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by: Liz Beaulieu - Friday, November 6, 2020

The big news story right now is the election and the herculean efforts by various states to count the unprecedented number of absentee and mail-in ballots, a task that stretched out well beyond the Nov. 3 vote.

The chants – count the votes by some, and stop the count by others – got me to thinking about CMS’s recent decision to drop 13 product categories from Round 2021 of competitive bidding.

When the news broke, there was a first wave of relief – the industry had been lobbying CMS to pause Round 2021 due to the current public health emergency and, in essence, this did just that for everything but off-the-shelf knee and back braces.

But then there was a second wave – of aggravation. CMS decided not to move forward with the new SPAs because they came out higher than the previous SPAs – previous SPAs that were set using an unfair bid process that has since been modified.

The agency’s exact words: “CMS is not awarding competitive bidding contracts for any of the 13 product categories for Round 2021 that were previously competed because the payment amounts did not achieve expected savings.”

When my thoughts about voting and bidding collided, I found myself chanting, count the bids, count the bids.

Which brought me back to some of the initial reactions to CMS’s announcement on twitter. “This is prime 2020 absurdity,” tweeted Tyler Riddle, a provider in Georgia. “CMS acknowledged the program needed reform and now they are admitting that their reform resulted in higher pricing. Doesn’t the law state the bidding program MUST be followed and implemented?!”

It turns out the law allows CMS to abstain from moving forward with the program if it doesn’t achieve savings, according to stakeholders, so there won't be any lawsuits trying to force the agency to implement the Round 2021 single payment amounts for those 13 product categories.

But there are plans to try and hold CMS accountable for them.

Tom Ryan, AAHomecare’s president and CEO, wrote in Nov. 4 bulletin to members: “In a call with CMS leaders this morning, I asked the agency to provide transparency on these results on the 13 product categories were bid. That information will be important to our work to advocate for sustainable rates and relief in the near-term and beyond.”

Managing Editor Theresa Flaherty’s with you Tom Ryan. She suggested we file a Freedom of Information Act request for those single payments amounts when CMS made its announcement on Oct. 27 and formally file a request we did on Nov. 3.

At the end of the day, the bids providers submitted for 13 product categories as part of Round 2021 may not be litigated but they won’t be wasted.

Count the bids.

by: Liz Beaulieu - Monday, October 12, 2020

It wasn’t intentional, but nearly every session at the virtual HME News Business Summit in September stressed the importance of providers leveraging technology to not only improve care but also make their businesses more efficient and profitable.

Sure, technology creeps up at the Summit every year and it’s often the focus of a session or two, but never has it so dominated our entire event.

There were sessions at the Summit that I knew would focus on technology, like the keynote by Dr. Jacob Warren of the Mercer University School of Medicine on how telehealth, remote patient monitoring and other technology can transform health care in rural areas. Providers in rural areas that leverage technology will have a “unique role to play in increasing care in a way that we haven’t seen before,” he said.

But the topic took a life of its own in other sessions. In “Post-pandemic: The rise of post-acute care,” Luke McGee, CEO of AdaptHealth, didn’t mince words when he said, “We need to be talking about…getting off the damn fax machine” as part of efforts to improve provider margins in an industry under constant reimbursement pressure. McGee walks the talk, here: AdaptHealth is an early adopter of Parachute Health’s e-prescribing platform.

McGee also said providers need to stop “lying to ourselves” that patients don’t want more technology in their lives. He believes it’s a situation where, if you build it they will come. They will download the app. They will use it to monitor their therapy.

In “The view from Wall Street: Wild cards in the fall,” Asim Akhtar, CEO & principal at Sullivan Health Holdings, said investors are putting a premium on providers that leverage technology. “Tech is everything and we have to be paced with the world at large, especially nowadays that everything is virtual,” he said. “It’s huge when you go into a company and evaluate whether to acquire it. If someone has a robust IT system and everything is automated, without a lot of human interaction or errors, that’s just going to drive the value up.”

In “Outlook for 2020 and beyond,” Jim Hollingshead, president, sleep and respiratory care, at ResMed, put it simply: “Adopt the tools.”

Even the format of this year’s Summit leveraged technology, making the event possible amid a global pandemic. Shout out to Go to Webinar and Zoom!

