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In brief: Audit update, CQRC comment, home infusion payment

In brief: Audit update, CQRC comment, home infusion payment

WASHINGTON – CMS plans to primarily focus MAC, RAC and SMRC medical reviews on claims with dates of service outside of the public health emergency, the agency stated in a recent clarification

CMS stated: 

“During the PHE, flexibilities were applied across claim types. For certain DME items, this included the non-enforcement of clinical indications for coverage. Since clinical indications for coverage were not enforced for certain DME items provided during the PHE, once the PHE ends CMS plans to primarily focus reviews on claims with dates of service outside of the PHE, for which clinical indications of coverage are applicable.” 

CMS noted that it may still review DME items, as well as other items or services provided during the PHE if needed “to address aberrant behaviors or potential fraud.” The U.S. Department of Health and Human Services and the Office of Inspector General may perform reviews, as well. 

“All claims will be reviewed using the applicable rules in place at the time of the claim dates of services,” CMS stated. 

AAHomecare noted that this is the first guidance that CMS has published regarding audits post-PHE. 

“AAHomecare is pleased to learn that CMS will not be primarily focused on waived claims,” it stated in a bulletin. “AAHomecare has been in contact with CMS concerning the transition out of the PHE and will continue to work with CMS and Medicare contractors as end of the PHE nears.” 

HHS plans to provide at least 60 days advance notice before ending the PHE. Currently, the PHE is in effect until at least Jan. 1.  

CQRC makes voice heard 

WASHINGTON – The Council for Quality Respiratory Care used a recent Request for Information from CMS to push for clear, objective clinical data elements for oxygen that are consistent with existing CMS-developed “templates” to ensure access to care for home respiratory patients. 

In its comments on “Make Your Voice Heard: Promoting Efficiency and Equity Within CMS Programs, the CQRC also urges CMS to issue clear guidelines about what to expect after the COVID-19 public health emergency ends so that patients continue to receive these services based on their existing documentation order. 

"Currently, CMS has yet to issue guidance as to how it plans to address these patients regarding the documentation and audit processes,” the CQRC states. “Requiring all these patients to return to their doctors, be tested again, receive a new prescription, and submit new documentation will overload the already stressed healthcare system.”   

CMS published the RFI in September, seeking public comment on access to health care and related challenges. 

The CQRC also commented on health care worker and provider well-being, saying that Medicare’s reliance on outdated, paper medical record reviews leads to high denial rates as a result of inconsistent document standards.  

“Suppliers simply cannot provide medically necessary services when they are not reimbursed because contractors determine that physician notes do not meet a standard that has not been shared with the physicians making those notes,” the CQRC states. 

CMS updates home infusion payments 

WASHINGTON – CMS has announced an 8.7% payment increase for home infusion therapy for calendar year 2023. 

The payment is based on the percent increase in the Consumer Price Index for all urban customers (CPI-U) for the 12-month period ending with June of the preceding year (9.1%), reduced by the productivity adjustment for CY 2023 (0.4%). 

“The single payment amounts are also adjusted in a budget neutral manner using standardization factors for geographic area wage differences using the geographic adjustment factors (GAF),” CMS states. “The CY 2023 GAF standardization factor that will be used in updating the final HIT payment amounts for CY 2023 is not available for this final rule. However, the standardization factor, the final GAFs, national home infusion therapy payment rates, and locality-adjusted home infusion therapy payment rates will be posted on CMS’s Home Infusion Therapy Services webpage once these rates are finalized.” 

CMS announced the payment increase in the CY2023 Home Health Prospective Payment System rate Update and Home Infusion Therapy Services Requirements – Final Rule (CMS-1766-F). 

Intuity Medical partners with Embecta to promote POGO system 

FREMONT, Calif., and FRANKLIN LAKES, N.J. - Sales representatives at embecta promote Intuity Medical’s POGO Automatic Blood Glucose Monitoring System to health care professionals within the U.S under a new co-promotional agreement. 

embecta, which spin off from Becton, Dickinson and Company in April, is a pure-play diabetes company with a nearly 100-year history of leadership in insulin delivery. Intuity Medical is a medical technology company focused on the development and commercialization of seamless and intuitive blood glucose monitoring solutions.   

“We are excited to partner with an established leader like embecta that has such extensive experience serving people with diabetes,” said George Zamanakos, president and CEO of Intuity Medical. “Working closely with the embecta team will help us expand where we’re able to offer POGO Automatic, giving a new option for simplifying diabetes to millions of people currently relying on conventional blood glucose meters.”  

