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In brief: Complex rehab momentum, telehealth risks, Medicare Advantage bill

In brief: Complex rehab momentum, telehealth risks, Medicare Advantage bill

WASHINGTON – A record 300-plus advocates participated in the NCART/NRRTS Virtual Congressional Fly-in on Sept. 14. 

Those advocates, who included consumers, clinicians, providers, manufacturers, family members, caregivers and others, held meetings with 292 congressional offices throughout the day. 

“In the weeks ahead, we will be carrying out the important task of following up with offices on the ‘congressional asks’ presented,” said Don Clayback in an email bulletin. 

Those asks included support for a new sign-on letter led by Reps. Jim Langevin, D-R.I., Brian Fitzpatrick, R-Pa., Debbie Dingell, D-Mich., and John Rose, R-Tenn., that urges CMS to move quickly to review coverage for power seat elevation systems. It also urges the agency to open the comment period for power standing systems. 

Members of the House of Representatives have until Oct. 3 to sign the letter. 

“Sens. Tammy Duckworth, D-Ill, Marsha Blackburn, R-Tenn., and Bob Casey, D-Pa., have agreed to lead a similar letter in the Senate,” Clayback said. “We will share details about that as soon as possible.” 

The fly-in also included a congressional briefing held by the ITEM Coalition to support coverage for power seat elevation and power standing systems. It was attended by Sen. Duckworth and Rep. Dan Meuser, D-Pa. 

“The briefing was well-attended and speakers shared clinical, personal and policy perspectives regarding the importance of establishing coverage for this technology,” Clayback said. 

Who will be the next HME Woman of the Year? 

WATERLOO, Iowa – The VGM Group will open nominations for the 2022 HME Woman of the Year Award on Sept. 19.  

The award, now in its 7th year, recognizes a woman who has made increasingly significant contributions throughout her career to her company, community, and the home medical equipment industry.   

“The HME Woman of the Year Award honors the incredible dedication that women have to the industry,” said Mike Mallaro, CEO, VGM Group. “It recognizes women who lead in a variety of ways, whether it’s being an innovator in the profession, sharing their expertise with their peers, or their devotion to helping others.”  

Each year, dozens of nominations are received from across the nation. Nominees include providers, manufacturers, association executives, and other professionals in the home medical equipment, rehab, respiratory, and mastectomy industries.  

Past winners are: 

2021 - Katie Stevens, Reliable Medical Supply

2020 - Patty Mastandrea, MedCare Equipment Co.

2019 - Wendy Russalesi, AdaptHealth  

2018 - Georgie Blackburn, Blackburn’s  

2017 - Barbara Smith, Healthline Medical Equipment

2016 - Dr. Kirsten Davin, Precision Seating Solutions

"Chances are you know a woman deserving of this award," said Jeremy Stolz, president, VGM & Associates. "Think of the people you work with every day, then be sure to submit your nomination. Can you imagine how much an award like this would mean to her?" 

HME Woman of the Year nominations are open to all women, regardless of title or position, who work within the HME industry.  

Nominations will be accepted through Oct. 28 at 

The winner will be announced during a virtual ceremony at 11 a.m. CT on Dec. 15, 2022. 

Great Elm: ‘DME demonstrated strong core profitability’ 

WALTHAM, Mass. – Great Elm Group’s DME operating companies reported $16.5 million in total revenue for the three months ended June 30, 2022, compared to $14.5 million for the same period the previous year. 

The increase in revenue was primarily attributable to more favorable intake and collections processes driving lower revenue reserve rates. 

DME recognized a net loss of $200,000 for the fourth quarter of FY 2022 compared to net income of $5.9 million for the same period the prior year. 

The decrease in net income is attributed primarily to a $4.7 million increase in net intercompany charges in the current period related to DME preferred stock that eliminates in general corporate. In addition, the prior period benefited from $2.3 million in government stimulus whereas no benefit was received during the three months ended June 30, 2022. 

DME reported total revenue of $63.5 million for the fiscal year ended June 30, 2022, compared to $57.6 million for the same period the prior year. It reported a net loss of $3.8 million vs. a net loss of $2.5 million. 

Great Elm noted in its earnings release that DME demonstrated strong core profitability despite challenging supply chain conditions, which improved gradually over the course of the fiscal year 2022. It also noted it successfully integrated two add-on acquisitions over the year, AMPM and MedOne, acquired in March 2021 and August 2021, respectively. 

