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In brief: Industry’s reimbursement uncertainty, MedPAC’s MA takedown, CMS’s Change flexibilities 

In brief: Industry’s reimbursement uncertainty, MedPAC’s MA takedown, CMS’s Change flexibilities 

WASHINGTON – Industry stakeholders are on the hunt for another vehicle for their legislation to extend the 75/25 blended Medicare reimbursement rate in non-rural areas through 2024. 

AAHomecare reports that its lobbyists and HME advocates on the Hill have indicated that reimbursement relief will not be included in a second segment of appropriations language that must pass Congress by March 22 to prevent another government shutdown. 

“We will continue to look for other legislative opportunities to move the 75/25 measures forward in the near term,” the association stated. “We encourage advocates to continue to reach out to healthcare staffers for your Senators and Representative to let them know this is still an important priority and ask for their support in making sure Congressional leaders understand this.” 

The 75/25 blended rates expired on Dec. 31, 2023. 

AAHomecare encourages stakeholders to mention, when reaching out to lawmakers, that the current lowered rates have made it even harder to withstand major incidents like the recent cyberattack at Change Healthcare, which has impacted their ability to process claims and reduced their cash flow. 

The majority of the respondents to a recent HME Newspoll reported that their cash flow has been reduced by more than 75% in the aftermath of the attack. 

MedPAC on MA: ‘Major overhaul’ needed 

WASHINGTON – When accounting for favorable selection of enrollees in Medicare Advantage and higher coding intensity, Medicare spends approximately 22% more for MA enrollees than for FFS Medicare enrollees, a difference that translates into a projected $83 billion in 2024, according to an annual report from the Medicare Payment Advisory Committee (MedPAC). 

Additionally, premiums will be about $13 billion higher in 2024 because of higher MA spending, according to MedPAC’s “2024 Report to the Congress: Medicare Payment Policy.” 

MedPAC says a “major overhaul” of MA is needed for several reasons. 

  1. Beneficiaries lack meaningful quality information when choosing among MA plans. 

  1. Medicare is paying more for MA than for comparable beneficiaries in FFS Medicare. 

  1. The disparity between MA and FFS payment disadvantages beneficiaries who—for medical reasons or personal preferences—do not want to enroll in MA plans that use tools like provider networks or utilization management policies and instead want to remain in FFS (which includes care provided through alternative payment models). 

  1. The lack of information about the use and value of many MA supplemental benefits prevents meaningful oversight of the program such that we cannot ensure that enrollees are getting value from those benefits. 

  1. The continued growth in MA will increasingly create challenges for benchmark setting because beneficiaries remaining in FFS may be higher risk (and thus have higher spending) in ways that risk adjustment cannot adequately capture. 

Over the past few years, MedPAC has made several recommendations to improve MA, including addressing coding intensity, replacing the quality bonus program, establishing more equitable benchmarks, and improving the completeness of MA encounter data. 

In addition to MA, MedPAC makes assessments and recommendations for hospital inpatient and outpatient services, physician and other health professionals services, outpatient dialysis services, skilled nursing facility services, home health care services, inpatient rehabilitation facility services, hospice services, ambulatory surgical center services and Medicare Part D. 

MedPAC only mentions durable medical equipment once: 

“The waiver of some of Medicare’s rules during the pandemic may have increased the risk of fraudulent Medicare claims. For example, CMS modified its provider enrollment screening process during the pandemic by waiving fingerprint-based criminal background checks for provider types that pose a high risk for fraud, waste, and abuse. After seeing a spike in enrollments by suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS), which is a provider type CMS considers to pose a moderate or high risk for fraud, waste, and abuse, CMS reintroduced these requirements in July 2020. It also revoked enrollments for providers found to be ineligible to participate in Medicare—83 percent of whom were DMEPOS suppliers (Government Accountability Office 2022).” 

  • To read the entire 561-page report, go here
  • To read the executive summary, go here

ResMed assesses sleep landscape 

SAN DIEGO – Fifty-seven percent of respondents say they are aware of sleep apnea, but only 26% of them have been diagnosed with the condition, according to ResMed’s 2024 Global Sleep Survey. 

People are becoming more curious about how they sleep, the survey found, with 36% of respondents tracking their sleep either through a smartphone app (44%) or wearable (31%). 

“With sleep being the third pillar of health, alongside diet and exercise, prioritizing your sleep is one of the most effective ways to improve your overall health,” said Carlos M. Nunez. M.D., ResMed’s chief medical officer. “Poor sleep can be an indicator of conditions such as insomnia and sleep apnea, so this World Sleep Day we want to empower people to take charge of their sleep health and have conversations with their healthcare provider.” 