With its 10-test cartridge technology, POGO Automatic is an automatic blood glucose monitor cleared by the U.S. Food and Drug Administration that lances, collects blood and produces a glucose result at the push of one button, ending the need to individually load and then dispose of lancets and test strips. 

Being able to offer POGO Automatic will expand the innovation and breadth of embecta’s diabetes care offerings.  

“The agreement to promote POGO Automatic to health care professionals not only enables us to expand our offerings to physicians we call on, but it does so within an innovative new category,” said Tom Blount, senior vice president and resident, North America, for embecta. “Automatic blood glucose monitoring is transforming this vital aspect of self-management into something truly seamless and simple for people with diabetes.”   

Aeroflow Breastpumps adds app-based mental health service for new moms 

ASHEVILLE, N.C. – Aeroflow Breastpumps has partnered with Canopie to offer app-based mental health care and psychoeducation to help parents and caregivers manage the highs and lows of parenthood. Research has long shown the correlation between a mom’s breastfeeding relationship and her mental health, with breastfeeding complications increasing the risk of developing a perinatal mood disorder like postpartum depression, Aeroflow says. By weaving a mental health intervention into lactation support, this first-of-its-kind partnership opens up the door to better, more seamless care delivery for moms, it says. “Every day, our team hears from moms who are struggling,” says Jennifer Jordan, vice president of sales operations at Aeroflow Healthcare. “The conversations begin with worries about feeding their baby, but so often they are intertwined with other fears, anxieties, sadness and frustrations. The clear overlap between breastfeeding and mental health makes our partnership with Canopie a natural fit and enables us to provide a more holistic solution in support of our mission to improve maternal health outcomes from the earliest stages of pregnancy and well into the postpartum journey.” The app, which customizes audio and text-based therapeutic programs in English and Spanish, addresses parenting challenges like sleep, feeding and bonding. It also escalates the most vulnerable users to live support. 

Medline inks $140M vendor deal with health system 

NORTHFIELD, Ill. – Medline has entered into a multi-year vendor partnership valued at $140 million with Nebraska-based Bryan Health. As part of the agreement, Medline and Bryan Health collaborate to identify new strategies for enhancing patient outcomes and streamlining supply chain operations for the health care system. "Medline's proactive approach facilitated a smooth implementation, and the customer support has been incredibly responsive," said Heather Seeba, director of supply chain for Bryan Health. "We look forward to partnering with the Medline experts to optimize our operational processes and improve our supply consistency." Also as part of the agreement, Medline will dedicate resources to working with Bryan Health to help address specific caregiver needs and operational efficiencies, with the goal of providing the highest quality of care for those they serve throughout the region. Bryan Health will also have the ability to easily monitor key metrics such as item utilization, contract compliance, price accuracy and spending by product categories through advanced analytics platforms from Medline. "Medline is committed to providing Bryan Health with continuously reliable, superior service," said Megan Schwellenbach, vice president of corporate accounts at Medline. "We are excited to enter into this prime vendor partnership and together develop solutions to help provide consistency and stability to its supply chain." 

Soleo Health earns Gold Seal 

FRISCO, Texas – Soleo Health has been awarded Gold Seal of Approval from The Joint Commission for three programs. It has been awarded new accreditations for both home infusion therapy and specialty pharmacy, and re-accreditation for home care – each valid for 36 months. The Gold Seal is a symbol of quality that reflects a health care organization’s commitment to providing safe and quality patient care.  “Our focus on clinical excellence, quality care and patient safety has always been at the forefront of Soleo Health’s delivery model,” said CEO Drew Walk. “We attribute the dedication of our team, an unwavering commitment to our patients, our innovative complex specialty pharmacy portfolio and deep expertise in therapeutic management services among the key reasons we earned these distinctive honors from the Joint Commission.” CCS launches Gestational Diabetes Management program, taps new CMO 

