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by: Theresa Flaherty - Wednesday, April 1, 2020

My most important task as a reporter when it comes to any crisis happening in the world at large is talking to HME providers to find out what’s happening on the front lines. What are you seeing? What’s been the impact? What are you doing? What do you need everyone (especially policymakers) to know?

We do this fairly frequently (hurricanes. competitive bidding. locusts). In-house, we refer to it as the disaster beat. However, nothing could have prepared us for the disaster unfolding in real time. The coronavirus pandemic has been unlike anything else I’ve covered in nearly 15 years at HME News. Providers are well and truly in the thick of a healthcare disaster that changes daily and they (and we) are doing our best to keep up.

I’ve been lucky to talk to quite a few of you, in quick snatches of phone calls taken at my dining room table, shouting into a speaker phone and praying the noice from the kitchen isn't too loud.

PPE? NOPE.

PPE remains the No. 1 concern for most of the providers I talk to. Brad Heath laughed out loud when I asked him.

“We have some distilleries making sanitizer for us,” he said. “We have been able to get some gowns. We started using shower caps as shoe covers at one point. As far N95 masks, we have a massive amount of orders and we can’t get those.”

KEEP YOUR DISTANCE

Like the rest of us, HME providers are also concerned about contracting Covid-19, but unlike many of us, lots of those positions can’t be done from home. At Bedard Pharmacy, they are doing their best on social distancing, says Sean Andrews.

“We have space to segregate each department,” he said. “They each have their own break rooms, bathrooms and they can’t go into anyone else’s.”

DOCUMENT, DOCUMENT

Tyler Riddle has been keeping an ongoing log of the situation as it unfolded in his corner of Georgia. He’s got an eye to the future.

“At the end of this, we are using all of this information to strengthen our narrative so when we go back to Congress we can say, ‘Hey, competitive bidding is egregious, this is what we do on the front line,” he said. “Or when UnitedHealthcare tries to cut reimbursement in three to six months. When a third-party says they are going to go back and audit all these claims we have a strong record of everything we did.”

by: Theresa Flaherty - Wednesday, March 4, 2020

We’re back in Las Vegas, complete with hand sanitizer stations in the lobby of Mandalay Bay and conspicuously thinner crowds in the restaurants and at the blackjack tables in the casino, what with the unfortunate confluence of coronavirus panic and Medtrade Spring. I’ve shaken plenty of hands. I’ve also done some no-contact hand waves and one elbow bump. Hey, whatever works!

Medtrade SXSW

Show Director Mark Lind is definitely shaking hands. He’s also working the show floor, moving from booth to booth to check in with exhibitors.

He asked us if we’d heard anything from providers about the big move next year to Phoenix.

Truthfully, everyone’s been asking ME what I think and, personally, I say, why the hell not? I love coming to Vegas but I can see where a change of scenery might be a good thing. It’s less expensive and surely, there’s less smoking everywhere.

Still, if you aren’t happy, Lind, who’s begun putting his stamp on the HME industry’s signature event, wants to know about it.

“Send them to me,” he said. “I won’t hide from it. I’m easy to find. I’m the guy with the bow tie.”

Gallagher Power

There’s another conference here, something about Gallagher Power. (They're in insurance, the guy in the elevator told me.) Signs extorting "Gallagher Power" abound and there are thousands of people moving en masse, adorned with bright Gallagher lanyards around their necks. So far, the HME industry’s own version of Gallagher Power, VGM’s John Gallagher, doesn’t seem to have let this newfound power go to his head.

Pretty sure he's loving it, though. I know the rest of us are.

Merv Griffin, who?

One of the most immediate changes upon Lind’s tenure is the AAHomecare Update, which has been rejiggered—possibly reimagined—as the Merv Griffin Show. Lots of attendees (yours truly included) got the joke.

Not so for provider Josh Marx, which he freely admitted.

“I don’t know who Merv Griffin is,” said he, as he took the mic during the update.

That admission also garnered plenty of chuckles. But his, uh, shorter cultural reference timeframe, is also a good thing. It shows that yes, there is still new blood getting in to the industry. And the industry needs that new blood to drag the industry kicking and screaming into a new era, one it needs to adapt to.

That’s true of the need to consider how you sell, what you sell, and who pays for it. (Hint, not necessarily Medicare.)

