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In brief: Home infusion fail, free tests, ResMed CTO

In brief: Home infusion fail, free tests, ResMed CTO

WASHINGTON - The National Home Infusion Association isn’t surprised by a recent report from CMS that shows a drop in the number of beneficiaries using the Medicare Part B home infusion therapy (HIT) services benefit. 

The association says the report shows the benefit has failed to draw sufficient participation from providers to ensure equitable access across the country. 

“The Part B HIT services benefit is clearly failing to meet the needs of Medicare beneficiaries,” said Tim Affeldt, PharmD, NHIA board chairman. “While nursing services are an essential component of home infusion, the pharmacist-driven services to coordinate care, provide sterile drugs, perform clinical monitoring, and ensure patients meet the overall goals of the plan of care are equally important and should be reflected in the benefit.” 

The report examined utilization of the Part B HIT services benefit, which was created by the 21st Century Cures Act passed in 2016, and the temporary transitional payment, which was required by the Medicare Part B Improvement Act of 2017. It found that utilization has dropped by more than 20% with the transition from the TTP to the permanent benefit, which requires providers to enroll with Medicare AB MACs and obtain HIT-specific accreditation.  

Other findings from the report: 

  • Only 9% of beneficiaries receiving a Part B HIT drug had a billable HIT service during the TTP. That number fell to 5% in the first quarter of the permanent benefit.  
  • Only 40 providers billed for HIT services in Q1 2021, despite there being nearly 1,000 DMEPOS pharmacies, 11,000 home health agencies, and a wide range of other providers in the U.S. capable of participating in the benefit. 
  • In most states, fewer than 100 visits were performed in each category over the 12-month period. In three states (North Dakota, Vermont and Wyoming), no services were provided under the benefit during the 12-month period. 

Medicare to pay for OTC COVID-19 tests 

WASHINGTON – Medicare will cover the cost of OTC COVID-19 tests for beneficiaries with either original Medicare or Medicare Advantage starting early this spring.  

Under the initiative, which is part of the Biden-Harris Administration’s ongoing efforts to expand access to testing, Medicare beneficiaries may access up to eight OTC COVID-19 tests per month for free. Tests approved or authorized by the U.S. Food and Drug Administration will be available through eligible pharmacies and other participating entities. 

Until then, beneficiaries can access free tests by: 

  • Requesting four free over-the-counter tests for home delivery at 
  • Accessing COVID-19 tests through health care providers at over 20,000 free testing sites nationwide. A list of community-based testing sites can be found here. 
  • Accessing lab-based PCR tests and antigen tests performed by a laboratory when the test is ordered by a physician, non-physician practitioner, pharmacist or other authorized health care professional at no cost. Beneficiaries can also access one lab-performed test without an order and without cost sharing during the public health emergency. 

In addition, the administration says Medicare Advantage plans may offer coverage and payment for OTC COVID-19 tests as a supplemental benefit in addition to covering Medicare Part A and Part B benefits.   

For more information: (PDF) 

Better Medicare Alliance applauds Medicare Advantage changes 

Washington, D.C. – CMS’s 2023 Medicare Advantage Advance Notice will “ensure stability” for beneficiaries, says Better Medicare Alliance, a research and advocacy organization supporting Medicare Advantage. The notice, which is open for comment for 30 days, details CMS’s plans to change the Medicare Advantage and Part D Star Ratings to take into account how well each plan advances health equity and how often they are screening for common health-related social needs, such as food insecurity, housing insecurity and transportation problems. “As we continue to review the Advance Notice in further detail, we appreciate that CMS has offered a thoughtful proposal that will help ensure stability for the millions of diverse seniors and individuals with disabilities who count on Medicare Advantage,” said Mary Beth Donahue, president and CEO of the Better Medicare Alliance. “The proposal additionally furthers our shared goal of improving health equity, recognizing progress made and more needs to be done. Medicare Advantage has proven its worth for seniors and taxpayers; providing lower costs, meaningful benefits that address social determinants of health, better outcomes and greater efficiencies for the Medicare dollar. A stable rate for 2023 ensures this work can continue.” CMS’s Advance Notice follows a recent Congressional letter in which a record-setting 346 bipartisan Members of Congress declared support for Medicare Advantage and urged the agency “to provide a stable rate and policy environment” for the program in 2023. 