Shameless plug: If you didn’t attend the Summit the week of Sept. 14, you can still register to access the recordings at www.hmesummit.com.

by: Liz Beaulieu - Friday, September 18, 2020

Earlier this month, Managing Editor Theresa Flaherty and I were trying to piece together the latest developments in reimbursement relief and we were both getting pretty frustrated.

AAHomecare announced recently that the industry’s champions in the House of Representatives had introduced H.R. 8158, a bill that would eliminate the budget neutrality requirement for home oxygen therapy. The association says the House Energy and Commerce Committee requested that the provision be peeled away from the other provisions in H.R. 2771 – those other provisions being, making permanent the 50/50 blended reimbursement rates in rural areas and introducing a 75/25 blended reimbursement rate in non-rural, non-bid areas.

The committee chose to separate the budget neutrality provision, because it knew that the other provisions would weigh it down, especially since those other provisions are technically already in place through the end of the year (50/50) and through the PHE (75/25).

Where we got frustrated – besides keeping track of it all – was with this approach of chipping away at bad policy.

Industry stakeholders and their champions have become accustomed to this approach. The blended rates in and of themselves are an attempt to chip away at competitive bidding rates that are unsustainable, particularly in rural and non-rural, non bid areas.

Then take accessories for complex rehab wheelchairs. CMS did away with bid pricing for accessories for complex rehab power wheelchairs, but then the agency said its hands were tied when it came to manual wheelchairs because of a technicality. Stakeholders and their champions were able to pause bid pricing for accessories for complex rehab manual wheelchairs for 18 months – chip, chip, chip – and now they’re trying to make that permanent.

See, frustrating. 

But as Cara Bachenheimer told me, something is better than nothing, and in the case of the H.R. 8158, it’s a “huge step” to ameliorate a requirement that has created a “double dip” reduction in reimbursement for oxygen.

And it’s really a testament to stakeholders – not only AAHomecare, VGM, and state and regional associations, but also the providers that are making the calls and sending the emails – and their champions in Congress that we’re here. They won’t stop chipping away, breaking up bad policy until what’s left, when put back together, has some semblance of sustainability.

by: Liz Beaulieu - Monday, August 17, 2020

There has arguably never been a more chaotic time in the HME industry.

The industry already had Round 2021 of national competitive bidding on the docket for this year, in terms of CMS announcing single payment amounts this summer and contract suppliers this fall. But it’s been the external pressures of the COVID-19 pandemic that have turned even our own little sector of health care upside down.

The two together have made the industry spin.

Will CMS pause the bid program? Even if it does pause the bid program, how long will the agency pause it? What happens after the pause? Will CMS stick to the bids that were submitted more than a year ago?

Will the blended reimbursement rates that have been extended in rural areas and introduced in non-rural areas for the duration of the public health emergency die along with COVID-19?

It’s against this backdrop that we’ll virtually gather for this year’s HME News Business Summit, Sept. 15-17.

The Summit has always been about thought leaders—both in the speakers who present, and the providers who attend. But this year, hearing that speaker and embodying that provider is more important than ever.

It’s three days to hear an epidemiologist talk about the pandemic speeding up the use of technology in rural areas, areas that providers struggle to serve. To hear top execs from the industry’s public companies talk about their predictions for the home oxygen, sleep therapy and mobility markets. To hear top execs from the industry’s national companies talk about post-acute care’s climb up the health care ladder. To hear investors talk about their crystal-ball takes on everything from the pandemic, to the election and to the bid program.

It’s heavy stuff. And not necessarily stuff that will affect a provider’s day-to-day business. It won’t answer the question: How should I prepare my claims for the next Medicare audit?

It’s even better, actually – it’s the stuff that will allow a provider to see the industry and their business in a different way. And that’s the stuff that often needs reviewing and reshaping.

So in a few short weeks, join us at the Summit. Make sense of the chaos. Find the opportunity.

by: Liz Beaulieu - Monday, July 13, 2020

It being July (how did that happen—very quickly and very slowly at the same time), I logged into Google Analytics to find the most read stories for the first half of the year.

Not surprisingly, all but one of the five most read stories are related to the coronavirus pandemic (see list with links below).

Let’s start with that one story that’s not related to the pandemic: “‘Wiser’ CMS executes new order” (No. 2). It was a big deal when CMS decided to replace four types of orders with one standard written order or SWO. This makes it a lot easier for prescribers and providers to comply with requirements and helps to eliminate potential future audits.