ResMed says this year’s findings are even more comprehensive, with 36,000 participants across 17 markets providing insights on the state of sleep around the world. 

Other findings from the survey include: 

  • 40% of respondents get no more than three nights of good sleep each week – and some individuals report just one. 

  • Respondents report feeling excessive daytime sleepiness (50%), negative feelings in the morning (40%) and more irritableness (39%). 

  • When asked about what was keeping them awake, the top reasons that emerged were personal anxiety (36%), insomnia (25%), breathing difficulties (15%) and obesity (13%). 

In its fourth year, the Global Sleep Survey is core to ResMed’s Discover Your Sleep Superpowers campaign. 

  • For more results from the survey, go here

Survey finds improving supply for CPAP devices 

NEW YORK – Respondents saw a 6% increase in sleep patient volume, on average, in the last 12 months, according to the HME Sleep and Oxygen Survey for the first quarter of 2024 from Needham and Co. 

Respondents expect 6.5% growth in the next 12 months. 

“We suspect that the increase is due to improving flow generator supply and HMEs engaging both new and backlogged patients that resulted from the Philips Respironics recall,” the report stated. 

Other findings from the survey: 

  • Respondents reported an average 0.6 month backlog of newly diagnosed sleep patients awaiting CPAP equipment, which is up from 0.4 months in the third quarter 2023 survey, but down from the 1.5 and 2.9 in the first quarter and third quarter surveys in 2023 and 2022, respectively. 

  • Respondents indicated that flow generator prices increased by 5.8% in the last 12 months compared to 7% a year ago, marking the fourth consecutive decrease in prices. 

  • Respondents reported they are able to get an average of 75% of their flow generator purchases from ResMed, 45% from React Health, 20% from Fisher & Paykel and 15% from other brands. 

  • Respondents plan to increase their purchases with ResMed by 23%, Reach Health 16% and other brands 7%. Fifty four percent plan to make no changes. 

For oxygen equipment, respondents reported 3.7% patient volume growth in the last 12 months and expect 4.5% growth in the next 12 months. They expect their POC purchases to increase, on average, 10.3% over the next 12 months. 

CMS announces flexibilities for Medicaid 

WASHINGTON – CMS has announced additional flexibilities to help state Medicaid programs provide needed relief to providers and protect access to health coverage after the cyberattack at Change Healthcare. 

CMS is encouraging states to submit Medicaid state plan amendments (SPAs) for authority to make certain interim payments for services providers have rendered but for which the provider cannot submit claims. The agency has now released guidance on related flexibilities, including the option to make interim payments retroactively to the date when claims payment processing was disrupted for affected claims, and the option to start drawing federal financial participation (FFP) as soon as the state submits an appropriate Medicaid SPA, subject to certain guardrails and conditions outlined in the guidance. 

“CMS continues to encourage states and other impacted stakeholders to protect critical links to health care coverage,” the agency stated. “The agency remains in close contact with state Medicaid agencies, health plans, providers, suppliers, and others to better understand their concerns. CMS will continue to work with partners to the full extent of its authority to support those who make health care possible for the millions served by CMS programs.”   

Additionally, CMS previously extended the data submission deadline and is now reopening the 2023 Merit-based Incentive Payment System (MIPS) Extreme and Uncontrollable Circumstances (EUC) Exception Application to provide relief to clinicians impacted by the cyberattack. The application will be open for the remainder of the data submission period, which closes April 15, 2024. 

VGMA signs Rhythm Healthcare 

WATERLOO, Iowa – VGM & Associates has executed a vendor partner agreement with Rhythm Healthcare to provide its members with access to the company’s respiratory, bent metal and mobility products. “Rhythm Healthcare has seen tremendous growth since their inception in 2020,” said Shelby Graveman, director of member success, VGM & Associates. “Bringing them on as a partner at VGM will allow our members to continue to expand their portfolios with a trusted partner in the market. VGM members can expect a partner who keeps the patient at the core of everything that they do, as they 'exist to bring comfort, safety, independence and hope' to those who connect with the Rhythm Healthcare brand. We are excited to work with their team and make sure that our members readily have access to partners who are willing to serve companies of all sizes.” Rhythm Healthcare recently named Mitch Yoel COO and recently launched a new warranty replacement policy for its POCs. " Rhythm Healthcare is committed to placing providers at the heart of our mission, offering not just products but a comprehensive partnership,” said Doug Francis, CEO, Rhythm Healthcare. “Our new contract with VGM is a testament to our shared dedication to empowering providers. Together, we'll enhance the capabilities of VGM members, delivering top-notch respiratory and DME solutions that drive down costs and elevate clinical outcomes.” 