Home Oxygen Company goes extra mile 

MODESTO, Calif. - Home Oxygen Company is taking a hands-on approach to the remediation of recalled Philips CPAP devices equipment. “We decided at the onset to handle this ourselves,” said Andrea Ewert, CEO. “We are already seeing the positive results and feedback from our patients.” Home Oxygen Company decided to go the extra mile and hand deliver all replacement units due to the rampant theft and loss of mail packages occurring throughout the country, as well as delays with all the national logistics carriers. “We wanted to assure our patients have their new unit in their hands before the mail system further complicates this already delicate situation,” Ewert said. Home Oxygen Company has also produced quick orientation videos to quickly familiarize patients with their new units. 

Verustat expands services 

NASHVILLE, Tenn. – Verustat, which offers a full-service remote patient monitoring system, has expanded its services to provide multiple levels of support for decentralized clinical trials (DCT). Verustat's customizable SELECT DCT program is a streamlined solution that offers increased compliance, stability and accuracy in a single, customizable source, the company says. "The launch of Verustat's DCT platforms marks an important evolution in our pursuit to modernize the way clinical trials are conducted for the life science industry," said Andy Maloy, senior vice president of technology and clinical trials at Verustat. "We are excited to have built this custom solution that services numerous DCT needs and will improve the overall experience for all parties." Verustat designed the DCT program to enhance the patient experience and improve compliance at their home, with each DCT customizable to their requirements. Service offerings include Verustat’s RPM platform, telemedicine visits, medical peripheral hardware sourcing, multiple communication methods, global customs management, Tier 2 technical support and equipment leasing. Verustat's trained call center team ensures that patients receive full training in how to use their medical and mobile devices. They are also available to answer any questions and to help ensure compliance during the trial. 

Quipt names former E&Y exec to board 

CINCINNATI – Quipt Home Medical has named Brian Wessel to its board of directors as an independent director and chairman of its Audit Committee. Wessel is a senior business executive with more than 34 years of global client service, operational and financial expertise, most recently as a senior partner at Ernst & Young. “The board is excited to welcome Mr. Wessel to serve as an independent director and serve as its Audit Committee Chair during a substantial period of growth for Quipt,” said Greg Crawford, chairman and CEO. “Mr. Wessel’s vast global experience, combined with his financial and accounting expertise, immediately positions Mr. Wessel well to contribute to our strategic growth plan,” . “Furthermore, Mr. Wessel will add significant value with his expertise in financial reporting oversight, adding clear, strategic, and thoughtful insights for the team to utilize. Mr. Wessel’s wealth of experience will be invaluable to us as we continue our aggressive expansion as an emerging leader in at home clinical respiratory care across the United States.” 

Entrusted Pediatric Home Care acquires AMP 

AUSTIN, Texas – Entrusted Pediatric Home Care, a Texas-based pediatric home health care provider, has acquired Advance Medical Pediatric Home Health (AMP), a private-duty nursing company based in McKinney, Texas. "We are excited to welcome AMP into the Entrusted team," said Nicholas Norwood, president of Entrusted Pediatric Home Care. "AMP has a strong reputation for integrity and putting patients and families first. Something we at Entrusted pride ourselves in, as well. In addition, this new venture allows us to grow into the North Texas market, where we can serve our clients better in cities all over the Dallas and Fort Worth metroplex." Entrusted Pediatric Home Care was founded in 2017. 

Responsive Respiratory marks 20 years 

ST. LOUIS – Responsive Respiratory is celebrating its 20th anniversary. The manufacturer of home oxygen equipment and supplies has grown from a small regional start-up to a nationally recognized domestic manufacturer and redistributor. “I am proud to celebrate this momentous milestone and look forward to many more years of providing exceptional products and service to our customers,” says Tom Bannon, president. “We offer a wide breadth of products, customizable solutions and outstanding service that set us, as a company, apart in the industry.” Founded in 2002 by three medical professionals, Responsive Respiratory is dedicated to providing the highest quality products and service to the home care, hospital and EMS markets, offering a broad portfolio of oxygen delivery, transport and storage solutions for high pressure oxygen, which is why they are known as “the high pressure oxygen experts.” 

Sunset achieves milestone 

CHICAGO - Sunset Healthcare Solutions has successfully passed the ISO 13485 and MD-SAP audit of its Chicago and Bloomingdale, Ill., facilities and will receive full certification this month. “This certification is our next step in establishing Sunset as a global medical device manufacturer,” says Joe Consoli, quality and regulatory director. “The outcome could not have been better.” The milestone allows Sunset to expand manufacturing capabilities and provide an array of medical products to international partners and their customer base. The company is currently working to obtain certification for its facility in Phoenix. 