I’m actually making a mental note to revisit the SWO, as back in January, when we wrote about this change, industry stakeholders were still waiting for “the dust to settle” and had inquired about a few “gray areas.”

The No. 1 story, “CMS loosens requirements for respiratory equipment,” was also a big deal. The agency decided, due to the pandemic, to temporarily waive the coverage criteria and face-to-face requirements for respiratory equipment during the length of the public health emergency. This, along with CMS’s decision to allow prescribers to use telehealth, has gone a long way toward keeping referral streams flowing during the pandemic.

The No. 3 story, like the two stories above, deals with the nitty-gritty of doing business, in this case relief that has helped providers to stay in business during the pandemic. “Package provides relief to HME industry ‘on the front lines’” details a stimulus package passed by Congress that extended the 50/50 blended rate to rural areas and created a new 75/25 rate retroactive to March 6, for non-rural, non-bid areas for the length of the emergency.

The other two most read stories, “Viemed’s Casey Hoyt on the RTs behind the vents” and “HME stands out as solution amid pandemic,” detail the important role the industry has played in the response effort to the pandemic. Shameless plug for our upcoming virtual HME News Business Summit: That second story will jump off the page into real life in a session with the CEOs of the industry’s national providers.

The second half of 2020 will continue to be dominated by the pandemic, but there will be an added layer of complexity due to Round 2021 of Medicare’s competitive bidding program. Will CMS announce the pricing this summer and the contract suppliers this fall as planned? Will the agency delay? With industry stakeholders saying CMS must make a decision sooner rather than later, we’re soon to find out.

Most read stories, January-June

CMS loosens requirements for respiratory equipment
Some fear, however, that new guidance is not explicit
WASHINGTON – CMS in an interim final rule published March 30 appeared to significantly expand access to respiratory therapy by temporarily waiving the coverage criteria and face-to-face requirements during the coronavirus pandemic.

'Wiser' CMS executes new order
WASHINGTON – Industry stakeholders are cautiously optimistic that CMS’s new standard written order will streamline documentation and reduce denials for HME.

Package provides relief to HME industry ‘on the front lines’
WASHINGTON – A stimulus package passed by Congress this afternoon will provide a financial boost to HME providers caring for patients during the current coronavirus pandemic, but there’s more work to be done, say industry stakeholders.

Viemed’s Casey Hoyt on the RTs behind the vents
LAFAYETTE, La. – Viemed Healthcare has been supplying ventilators to healthcare facilities around the country and educating them on using the high-tech devices, even as it maintains its own role in treating patients in the home to free up hospital beds for COVID-19 cases.

HME stands out as solution amid pandemic
YARMOUTH, Maine – HME providers are the “pressure release valve” for acute care facilities that are expected to strain from the number of patients who have COVID-19 and need care.
 

by: Liz Beaulieu - Monday, June 22, 2020

We made the decision to transition the HME News Business Summit in September to a virtual event pretty early on during the coronavirus pandemic.

In addition to the uncertainty that faces us in the fall, we knew that if we didn’t have a face-to-face event, we wanted to give ourselves enough time to plan a virtual event that wasn’t just an afterthought.

With the gracious approval of our sponsors (thank you Brightree, Fischer & Paykel, Allegiance Group, TIMS Software, Sunset Healthcare Solutions, Prochant and ACU-Serve!), we’ve been working behind the scenes to make this year’s Summit one of the best yet.

More on that in a minute.

First, let’s address the elephant in the room: Will it feel like the usual Summit?

In one regard, probably not: It’s hard to replicate those cocktail napkin conversations and networking opportunities with a virtual event.

But we’re sure going to try!

We’re planning to create a Slack account for the event with channels for specific sessions to encourage conversations among attendees.

We’re also planning a virtual happy hour to break up the week’s sessions.

From an education perspective, though, it should feel much like the usual Summit, with one-hour presentations, including time for Q&A. In fact, having a virtual event that requires no travel and hotel expenses has helped us draw some pretty big-name speakers this year, including:

  • A hospital exec on the importance of remote monitoring technologies in caring for patients in rural populations—and now, patients who are isolating at home
  • A panel of the largest HME providers in the country on how the pandemic is finally hitting home the importance of post-acute care
  • A panel of large investment bankers on larger health care trends, consolidation and more
  • A panel of CEOs from the HME industry’s public manufacturers on market trends


We’ll be offering passes to the Summit, which will comprise two sessions per day for three days (Sept. 15, 16, 17), and we think there’ll be a number of sessions that will make it worth your time and the registration fee.