Stay tuned.

by: Theresa Flaherty - Wednesday, February 19, 2020

HME News World HQ is located in a tiny little dip where the land meets the sea. There are three roads out, all uphill. In yesterday’s snowstorm, which wasn’t markedly different than any other snowstorm, I found myself unable to coax my car up the steep hill to Main Street. Literally halfway up, it refused to budge and I found myself reversing direction back down the hill to relative safety.

The whole scene called to mind the often Sisyphean tasks providers contend with, namely fixing the competitive bidding program. For example, they get a bill introduced, they start pushing it up the hill, and then the clock runs out. Or they get CRT accessories excluded, only for vents to be added.

Often, it simply starts to feel like such a long slog: for me to write about, certainly, but also for our famous “stakeholders,” tasked with the endless cycle of calls and meetings and lawmaker visits.

Speaking of stakeholders, this week’s MAMES member bulletin highlights this beautifully. The top story: “Legislative Update: No change from last week.”

That's what we in the biz call a slow news week!

Fortunately, the bill IS picking up cosponsors, most recently Rep. Morgan, R-Va. on Feb. 6. With the impeachment boondoggle behind us, perhaps lawmakers can now turn to other matters, but time will tell.

As for me, I headed in a different direction and eventually made it home, no worse of the wear.

by: Theresa Flaherty - Thursday, January 23, 2020

I’m not a big app user, but I recently downloaded, after years of hearing about it, the myfitnesspal app. It lets you log pretty much all the food (including your recipes! You can scan labels!), and calculates nutrition and macros and all that.

OMG, I love it. I’m not only seeing how many more calories I’m consuming then I was telling myself (but that those snug jeans were screaming about loud and clear), but it’s so much easier to track my carbs—critical for an *insulin user.

My biggest regret right now is that myfitnesspal doesn’t integrate (sync?) with my FreeStyle Libre app to also pull in blood sugar data and, when I can be bothered to enter it, insulin doses. Maybe down the road, eh?

Last week, I listened to the latest Special Open Door Forum on the documentation lookup service. It sounds like it’s moving along swimmingly, but unsurprisingly, there’s a roadblock: Not everyone is using electronic health records, or they are not using the same EHRs as others or they are not using the same version.

This is also borne out in a recent story by Liz Beaulieu on e-prescribing, in which AAHomecare’s Kim Brummett summed it nicely:

“It’s really up to the ordering physician or hospital: Do they want to do it, and what platform do they want to use. If I’m a provider, I can choose to use this platform, but that doesn’t mean my referral sources will.”

That all adds up to a whole lot of inability to fully integrate and communicate across the healthcare continuum, despite that being exactly where healthcare needs to go. And where it is going. In many cases, the patients are already there, waiting for the system to catch up.

*Fun fact: While there is some disagreement, this day in 1922 is widely credited with being the date of the first successful insulin injection.

 

by: Theresa Flaherty - Thursday, December 5, 2019

“How ‘bout those CGMs?"

I was at the doctor’s office today—not the endo’s—and the nurse was double-checking I still used the Freestyle Libre.

Turns out, she has a Dexcom. I’ve said it before in this forum: the advances in diabetes tech are game changers. They have forever changed the way diabetes is managed. End game: more time in range (this is a fairly new concept), better AICs.

I discussed this recently with several diabetes providers for a recent story on Walgreens entering the market. They love this stuff.

But for all this technology, nothing is perfect. Take the Dexcom outage last weekend.

I don’t know the details, except that users were not receiving alerts that their numbers were high or low. This was especially frightening for parents who use Dexcom to keep track of their young, sugar-free children.

It’s at times like this I hope everyone has a backup meter and a paper logbook, but then, I am an anachronism.

Earlier this week, I actually did have an appointment at the endo’s office, with the CDE. I checked in 15 minutes early for my appointment. Some sort of glitch (human? computer?) failed to register me. Looking up from the computer screen to see me not-so-patiently waiting in the nearly empty waiting room where I was trying to avoid making eye contact with an annoying person from another life might have solved this, but I digress.