Encore buys Primus 

CLEVELAND – Encore Clinical Holdings Corp. has acquired Primus Wound Care, establishing the company as the largest provider of wound care in Ohio, it says. The acquisition not only expands Encore’s footprint but also increases the volume of patients served, with the company’s clinicians now seeing an average of 6,000 wounds per week across Ohio and Pennsylvania. "Primus Wound Care founder Dan Borison built a great company, whose greatest asset is a tremendous team of clinicians, and exceptional operators at the management level,” said Neall French, a shareholder at Encore. “We have the team and resources in place to bring superior outcomes and results to our patients and facility partners." The acquisition further expands Encore’s technology-driven model, offering benefits such as increasing cost savings for facilities and patients, maintaining facility census, improving patient outcomes through clinical stewardship, and providing accurate documentation for reimbursement purposes, it says. 

NHIA grows infusion council 

ALEXANDRIA, Va. – The National Home Infusion Association has added Managed Health Care Associates to its Future of Infusion Advisory Council (FIAC), a strategic group comprised of manufacturing and service companies that are invested in the home and alternate site infusion industry. The FIAC works with the NHIA’s board of directors to address critical issues, challenges and opportunities facing this growing segment of health care. “We are thrilled to be part of FIAC and work alongside stakeholders in the infusion industry,” said Mark Yarnevich, vice president, Strategic Accounts, at MHA. “By understanding the challenges and opportunities, together we can identify ways to help providers continue to provide patients access to lifesaving and life-sustaining treatments.” MHA has a long history of supporting the home and alternate site infusion providers through active participation in NHIA educational programs and activities. It helps infusion and specialty pharmacy members meet the needs of their clinically complex patients with a broad contracted portfolio of infusible and injectable pharmaceutical products, with cost savings that help members meet their financial goals. 

AAHomecare launches WHY Campaign 

ARLINGTON, Va. – AAHomecare will launch its “WHY Campaign” at Medtrade. The campaign – centered around the question, “What’s your WHY for being in the HME industry?” – aims to highlight the value of HME and the importance of membership in AAHomecare. The association is inviting Medtrade attendees to share their personal "WHY" at its booth (#750) by filling out cards and adding them to a display wall. Attendees can also have their “WHY” captured by a photographer and get inspired by the cards of other attendees. Additionally, as part of the “WHY” campaign, AAHomecare is offering two promotions to invite companies to join and experience the return on investment of an AAHomecare membership: Companies that join the association at Medtrade will be eligible to win a giveaway of a free 1st-year membership and a 30-minute consult with policy staff on a topic of their choice; and companies that join by March 31 receive one-third off the membership rate for one year. 

McKesson readies to ideaShare 

IRVING, Texas – McKesson has opened registration for McKesson ideaShare, a destination for community pharmacists to come together to strengthen the overall health of pharmacy and elevate their roles. The event, scheduled for June 23-36 in New Orleans, will feature three days of educational sessions on topics like maximizing reimbursement, diversifying revenue streams and advocating for the pharmacy profession. “New Orleans is known for its strength and resilience as is our community pharmacy industry,” said Scott Miller, president, Strategic, Community, and Specialized Pharmacy, McKesson. “McKesson ideaShare’s collaborative environment will celebrate our industry while addressing key challenges head-on. With an emphasis on community impact and profitability, pharmacy teams will share ideas with thousands of their colleagues. And they’ll walk away with the latest clinical and business expertise in pharmacy operations." McKesson ideaShare will offer more than 30 continuing education courses led by pharmacists and pharmacy owners – worth 11 credit hours of evidence-based education. The event will culminate with the celebration of the 2024 Health Mart Pharmacy of the Year and a concert headlined by Harry Connick, Jr. 

Swift Medical secures AI-related funding 

TORONTO – Swift Medical has announced a strategic co-investment from DIGITAL, Canada’s Global Innovation Cluster for digital technologies, to expedite the adoption and commercialization of the company’s AI technologies. The total project investment stands at $9 million, with DIGITAL co-investing $4.5 million, alongside project partners. “DIGITAL is excited to build upon the over five years of investments we’ve made in applied AI with this latest announcement,” said Nadia Shaikh-Naeem, vice president of programs at DIGITAL. “We continue to be proud to co-invest alongside innovators like Swift Medical, in collaboration with partners like Giishkaandago'Ikwe Health Services; Brightshores Health System; and the University of Northern British Columbia’s Centre for Technology Adoption for Aging in the North to deploy Swift Medical’s enhanced wound care solution within urban, rural and Indigenous communities. Partnerships such as these are how we can continue to build on Canada’s global reputation for AI R&D while focusing on advancing global commercial pathways for Canadian companies.” The partnership will focus on the deployment of Swift Medical's cutting-edge AI technologies in three tools: SmartTissue, AutoDepth and HealingIndex. 


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