DALLAS – CCS has launched a Gestational Diabetes Management program as part of its LivingConnected solution. This new program is the first of its kind to couple intensive nutrition and clinical coaching with remote monitoring of blood glucose to address the adverse outcomes for mom and baby of uncontrolled gestational diabetes. CCS says LivingConnected has delivered 45% reduction in total cost of care for engaged members in one large employer group compared to the customer's non-engaged population—demonstrating the power of connected devices and thoughtful program design to drive behavioral change and improve health care utilization. Extending this high-touch approach, the LivingConnected Gestational Diabetes Management (GDM) program partners with plans and OBGYN practices to identify women with gestational diabetes earlier in their pregnancy to then leverage evidence-based best practices to help expectant women understand their condition and manage it appropriately. CCS has also announced that Dr. Arti Masturzo has joined the company as chief medical officer. As a board-certified internal medicine physician with extensive experience in providing services in multiple sites of care, Masturzo will be instrumental in the continued expansion of clinical care services from CCS. She has held strategic and operational roles in private equity-backed health care companies and most recently she served as vice president of Clinical Innovation, Home Care, at Humana. "The addition of Arti as Chief Medical Officer is another important investment in our CCS Health division and clinical expertise," said Tony Vahedian, CEO. "Throughout her career, Arti has used her leadership and health care knowledge to direct efforts that improve outcomes, lower total cost of care and elevate the health care experience. We are excited for her to leverage this skill set to drive profitable growth with our solutions focused on diabetes care and other chronic conditions at home." 

InfuSystem’s ITS business drives Q3 growth 

ROCHESTER HILLS, Mich. – InfuSystem Holdings reported net revenues of $27.3 million for the third quarter, an increase of 3% over the same period the prior year. Integrated Therapy Services (ITS) net revenue was $17.4 million, an increase of 5% vs. the prior year. Durable Medical Equipment Services net revenue was $9.9 million, a decrease of 1% vs. the prior year. “The financial performance for the third quarter was solid with record revenue of $27.3 million and strong gross margin of 59.5%, which increased 202 basis points versus the comparable quarter last year,” said Rich Dilorio, CEO. “I am proud that our talented team continues to deliver industry-leading service levels, which we believe sets the stage for a strong business ramp going into 2023.” Gross profit was $16.2 million, an increase of 6% vs. the prior year. InfuSystem is estimating total revenue of approximately $112 million for the full year 2022, which is at the low end of the previously stated guidance of 10% to 13% revenue growth for 2022. 

CPAPSupplies.com, Resonea partner to offer OSA screening, equipment 

ARDEN, N.C., and SCOTTSDALE, Ariz. – CPAPSupplies.com and Resonea, a medtech company focused on sleep health, have partnered to offer OSA screening services and equipment. “We strive to give our customers top-rated products from trusted brands at competitive prices and exceptional care,” said Lauren Bennet, vice president of sales operations at CPAPSupplies.com. “Being able to offer OSA screening to our clients that they can do from their smartphone is a game changer for us. It means our customers will now have a highly reliable and accurate one-stop-shop for all of their sleep apnea assessment and treatment needs.” Under the new partnership, CPAPSupplies.com will offer Resonea’s DROWZLE sleep apnea screening at no charge. Users can then purchase DROWZLE PRO, the first smartphone-based home sleep test cleared by the U.S. Food and Drug Administration to confirm their results with a sleep medicine provider and get a prescription for therapy if indicated. “Partnering with CPAPSupplies.com allows us to offer an end-to-end solution for patients suffering from sleep apnea,” said Dr. Karen Underwood, chief medical officer at Resonea. “Eighty percent of people with sleep apnea never get diagnosed. This partnership allows more people to screen themselves in the privacy of their own home and take the next steps to testing and treatment.” 

NCPA releases first episode of new reality series 

ALEXANDRIA, Va. – The National Community Pharmacists Association has released the first episode of its new educational reality series “Show Me.” The series, which is styled after popular TV makeover shows, stars pharmacists who need help getting a certain aspect of their business on track. In the first episode, coaches Meredith Ayers, CPhT, and Tana N. Kaefer, PharmD, help pharmacy owners Chris and Gwen O’Neill of Circle Pharmacy in Philadelphia find additional streams of revenue by boosting their immunization program. As Ayers and Kaefer quickly find out, the O’Neills are accustomed to doing it all. Can they incorporate their capable team, as they work to reach the immunization goals developed with their coaches? Will they get overwhelmed and be left behind? Watch the episode here. The NCPA Innovation Center announced the series, which is sponsored by Pfizer, at the NCPA 2022 Annual Convention in early October. The rest of this season’s five episodes will be released in the coming weeks on NCPA’s various internet platforms, including its website and YouTube channel, NCPAvids. The NCPA is actively soliciting ideas and sponsors for the next season of “Show Me.” Interested pharmacists, industry professionals and companies should contact [email protected] 

