognized a lot can go wrong.” Eighty-two percent of LTC pharmacists believe CVS and Walgreens personnel don’t have enough experience with nursing homes to administer the vaccine safely and effectively; 87% percent say the big chains don’t have enough staff to serve the facilities; and 36% say big chain pharmacists and techs lack adequate training to immunize LTC populations. What’s more, 33% of LTC pharmacists said the chains have reached out to them, asking for help with nursing homes. The NCPA and ASCP have shared the survey results with the Centers for Disease Control and Prevention. 

AdaptHealth looks to raise $500M 

PLYMOUTH MEETING, Pa. – AdaptHealth has launched a $500 million offering of aggregate principal amount of senior notes due 2029. 

The gross proceeds from the offering will be deposited into a segregated escrow account pending completion of the company’s previously announced acquisition of AeroCare Holdings. At the closing of the acquisition, the net proceeds from the offering will be released from escrow and, together with term loan borrowings and cash on hand, will be used to finance the cash portion of the consideration for the AeroCare acquisition and to pay related fees and expenses. 

The gross proceeds from the offering will replace the outstanding bridge commitment in place with Jefferies Finance, in connection with funding the AeroCare acquisition. 

The AeroCare acquisition is expected to close in the first quarter of 2021. If it’s not completed by May 31, the issuer will be required to redeem the senior notes at a redemption price equal to 100% of the principal amount of the senior notes, plus accrued and unpaid interest. 

Ability Members Group buys into new standard 

TORONTO, Ontario – Fifty-nine rehabilitation technology specialists from Ability Members Group have applied for registration with NRRTS as part of a new partnership between NRRTS and the Canadian Assistive Devices Association. “When it comes to complex rehab technology and related services, being able to identify trained and qualified providers ensures that you’re dealing with the right people,” said Jamie Church, CEO of Ability Members Group. “That confidence is important whether you’re a consumer, caregiver, clinician or third-party payer.” Successful candidates must meet various educational and professional criteria to qualify as a registered rehabilitation technology supplier or RRTS. The Ability Members Group, launched in 2017, is a national network of HME providers operating 74 locations across Canada. 

BOC wins award for ‘rethinking’ business 

OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) has been recognized as a silver winner of a 2020 Golden Bridge Award. The award’s “Company Rethinking of the Year” category applauds companies that have demonstrated resiliency and creativity in adapting their business models and customer service offerings during the COVID-19 pandemic. “COVID-19 continues to present a wide range of challenges for health care professionals and DMEPOS facilities,” said Claudia Zacharias, BOC’s president & CEO. “Like many organizations, BOC has embraced the opportunity to rethink and adapt. We are honored to be named a Silver Winner of this prestigious award.” BOC was acknowledged for introducing tools and technologies to support customers during the pandemic, including offering live, online, remotely proctored exams for certification; conducting virtual site surveys; and publishing thought-leadership articles. The Golden Bridge Award is a business recognition program to honor achievements and innovations from every major industry worldwide.  

MHA sponsors home infusion benchmarking program 
ALEXANDRIA, Va. – Managed Health Care Associates, an alternate site  group purchasing organization, will serve as the 2021 sponsor of The National Home Infusion Foundation’s benchmarking program. The goal of the program: to establish national standards for patient satisfaction and clinical outcomes for home and specialty infusion. “Through the NHIF benchmarking initiatives, the industry can advocate effectively for expanding access to home infusion services, validate clinical outcomes, and solidify home infusion as a safe and effective method of care,” said Connie Sullivan, president and CEO of the National Home Infusion Association. NHIF is currently in pilot testing for two new program metrics: status at discharge and 30-day hospital readmission. These metrics will help the industry to better understand the reason patients are discharged from service, as well as the rates of readmission within 30 days of the start of care for patients receiving parenteral nutrition and inotrope therapies, offering a first look at how clinical characteristics impact therapy success rates.  


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