OIG assesses telehealth risks, CQRC responds 

WASHINGTON – High-risk providers represent a small portion of all providers who billed for a telehealth service, but strong, targeted oversight of these services is still important, according to a new report from the Office of Inspector General. 

The OIG identified 1,714 providers out of about 742,000 whose billing for telehealth services during the first year of the pandemic posed a high risk to Medicare, representing a total of $127.7 million in Medicare fee-for-service payments for about 500,000 beneficiaries. Each had concerning billing on at least one of seven measures that the OIG developed that may indicate fraud, waste, or abuse of telehealth services. 

The agency recommends that CMS (1) strengthen monitoring and targeted oversight of telehealth services, (2) provide additional education to providers on appropriate billing for telehealth services, (3) improve the transparency of “incident to” services when clinical staff primarily delivered the telehealth service, (4) identify telehealth companies that bill Medicare, and (5) follow up on the providers identified in this report. 

CMS concurred with the OIG’s recommendation to follow up on the providers identified in the report but did not explicitly indicate whether it concurred with the other four recommendations. 

The Council for Quality Respiratory Care believes the report’s findings of small number of high-risk providers support extending the flexibilities around telehealth post-public health emergency. 

“The OIG’s latest report on telehealth use, which found an extraordinarily low rate of high-risk billing, indicates that the flexibilities established during the first year of the pandemic are working well and meeting the needs of Medicare beneficiaries, while also maintaining the integrity of the program,” said Crispin Teufel, chairman of the CQRC. “Telehealth has been an essential tool in enabling providers to reach patients with COPD and other respiratory illnesses who require supplemental oxygen to remain safely in their homes.” 

Under the regulatory relaxations, prescribing physicians are able to carry out required face-to-face and follow-up visits for home oxygen and sleep therapies following a physician order via a telehealth visit. 

The CQRC says since patients with serious and chronic respiratory illnesses are exceptionally vulnerable to other infections, it is absolutely critical for providers to use telehealth services to minimize patients’ risk, while ensuring they can continue to access the home respiratory therapies prescribed by their physicians.  

BMA applauds House for passing Medicare Advantage bill 

WASHINGTON – The Better Medicare Alliance applauds the House of Representatives for passing H.R. 3173, the Improving Seniors’ Timely Access to Care Act. The bipartisan legislation, which was sponsored by Reps. Suzan DelBen, D-Wash., Mike Kelly, R-Pa., Ami Bera, MD, D-Calif., and Larry Bucshon, MD, R-Ind., and endorsed by Better Medicare Alliance, would modernize the way Medicare Advantage uses prior authorization as a clinical tool to coordinate beneficiary care. “The Improving Seniors’ Timely Access to Care Act is commonsense, bipartisan legislation to further raise the bar of care delivery in Medicare Advantage – where seniors already experience a 94% satisfaction rate, nearly $2,000 in annual consumer savings, added benefits, and improved health outcomes, just to name a few,” said Mary Beth Donahue, president and CEO of the Better Medicare Alliance. “Importantly, this bill builds on efforts already underway in Medicare Advantage to modernize prior authorization while protecting its essential function in facilitating safe, high-value, evidence-based care. We look forward to swift passage in the Senate and putting this legislation on President Biden’s desk for his signature.”   

Aetrex launches 

TEANECK, N.J. – Aetrex, a global leader in foot scanning technology, orthotics and comfort and wellness footwear, launched the Data Portal, a dedicated platform to help shoe manufacturers around the world create better fitting footwear. Users can view and extract global 3D foot data broken down by gender, foot size, country and more. The launch of the portal marks a major step forward in the advancement of footwear development technology by taking the guesswork out of the equation. “The availability of complete, accurate 3D measurements of the foot to help develop better fitting shoes and lasts has not been possible until now,” said Larry Schwartz, CEO. “Our mission with is to provide our brand partners with the data they need to create anatomically correct, highly informed lasts for shoes that not only fit more comfortably but also enhance performance.” The portal aggregates foot scans from Aetrex’s two newest 3D foot scanners, Albert 2 Pro and Albert 3DFit. The scanners are engineered with a pure computer vision model, a proprietary process designed to collect comprehensive foot data and create the most accurate 3D reconstruction of the foot. From these 3D models of feet, Aetrex can pull accurate measurements from any part of the foot. 