Anywho, it turns out my chagrin over, uh, bouncy numbers Thanksgiving week were for naught. I very recently switched from using my Libre reader to scanning the sensor with my iPhone. That means, instead of uploading my numbers directly to the computer, it had to be sent, as if by magic (and electronic invitation), to some server or some such. Alas, the mobile dead spot I was in meant I couldn’t get past step No. 2 (accepting the terms, for those of you keeping track.) to get all set up.

Yep, waited 35 minutes to be seen only to have no data to look at.

by: Theresa Flaherty - Friday, August 23, 2019

I believe there's a saying that 5% of the people do 95% of the work.

It's a comment that's been made to me many times over the years on the HME legislative beat and one that was certainly born out by our September Newspoll in which 62% of respondents say they hadn’t set up a meeting with lawmakers or their staff in their district offices; 77% said they didn’t plan to host lawmakers at their location.

But, it's the all-important August recess!

“I’m just burnt out on trying to get the industry’s point across to anyone in Congress,” said one respondent. “I feel like I am shouting into a void.”

In other instances, the lack of scheduled meetings is not due to a lack of trying, providers say.

“I’ve asked my closest (geographically) Congresswoman for years to meet with me,” wrote on respondent. “She recently announced she is not seeking re-election, so it will never happen.”

I don't totally understand folks who do nothing but I certainly can't fault providers for being burned out by the whole prospect of advocacy. I hear ya! Confession time: There are days when the prospect of writing yet another story about competitive bidding makes me want to scream. But I refrain. Not only would it not solve anything, editor Liz would tell me "tough luck."

But all that burnout is balanced by the news in today's email inbox recounting visits that have taken place in the past week, including visits in Wisconsin, North Carolina, New York and New Mexico. Upcoming visits will span New England, thanks to the hardworking folks at HOMES.

Next weekend is Labor day and the unofficial end of summer. I'm kind of looking forward to getting back to work with a renewed focus and energy.

by: Theresa Flaherty - Tuesday, June 11, 2019

When last year’s Heartland Conference rolled around, I had just gotten my Freestyle Libre and was excited to take it on the road and see how much easier it was to check my blood sugar from the confines of a plane or during a session. Unfortunately, I knocked it off two days prior, courtesy of a doorframe that came at me out of nowhere (rookie mistake). Insurance policies being what they are, I had no way to replace before I took off, alas.

Fast forward to this year’s event and I can report that yes, living life in general and traveling in particular with Type 1 diabetes is So. Much. Easier. It’s a game changer.

And technology like that (and beyond) is coming ever faster. There’s a proliferation of devices aimed at managing chronic conditions, according to Jeff Cribbs, today’s keynote speaker during a dynamic session: “The Future of Digital Health is Centered in the Home.”

“We’ve gone from spot measurement to continuous event monitoring,” he said. “Real time signal processing.”

That, in turn, allows diabetics to make 200 decisions related to their diabetes daily, he said. 200! I’ve been busy counting carbs instead, but it sounds about right.

Libre aside, some things stay old school. I use syringes and toss them in a Folgers coffee can.

Bring home that bacon!

Speaking of Folgers coffee cans, Jennifer Leon is still trying to get you to collect those patient copays, 73% of which go past 30 days. Make it easier for them to pay. Set those expectations, now. Know that it’ll be harder with the existing patients but do it any how. They’ll try to tell you they don’t have a credit card, that they keep their cash in a Folgers can buried in the backyard.

Don’t fall for it.

As to your new patients?

“They don’t know you used to give away the equipment for free,” she said.

From the soapbox

As I move through sessions at this year’s conference, I am doing so with an eye on the future, the need to shake things up and the need to rethink business models, modes of thinking and just the same old, same old.

So, in that vein, I have two, oh so tiny, quibbles.

First minor quibble: Please stop labeling us diabetics. We are people who happen to have diabetes. I may make 200 decisions a day related to my diabetes, but I make a thousand more related to other stuff.

Second minor quibble: While I would never bite the hand that feeds me, literally or figuratively, it can be a challenge to eat at another’s table. Today, boxed lunches were served. I am fairly confident the boxes with the V on them were vegetarian. In the Midwest, I know, this is no small concession toward the non-meat eaters of America and it was nice to see. I’d like to see that go further, with a vegetarian option extended to the beloved hog roast. For the record, I am not a vegetarian myself, but even at the Heartland Conference's signature event, it’s time to set a place at the table for everyone.

(Jumps off soap box).