NasoClenz has potential to increase CPAP compliance, study finds 

FRISCO, Texas – NasoClenz reduced bacterial colonization, while increasing comfort and compliance, in patients who use CPAP therapy to treat sleep apnea, according to the results of a clinical evaluation recently presented at the American College of Surgeons Clinical Congress. “Sleep apnea is a very serious health issue,” said lead author and presenter Keith Matheny, MD, FARS. “Anything we can offer patients that might help improve compliance with CPAP will have a tremendous impact on patients’ lives.” This initial evaluation included a group of routine CPAP patients who were given NasoClenz, an antiseptic cleansing kit that includes anatomically designed, soft nasal applicators used in conjunction with a specially formulated antiseptic gel. Participants used the pre-packaged NasoClenz kits before and after using CPAP for a period of two weeks. They completed a survey before the study started and after two weeks. In the “after” survey, more than 50% of participants reported that the kits made CPAP more comfortable and at least 50% noted that this helped to increase their use of CPAP.  The results also showed a decrease in bacterial colonization. Out of 18 participants, six were randomly selected for pre- and post-study bacterial cultures. Prior to the study, 50% of those patients had antibiotic-resistant strains of bacterial colonization; following two weeks of twice-daily NasoClenz use, bacterial colonization was reduced or eliminated in all but one participant. These results were presented at the American College of Surgeons Clinical Congress Oct. 16-20 in San Diego. 

Infusion Solutions closes, citing ‘increased competition’ 

ASHLAND, Ky. – The board of directors of Infusion Solutions, which provides home infusion therapy to patients from two locations in Ashland, Ky., and Charleston, West Va., has agreed to dissolve the company, according to the Daily Independent. The company is owned equally by St. Mary’s Medical Center, Charleston Area Medical Center and St. Claire HealthCare. “This was an extremely difficult decision for the board and one we do not take lightly,” said David Sheils, Infusion Solutions board president. “Due to the impact of COVID-19 on the home infusion business and increased competition from larger entities, it is no longer financially feasible for us to continue.” Infusion Solutions, which also serves parts of Ohio, will likely cease operations in the next 30 days, according to the newspaper. 

Tomorrow Health bolsters leadership team 

NEW YORK – Tomorrow Health has added Anna Lenhardt and Ryan Colby to its team as chief people officer and head of go-to-market, respectively. Lenhardt joins Tomorrow Health from Hippo Insurance and Oscar Health, where she held vice president roles. In her new role, she will scale Tomorrow Health’s culture as it expands its patient footprint and geographic health plan, care provider and supplier reach. Her duties will include aligning strategy and vision with talent acquisition efforts, operationalizing company values, spearheading DEI programming, engaging employees and more. Colby joins Tomorrow Health from Elemy, a behavioral health innovator, and Uber, where he held operations roles. He will be responsible for applying Tomorrow Health’s model to new markets, implementing partnerships with payers and bringing new referring providers and suppliers onto the company’s marketplace. 

OM names flagship charity partner 

RICHMOND, Va. – The Owens & Minor Foundation has named Ronald McDonald House Charities (RMHC) as its flagship charity partner in a new collaboration that advances the foundation’s goal of helping create healthier communities. The partnership launches with a $500,000 donation from the foundation to support RMHC programming that directly improves the health and well-being of children and their families and enhances the organization’s mission delivery around the world. “Our partnership with RMHC embodies The Owens & Minor Foundation’s dedication to working with organizations that share our values and support our ongoing efforts to create meaningful, positive impact in our communities,” said Faith Cristol, president, Owens & Minor Foundation. “RMHC builds stronger communities by giving the families it serves much-needed access to medical care, and we are humbled to support this important programming.” The partnership kicks off with a national engagement campaign offering OM teammates a variety of in-person and virtual volunteer opportunities that directly support RMHC and its chapters in eight communities where the company has a major presence: Richmond, Va.; Atlanta; White Plains, N.Y. Huntington Beach, Calif.; Lexington, N.C.; Louisville; Salt Lake City; and Downers Grove, Ill. RMHC represents a network of more than 260 chapters in more than 60 countries and regions that operate and support programs that help keep families with children who are sick together and close to the medical care they need. Owens & Minor Foundation’s contribution will, among other things, help to provide more than 5,000 overnight stays for families at a Ronald McDonald House or Family Room.

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