Permobil Foundation gifts wheelchair 

NASHVILLE, Tenn. – Permobil Foundation, in partnership with the St. Louis Cardinals, LiveLikeLou, Phi Delta Theta and Cardinals Care, gave Alan Brown his own team-branded, custom Permobil M3 Corpus power wheelchair. “Alan has dedicated his life to providing adaptive equipment to others,” says Ashley Davis, executive director of the Permobil Foundation. “We were so impressed with the stories we heard from his 40 years at BraunAbililty, like crafting custom wheelchair solutions or his weekly trip to the VA to hand deliver prosthetics to veterans. Now we can help him in his time of need.” Brown was diagnosed with ALS in 2020. “I can’t explain what this means to me and my family. I never thought it would be me needing the chair, but now this chair will allow me to continue to do more with my family and come see the Cardinals play. 

Mother, daughter charged with fraud 

MIAMI – A south Florida federal grand jury has charged Mirosis Gonzalez and her daughter Berioska Sosa with paying kickbacks in exchange for referrals of Medicare beneficiaries to their pharmacy, then using the referrals to steal millions from Medicare. Gonzalez and Sosa owned and operated Aviva Care Pharmacy (which did business under the name American Care Pharmacy) in Sunrise, Fla. From August 2016 through May 2020, the defendants allegedly paid kickbacks and bribes to marketing and telemedicine companies in exchange for referrals for Medicare beneficiaries, as well as doctor orders and prescriptions, to Aviva Care Pharmacy.  It is alleged that the bribed companies sent, and Aviva accepted, orders for DME and prescriptions for pharmaceutical medication, without considering medical necessity or Medicare reimbursement eligibility.  The defendants allegedly negotiated the kickback and bribe arrangements with the companies and created sham contracts meant to disguise the bribes as payments for marketing and other services. Gonzalez and Sosa reportedly submitted more than$12 million in false claims to Medicare and Aviva Care Pharmacy received payments totaling more than $8.4 million. 

Trella Health releases market insights for HME, home infusion 

ATLANTA – Trella Health has released its Marketscape Insights for home medical equipment and home infusion providers. The market insights will provide these organizations with the ability to improve their business strategies with enhanced market data through a streamlined and intuitive user experience. "Trella's enhanced market insights will allow HME and infusion suppliers to gain the competitive advantage they need to identify new markets for growth and improve their business development strategies," said Andy Powell, senior vice president of customer experience. "With Marketscape Insights, our customers are set up for success with the data they need to partner with the best referral sources for growth." Marketscape Insights includes increased filtering capabilities to target specific code sets and specialties, as well as the ability to view charts and graphs for specific physicians, patient populations, utilization and referral market share. HME and infusion organizations will also be able to analyze and track competitive market share for each referral source and product line. Users can more strategically grow their business using the insights to identify new product and market expansion opportunities. 

RESNA appoints new board members 
ARLINGTON, Va. – RESNA has appointed a new treasurer and members to its board of directors. They are: Ed Giesbrecht, treasurer, term ends July 31, 2023; Alisa Brownlee, term ends July 31, 2023; Nicole Zaino, term ends July 31, 2023; Heidi Koester, term ends July 31, 2024; and Rita Stanley, term ends July 31, 2025.

Elidah, VGM partner to expand access to female health solution 

MONROE, Conn. – Elidah, a growing medical solutions company that focuses on delivering FDA-cleared, clinically proven treatment devices for difficult-to-treat female health urinary conditions, has signed a national agreement with VGM & Associates. The agreement expands Elidah’s reach for the one-in-three women who suffer from pelvic floor dysfunction with urinary incontinence, according to a press release. “We are very privileged to partner with VGM & Associates as their reach and focus will enable us to expand our voice and help more women through their prescribers,” said Gloria Kolb, CEO of Elidah. “The demand for home medical equipment is fueled by the increasing prevalence of chronic conditions and rising adoption of self-health management. Using a device at home is a very cost-effective treatment.” Elidah’s ELITONE device, which is indicated for stress urinary incontinence for both over-the-counter and prescription use, primarily reaches consumers through direct-to-consumer marketing. The agreement with VGM’s Essentially Women division significantly broadens its reach beyond e-commerce to the health care professional and prescription channel. The EW network has more than 750 locations of women’s health suppliers nationwide that focus on delivering female health solutions and treatments.  