RESNA calls for board nominations 

ARLINGTON, Va. – RESNA is seeking nominations for president-elect, secretary and three board members. The deadline is Feb. 28. President-elect is a six-year commitment; secretary is a two-year commitment and board positions are three-year commitments. While it is preferred that a board candidate have a history of participation in and contribution to RESNA activities, including having served in some leadership capacities, it is not required.  The Governance Committee will review nominations and forward proposed candidates to the board of directors for consideration at its spring meeting. After approval by the board, RESNA will make the online election system available to its membership. 

MedPAC, MACPAC update data book 

WASHINGTON – MedPAC and the Medicaid and CHIP Payment and Access Commission (MACPAC) have released the newly update data book, Beneficiaries Dually Eligible for Medicare and Medicaid. This version of the book is the first to use data from the Transformed Medicaid Statistical Information System, which captures more recent data and information than previously available. The book compares subgroups of dually eligible beneficiaries, including those with full versus partial benefits and those under age 65 versus those ages 65 and older. It also compares dually eligible beneficiaries with non-dually eligible Medicare and Medicaid beneficiaries. The book is available here

ResMed names new CTO 

SAN DIEGO – ResMed has appointed Urvashi Tyagi as CTO to lead the company’s Digital Health Technology team. She is charged with driving the innovation and adoption of ResMed’s cloud-based digital health platforms, as well as making investments in emergency technologies like artificial intelligence and machine learning. “Urvashi brings world-class technology and engineering know-how, combined with senior leadership experience from other top fintech and consumer tech companies, that will help ResMed accelerate growth of our digital ecosystem, and achieve our goal of improving the lives of 250 million people in 2025,” said ResMed CEO Mick Farrell. “Urvashi has seen and developed best practices in technology across multiple industries, and her strong leadership and team development skills will help her infuse those learnings and practices into the market-transforming work we do here at ResMed.” Tyagi has more than 25 years of experience in IT and mechanical engineering, user experience, finance, business development and executive leadership. Before joining ResMed, she was global head of commercial data engineering for American Express. She has also held senior roles at Amazon’s Audible business, Microsoft and IBM. Bobby Ghoshal, ResMed's previous CTO, will now transition full time to leading the company’s SaaS business as president. 

New ATF program focuses on pressure injuries 

NEWNAN, Ga. – ATF Medical has introduced a Pressure Injury Prevention and Intervention Program to make sure injured workers have all the information they need to prevent or properly treat pressure injuries or wounds. “There is a large body of information from credible nursing, rehabilitation and equipment manufacturers about pressure injuries, but it is not all in one place and not customized to the individual and circulated to all the providers who need it,” said Edwina Murphy, OTR, ATP, ATF Medical’s director of rehab technology. As part of the program, ATF Medical designs a customized pressure management program for the injured worker, synthesizing relevant treatment protocols, durable medical equipment data and educational materials, and shares it with the injured worker, providers and the claim representative. The report recommends solutions, such as pressure relief schedules to increase circulation or power-assisted tilt for a person who cannot move him or herself. “Our program is designed to avoid and reduce costs through proper communication, coordination and accountability,” Murphy said. 

Soleo earns specialty accreditation 

FRISCO, Texas – Soleo Health has achieved accreditation through the Accreditation Commission for Health Care as a specialty pharmacy with distinction in rare disease and orphan drugs. It’s one of only six nationally to earn the distinction. “Soleo Health prides itself on delivering the highest quality care and bringing innovative specialty pharmaceuticals to patients,” said Drew Walk, Soleo Health's CEO. “This accreditation is indicative of our abilities to consistently strive to exceed the expectations of our stakeholders, including patients, providers, manufacturers and payers. We are honored to be recognized by the ACHC with this prominent distinction, which demonstrates our unrelenting commitment to care.” Soleo Health’s locations in Chicago, Philadelphia, Phoenix and Columbus, Ohio, which each have a national reach through the company’s licensure in all 50 states, have earned the accreditation. The process involved audits of Soleo Health’s policies and procedures, compliance checks and analysis of training tools, as well as evaluation of patient protocols and delivery of care processes. 

Philips honored for workplace equality 

CAMBRIDGE, Mass. – Royal Philips has received a score of 100% on the Human Rights Campaign Foundation’s 2022 Corporate Equality Index, a national benchmarking survey and report measuring corporate policies and practices related to LGBTQ+ workplace equality. It’s the fourth consecutive year that Philips has been named to the list. "We aim to be the best place to work for our employees, embracing diversity and inclusion, and assuring a safe and healthy work environment," said Lauren Gohde, Philips North America Inclusion & Diversity Lead. "Achieving CEI’s designation as a ‘Best Places to Work for LGBTQ+ Equality’ with a 100% score is the result of collaboration at all levels and from across the entire organization. While there is always more work that needs to be done, we are grateful for this recognition and what it stands for. Our commitment to ensuring a culture of inclusion and belonging for all has never been stronger." Philips is one of only 30 health care companies in the country to score 100%. The company’s most recent workplace equality initiatives include the launch of Corporate Social Responsibility Giving Guidelines, a vendor non-discrimination agreement and a commitment to employee education on gender identity and sexual orientation. 