But please, don’t take away my bacon.

by: Theresa Flaherty - Monday, June 3, 2019

Have you ever been in Best Buy, simply trying to purchase whatever electronic device and been forced to listen to *The Spiel? It’s been a few years for me, but I seem to recall it had to do with them trying to sell you some sort of warranty and now matter how politely or firmly you try to stop the cashier from wasting their breath (and your time), they are required by the Corporate Overlords to do it any way.

I was reminded of this recently while reporting a story about ongoing confusion regarding ABNs and when providers are required to educate beneficiaries on the use of ABNs.

The answer: Even if the provider is non-participating AND even if the beneficiary has every intention of paying for said item with cash, you must advice them that item may be covered by Medicare.

As Andrea Stark advised: It’s always best to err on the side of full and utter transparency if there’s even the slightest chance your customer looks like they might have Medicare.

Using my mom as an example: If my 70-year-old mother takes a **cane up to the front counter at CVS, in theory, they should be sending her back to the pharmacy where the pharmacist would presumably explain about Medicare.

I am pretty sure my mom would have been irritated to have to hobble back to the pharmacy and wait in line to hear the spiel when she has a credit card in hand, ready to pay.

That goes for the mom-and-pop providers as well as the CVS and Walgreens of the world, something I didn’t include in the story (space, my kingdom for a few more column inches). I should have however, as many providers, like the one who emailed today to ask that very question, probably still wonder if they are taking it on the chin while the big guys get away with it.

For an online like Amazon, they could have a disclaimer at say, the "checkout" point (or elsewhere) stating that Medicare may pay for the item.

Does all this mean the government is throwing out consumerism or the patient’s right to choose what products they want or the right to pay however they choose? Of course not, but it does serve as a reminder to providers everywhere not to take any chances that the DME item you sold for cash today won’t come back with someone wondering why they paid full price while someone else had Medicare pay for theirs and demanding a refund on the item.

*I have avoided Best Buy ever since and have no idea if this practice is still in effect.

**My mom actually did buy a cane at CVS when we visited Vegas. I suspect she paid cash right at the front counter. Fun fact: She proceeded to leave the cane behind all over the strip.

 

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by: Theresa Flaherty - Thursday, March 21, 2019

The latest news cycle certainly kicked off with a bang! First, the latest update on the competitive bidding program, which features an aggressive timeline and added certain orthotics and non-invasive vents (vents! I tell ya!).

Then, BioScrip and Option Care dropped a merger into my lap (side note: whenever I am having trouble finding stories I have been known to state: “I need a merger, a bill or a lawsuit.”). It’s been awhile since we had a heady home infusion merger story.

And the mail-order diabetes category is being tweaked so it’s not even up for bidding at the moment. Coincidentally, I had already been poking around (haha, get it?) in the diabetes arena after a few members of a Facebook diabetes group I belong to asked if the gap period meant they could get supplies everywhere. In theory, sure, in reality, not so much, which they had kind of noticed.

Speaking of diabetes, yesterday, Roche filed another lawsuit against yet another company, Alliance Medical Holdings, for insurance fraud involving test strips.

The stories for specialty are writing themselves this month.

by: Theresa Flaherty - Monday, January 21, 2019

So apparently, the New England Patriots won the AFC East (am I saying that right?) last night.

If my Facebook and Twitter feeds are anything to go by, it was a real heartstopper of a game, due to the myriad posts from people saying things like, “My heart just stopped,” and “My heart can’t take this anymore.”

My favorite? Karyn Estrella, of HOMES fame who is smack dab in the middle of Patriots country, who asked, “Where’s an oxygen tank when you need one?”

That’s an excellent question. My guess is, for many beneficiaries, that’s a question that will be asked very frequently if recent trends continue. The latest GAO report on supplier numbers showed a decrease of 11% for 2017. That’s on top of an 8% decrease in 2016.

It’s also in line with an AAHomecare analysis that shows a decrease of about 35% between 2010 and 2018.

The big question now is, with the industry just starting in on two years of any willing provider, will access problems worsen, less or stay about the same?

As the executive director of HOMES, Karyn presumably has an inside track on the best oxygen tank suppliers in her area, should she actually need one to watch the Superbowl.

If you are a beneficiary, or their caregiver, it might not be so easy.

 

 

 

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