NCPA secures fireside chat with FTC official 

ALEXANDRIA, Va. – The National Community Pharmacists Association has announced that Federal Trade Commissioner Chair Lina M. Khan will headline the organization’s 2022 Annual Convention Oct. 1-4 in Kansas City. Khan will speak during the Second General Session on Oct. 3 in a fireside chat with NCPA CEO B. Douglas Hoey, pharmacist, MBA. “As FTC chair, Khan has been receptive to hearing the concerns of independent pharmacists, and this is a great opportunity to get her thoughts about issues in our industry and talk about the important work her agency does on behalf of consumers,” Hoey said. “I appreciate that she’s taking the time to join us and be a part of our strong lineup of speakers!” The session will also include time for Q&A. Khan was sworn in as chair of the FTC on June 15, 2021. She has previously criticized vertical mergers in technology. 

NCPA hosts policymakers 

ALEXANDRIA, Va. – The National Community Pharmacists Association completed 60 pharmacy meetings with policymakers or their staff as part of its Month of Action initiative in August and earlier this month. The initiative took the place of the NCPA’s congressional fly-in to Washington, D.C., which usually takes place in April. “These opportunities to share how decisions made in Washington affect independent pharmacies and patients across the country are times well-spent,” said NCPA President Michele Belcher, owner of Grants Pass Pharmacy in Grants Pass, Ore. “I’m glad to have participated in NCPA’s Month of Action and am proud that so many independent pharmacists were prioritized by policymakers’ offices for meeting with this summer.” Twenty-two meetings were with legislators who serve in leadership or on key committees for community pharmacy, including Sen. Ron Wyden D-Ore., chairman of the Senate Finance Committee, and Rep. Cathy McMorris Rodgers R-Wash., ranking member of the House Energy and Commerce Committee. CMS Administrator Chiquita Brooks-LaSure also visited a community pharmacy. Nearly 40% of pharmacies participating in the Month of Action hosted a legislator for the first time.      

Corner Home Medical buys part of health system’s DME business 

ST. PAUL – Corner Home Medical will purchase elements of Essentia Health’s DME services, according to the Grand Rapids Herald Review. Effective Aug. 1, Corner Home began servicing Essentia’s patients currently under equipment rental agreements and moving forward, it will manage all orders, the newspaper reports. “As we pursued this agreement, it became clear that Essentia and Corner Home Medical share similar values and a commitment to quality that will continue to benefit our patients,” said Matt Posinski, Essentia’s senior vice president for system clinical and support services. “Essentia is always looking for opportunities to provide the best possible care, and that includes finding improved options for services our patients need.” Essentia Health will continue to offer orthotics and prosthetics services at its locations in Duluth and Fargo. Essentia Health is an integrated health system serving patients in Minnesota, Wisconsin and North Dakota. 

Health system launches home infusion program 

NEW HAVEN, Conn. – Yale New Haven Health (YNHH) has launched a home infusion program, expanding access to care at home, improving patient convenience and reducing barriers and disruptions in care. YNHH’s Home Infusion Center is located at its Regional Operations Center in New Haven, with a total area of 8,475 square feet. “Implementing home infusion services for our patients is an important step forward in today’s health care environment where patients can receive safe, high-quality care without leaving their homes,” said Lorraine Lee, SVP, clinical operations, Yale New Haven Health. “This investment will serve all our patients well, as drug therapies can be given safely and with the same standards of care as when administered in the hospital setting.” Eligible patients across Connecticut will be able to receive infusion treatments at home for conditions that until now may have required a hospital or infusion clinic visit. Infusions will be mixed/dispensed by the Yale New Haven Health Home Infusion Pharmacy, will include education and administration provided by an infusion nurse and will cover a range of needs from routine intravenous hydration, parenteral nutrition, antibiotic therapy and immune and monoclonal therapies. YNHH’s home infusion services will include a specially designed “clean room” where compounded sterile products are prepared, with a phased roll out of prepared products, including total parenteral nutrition for all adult and pediatric patients, and TPN and specialty infusion medication for at-home patients. 

Medtrade calls for speakers under new format 

DALLAS – Show organizers, including the Educational Advisory Board, have put out a call for speakers for Medtrade, March 28-30 in Dallas. The educational program will feature a new format that includes content categories and topics pre-selected by the EAB; descriptions and overarching objectives to serve as a guide for presentations; learning objectives submitted by speakers; and presentations that adhere to the description and learning objectives. “Please understand that this is not a call to propose a program,” they say. “Instead, we are looking for speakers to present a specific topic listed within each category. While there is some flexibility in the specific content for the program, the content must adhere to the description and overarching objectives outlined.” The EAB’s pre-selected content categories and topics are audits, business operations, contractor updates, federal legislative and regulatory, leadership, legal, payer relations, products, services, sales and marketing, state legislative and regulatory, retail and technology. The deadline for submissions is Oct. 17.


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