ConvaTec enters new market 

BRIDGEWATER, N.J. – ConvaTec will enter the wound biologics segment with its planned acquisition of Memphis, Tenn.-based Triad Life Sciences for an initial consideration of $125 million. 

The company says the wound biologics segment is estimated to be worth $1.8 billion per year globally. 

“Today’s announcement marks another successful step in our strategic intent of pivoting to sustainable and profitable growth,” said Karim Bitar, CEO of ConvaTec. “This transaction will strengthen our Wound Care business and enable ConvaTec to enter the rapidly growing wound biologics segment. Triad Life Sciences has innovative and differentiated products and an exciting pipeline which is consistent with our vision – Pioneering trusted medical solutions to improve the lives we touch.  We are delighted that (Russ Olsen, president and CEO) and the team have decided to join ConvaTec.”    

The initial consideration also comprises two potential additional payments of $25 million each related to short-term milestones. Additionally, it comprises two earnout payments conditional on performance during the first and second year after the deal is completed, with a maximum earnout of $275 million. 

Triad, founded in 2017, has 50 employees. 

Oventus names new CEO, reports results 

BRISBANE, Australia – Oventus Medical has announced that John Cox will replace Dr. Chris Hart as CEO on Feb. 1. Hart will remain executive director and will also take on the new role of chairman of the Scientific Advisory Board to lead scientific and clinical research projects designed to position the company’s O2Vent Opima technology as the first choice for patients and clinicians for the treatment of OSA. “On behalf of the board, I want to thank Chris for his leadership and the many significant contributions he’s made to Oventus since the company’s inception,” said Sue MacLeman, chairperson. “He invented the technology, founded the company, and has led Oventus through its early stages with conviction and passion. Now, Chris would like to return over time to his clinical practice and devote more time to the advancement of the O2Vent technology. “We are grateful to be able to retain Chris’ substantial clinical skillset and corporate knowledge as John makes his planned transition into the role of CEO.” Cox has a strong track record in successfully commercializing medtech therapeutics, including those for obstructive sleep apnea, Oventus says. The company also announced financial results for the quarter ended December, including total revenue increased 51% to $334,000 and revenue for O2Vent, specifically, increased 39%. Other highlights: Direct-to-consumer marketing drove an 88% increase in active leads compared to the prior quarter and completed telehealth consults nearly doubled to 1,318.  

Big chunk of Congress supports Medicare Advantage 

WASHINGTON – A recent letter signed by 346 members of the U.S. House of Representatives makes the case for a “stable” Medicare Advantage program. In the letter to CMS, lawmakers urge the agency to “provide a stable rate and policy environment that ensure Medicare Advantage can continue to provide the affordable, high-quality, patient-centered coverage our constituents rely on every day.” “Medicare Advantage continues to reach new highs in enrollment, beneficiary satisfaction, and now, congressional support,” said Mary Beth Donahue, president and CEO of the Better Medicare Alliance. “At a time of increasing polarization in Washington and around the country, Medicare Advantage garners overwhelming bipartisan support because it delivers on its commitment to achieve lower costs and better outcomes for seniors.” The letter comes as CMS prepares its annual rate-setting process for the 2023 plan year. Additionally, more than 30 of the nation’s top provider groups, consumer organizations, professional associations, community-based nonprofits and health advocacy organizations have signed letters of support for Medicare Advantage, according to Better Medicare Alliance. Better Medicare Alliance is a community of more than 600,000 grassroots beneficiaries and more than 170 ally organizations working to improve health care through a strong Medicare Advantage program. 

Improper payment rate drops 

WASHINGTON – The improper payment rate for DMEPOS was 28.6% from July 2019 through June 2020, a 3.2% decrease from the prior year, according to the latest 2021 Medicare Fee-for-Service Supplemental Improper Payment Data Report from CMS. The improper payment rate varies by product category, AAHomecare pointed out in a bulletin, from 8.8% for power wheelchairs to 40.8% for enteral nutrition. CPAP devices and oxygen concentrators had improper payment rates of 30.8% and 22.3%, respectively. The main driver for the improper payment rate is insufficient documentation (76.9%). Go here for the full report.


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