I’ll miss seeing all of your friendly faces in person, but I look forward to “seeing” you in whatever way I can in September.

by: Liz Beaulieu - Thursday, May 14, 2020

I caught up with Brad Smith, managing director and partner at Vertess, recently and he said the mergers and acquisition market for HME has been “a wild rollercoaster ride” amid the coronavirus pandemic.

First, investors and buyers charged ahead, then they paused and then they stopped, he says.

But by the end of April, Smith had a handful of deals scheduled to close in May.

Investors and buyers were charging ahead again, with the pandemic as “the new normal.”

“They like certainty, whether it’s good or bad,” Smith said, “and they navigate from there.”

But they’re not looking at HME companies the same way, he says.

Their main question: Do they offer a workaround to a challenge created by the pandemic? Does an HME company offering sleep therapy, for instance, have relationships with and get referrals from physicians who use home sleep testing vs. in-lab
testing?

This way, they’re still keeping, if not increasing, their market share, even in a pandemic.

“They all want to know what you’re doing to keep people in their homes,” Smith said.

The Braff Group details this same phenomenon in a recent report on “Health Care M&A in the Time of COVID-19.”

“Buyers will once again favor health care investments, but likely in a different manner than we’ve seen in the past,” the report states.
TBG predicts health care dollars will stream toward areas like telemedicine and telepsychology, remote patient monitoring, home diagnostic testing and bio-pharmacology.

So perhaps the bigger issue now is, not a lack of buyers, but a lack of sellers, Smith says.

“I had a big pipeline of people who were looking to sell or recap this year,” he said. “Since the pandemic hit, they’re taking more of a wait-and-see approach.”

Other takeaways from The Braff Group include:

  • Deal flow will contract—immediately, and at least for the next three to six months.
  • Credit necessary to finance deals will tighten.
  • At least some PE dry powder will be used to shore up existing portfolio.
  • Valuations are going to take a hit.
  • As buyers cautiously re-enter the market, they will once again start with comparatively smaller deals.


So what’s the good news? The Braff Group closed its report with this: “Well, it can be (good news) if you’re a well-capitalized provider and use  the disruption in the market to rescue faltering companies. This doesn’t have to be a shark-fest.  Sellers under such circumstances recognize that they aren’t going to get a  premium. But for buyers willing to pay a fair price, and equally important, give the seller’s caregivers and support staff a home, there could be extraordinary opportunity to gain an inside track on such deals, as well as do some good  for your business, the seller, their employees, the community, and you.”

by: Liz Beaulieu - Friday, March 27, 2020

I saw some back-and-forth on twitter between HME providers asking what the HME industry is like in Italy and the role it is playing in responding to the coronavirus pandemic there. So it was timely that I also saw an article in STAT about a paper published in NEJM Catalyst by a group of physicians at the Papa Giovanni XXIII Hospital in Bergamo about what they’ve learned during this pandemic, and it reads like a warning.

“Western health care systems have been built around the concept of patient-centered care, but an epidemic requires a change of perspective toward a concept of community centered care,” they write.

What’s community centered care?

“Pandemic solutions are required for the entire population, not only for hospitals,” they write. “Home care and mobile clinics avoid unnecessary movements and release pressure from hospitals. Early oxygen therapy, pulse oximeters and nutrition care can be delivered to the homes of mildly ill and convalescent patients, setting up a broad surveillance system with adequate isolation and leveraging innovative telemedicine instruments.”

Dan Starck of Apria Healthcare and the Council for Quality Respiratory Care told me last week that the HME industry stands ready to be the “pressure release valve” for acute care facilities. Oxygen therapy, pulse oximeters and nutrition care … HME providers have all that and more covered.

The Italian docs continue: “This approach would limit hospitalization to a focused target of disease severity, thereby decreasing contagion, protecting patients and health care workers, and minimizing consumption of protective equipment.”

The Italian docs concluded that this disaster could have been averted only by massive deployment of outreach services and noted, “we need a long-term plan for the next pandemic.”

That plan, they argue, is to transition away from a “more medicalized and centralized…society”

Weesie Walker of NRRTS says if there’s a silver lining in the current crisis, it’s that home care will be seen in a new way, a better way.

“I’m a very optimistic person, but this (pandemic) has been hard for me,” she said. “I just keep thinking there has to be a lesson we can learn and what I’m hopeful that lesson is, is a spotlight on the value and importance of (CRT and the HME industry). It really speaks to what we’ve been preaching for years. We have dedicated people out there, doing everything they can to still get equipment to people.”

by: Liz Beaulieu - Wednesday, February 12, 2020

I was recently a guest on Erik Mickelson’s podcast “DME Coach.” Erik asked me, “You’re a reporter; what makes your life easier, from the reporter side of things; what are you looking for from us providers?” I joked, “That the providers we call pick up the phone and talk to us?”

But it’s true. The HME industry is not so much an industry of press releases and press conferences, and so covering the industry, from our small office in Yarmouth, Maine, entails a lot of … well, calling providers and hoping they pick up the phone.

We have this tradition at HME News, going back to former editors Jim Sullivan and Mike Moran, of the “cold call corral,” when we call half a dozen providers a day for the first three days of working on a new issue. These calls are our way of having boots on the ground. They’re an opportunity to ask providers: Are you doing anything new; have you launched a new program or added a new product; what’s keeping you up at night?

Sometimes we go into these calls with a short checklist of things we want providers to weigh in on, like the most recent round of Medicare’s competitive bidding program or the most recent audit to get picked up by the RAC. But more often than not, we want you to talk, and we want to listen.

These phone calls are often what lead to our best stories, the stories HME News is known for and the stories that, often, no one else has (because, see above re: “cold call corral”).

Later in the podcast, Erik asked me, “What’s a question that I haven’t asked you that you wish I would ask you?” I asked Erik, “What do you, a provider and reader of HME News, wish we’d do differently?”

His answer: “My favorite thing that I come across when you guys do do this, are individual stories of someone who is fighting the good fight. They’re leaving the cave to go kill something and bring it home, because that’s what we’re all trying to do…Typically, if you look at a business like an Airbnb, there was a need, someone came up with an idea and they fixed it. They came up with something unique on how to build something. Those are my favorite stories. When you have a new product category and it works. I love to hear about the Smiths and the Joneses and the Johnsons. That’s my favorite part. (Everything else)—data is data, and things are what they are.”

We don’t get press releases from the Smiths, Joneses or Johnsons, so help us give you what you want. Pick up the phone. Talk. We’re ready to listen.

by: Liz Beaulieu - Wednesday, January 15, 2020

As Theresa and I put together our upcoming February issue this week, it has occurred to me that 2020 is not off to a bad start.

Just check out the front page lineup for the issue:

  • a new standard written order that replaces four other types of orders, which should result in streamlined documentation and reduced denials;
  • a pricing policy for accessories for complex rehab manual wheelchairs that has been reversed, which will result in improved rates for providers;
  • an M&A market that’s active, which will result in increased options for providers, not to mention increased attention from investors; and
  • an Invacare that’s rebounding in its 40th year in business and planning to launch more than a dozen new products this year, which will result in more diverse buying choices for providers.


Every one of these stories can be seen in a positive light.

The only thing (well, maybe not the only thing) that would make this front page better: a story on a bill passing to make permanent the 50/50 payments in rural areas and introduce 75/25 rates in non-bid, non-rural areas.

That’s still a work in progress.

And therein lies the rub with 2020: competitive bidding.

Late summer, early fall will likely be an inflection point for the industry: Will the rates for Round 2021 trend up as hoped, due to lead-item pricing and other changes to the program; or will they curve down, as they have in previous rounds?

We have five to eight months before we’ll find out.

So, in the meantime, let’s, as Miriam Lieber writes in a recent guest blog, simulate all possible outcomes: win a contract, don’t win a contract; win a contract, with higher rates; win a contract, with lower rates.

It’s a lot to unpack—start now.

Another good reason to start now: Things could get dicey in the back half of this year, with or without competitive bidding, as industry analysts point out in that story on M&A.

Who will win the presidential election?

Is there a looming recession?

As Brad Smith puts it, “Health care is not going anywhere, but what is bad for business, overall, is uncertainty.”

But let’s not get ahead of ourselves, unless it’s to simulate all possible outcomes for Round 2021. Or to talk about any of the other items on Lieber’s checklist.

Let’s talk about anything, as long as it has nothing to do with lambs.

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