despite today’s challenges, the hme industry will survive...
TRANSCRIPT
As the industry approaches implementation of Round Two of competitive bidding,
it’s impossible not to look back on the industry’s past and ponder how much it has transformed.
Over the past 20 years, HME providers have seen an incredible amount of change. Providers have watched their marketplace go from a time of substantial reimbursement accompanied by equally substantial product and patient care innovation, to an era of drastic, nothing-is-sacred Medicare funding cuts. We have gone from one extreme to another.
Will the industry, Medicare and the public policy that shapes them fi nd some happy median? We certainly hope so. But in the meantime, providers need to shape business strategies that will help them continue to serve patients successfully and profi tably. It has certainly been HME Business’s editorial mission to help them accomplish that.
To commemorate our 20th anni-versary, we asked various industry veterans to share their views on where the HME industry has been over the past 20 years, where it is headed, and what providers need to focus on in order to survive today and thrive tomorrow. Their answers offer not only insights, but also hope when it comes to the industry’s future.
HME Then and Now . . Page 17
Despite Today’s Challenges, the HME Industry Will Survive
April 2013Volume 20, Number 4
hme-business.com
What’s Inside:
The Future of Portable Oxygen . . . . 24
Rock-Solid Documentation . . . . . . . 30
Advocacy: Enlisting Referrals . . . . . 14
Servicing the Bariatric Spectrum . . . 16
Compression Products . . . . . . . . . . . 36
Tackling Round Two . . . . . . . . . . . . . 42
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4 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
ID STATEMENTHME Business (ISSN 1940-6479) is published monthly by 1105 Media, Inc., 9201 Oakdale Avenue, Ste. 101, Chatsworth, CA 91311. Periodi-cals postage paid at Chatsworth, CA 91311-9998, and at additional mailing offi ces. Complimentary subscriptions are sent to qualifying subscribers. Annual subscription rates for non-qualifi ed subscribers are: U.S. $77; Canada $147 (U.S. funds); International $187 (U.S. funds). Subscription inquiries, back issue requests, and address changes: Mail to: HME Business, P.O. Box 2166, Skokie, IL 60076-7866, email [email protected], or call (847) 763-9688. POSTMASTER: Send address changes to HME Business, P.O. Box 2166, Skokie, IL 60076-7866. Canada Publications Mail Agreement No: 40612608. Return Undeliverable Canadian Addresses to Circulation Dept. or XPO Returns: P.O. Box 201, Richmond Hill, ON L4B 4R5, Canada.
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HME Business April 2013Table of ContentsVolume 20 No. 4
6 Opening Note
14 Industry AdvocacyEnlisting Referral Partners
15 Product SpotlightMedAct’s Business Manager
16 Problem SolverServing up a Bariatric Spectrum
36 Product SolutionsCompression
38 HME Inventory
40 Classifi eds/Ad Index
42 Observation DeckResponding to Round Two
8Industry speaks at congressional bidding briefi ngs; PECOS Phase 2 effective on May 1; Provider poll: PECOS; DME Medicare participation enrollment extended; Complex rehab bill re-introduced into House; People in HME: Eagen named vice president of OPGA
17 HME Then and NowHME Business celebrates 20 years in publication by asking various industry veterans to share their thoughts on where the industry has been, where it is headed, and what providers should be doing today to be here tomorrow.
Cover Feature:
24 The Future of Portable O2Portable oxygen technology has revolutionized not only patient care, but how providers run their businesses. Moreover, it has helped HMEs survive CMS’s massive funding cuts. What does the future hold for portable O2?
30 Rock-Solid DocumentationAs providers continue to fi nd themselves swimming in a sea of post- and pre-payment Medicare audits, they know fl aw-less documentation is their best life line. What are the key ways they can implement strong documentation?
6 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
M arketplaces and public policy are often
subjected to pendulum swings from
one extreme to another. One needs
only to look at the housing market’s recent, massive
boom and bust cycle, or the jarring gear changes
between centrism and extremism in American
politics to see how much pendulum swings impact
nearly ever aspect of our daily lives. And certainly,
the home medical equipment is undergoing an
incredibly wide swing of the Medicare reimburse-
ment pendulum.
HME Business magazine was originally founded
20 years ago as Home Health Products in Dallas by
Stevens Publishing, and back then, HME providers
were enjoying the salad days of the Centers
for Medicare and Medicaid’s Durable Medical
Equipment, Prosthetics/Orthotics, and Supplies
program. This was the era of the so-called “golden
commode,” when reimbursement for HME was
veering into “silly money” territory. They were the
proverbial salad days for HME providers.
And that sizable reimbursement providers were
earning wasn’t squandered, either. It ushered in an
incredible number of equipment, care and service
innovations that radically overhauled the entire
defi nition of home medical equipment. Advances
in power mobility and respiratory equipment, for
example, were the reason why HHP was launched.
Providers needed to stay on top of the innovations
they could offer to patients.
But with that money came fraud. There’s no
denying the fl y-by-night providers that weren’t
really providers, but were really slick fraudsters
who bilked the Medicare program out of millions
upon millions of dollars, and if they weren’t caught,
they faded away into the shadows leaving taxpayers
and legitimate providers equally irate, but for
different reasons. The former were angry because
they had truly been robbed, and the latter were
upset because they knew they’d almost certainly be
lumped in with the rip-off artists. (And they were.)
That fraud and lush reimbursement, partnered
with a massive infl ux of Baby Boom-age benefi -
ciaries, ushered in the pendulum swing the HME
industry has been experiencing. Now we are
approaching the extremity of that arc’s negative
half: implementation of Round Two of competitive
bidding, which will effectively take the program
national. Think of it: we’ve gone from abundant
funding to an average 45 percent cut to reimburse-
ment for DME.
That pendulum swing is exactly why we
re-launched Home Health Products as HME Business
magazine fi ve years ago. With CMS revving up
competitive bidding Round One at the time,
as well as implementing programs such as the
36-month rental cap for oxygen, we knew that
while providers were still going to need to know
about innovative DME, they also were going to
need to know much more about innovative busi-
ness strategies that would help them survive and
thrive — surthrive — what were sure to become
extremely diffi cult times.
Well, the diffi cult times are here, and the
industry continues to slug it out on Capitol Hill
in hopes of stopping the competitive bidding
program and replacing it with an alternative, such
as the Market Pricing Program, which is actu-
ally market-based and competitive. And while all
that is happening, HME Business will keep serving
up ways to drive new effi ciencies, cut costs, and
explore new revenue opportunities in order to
surthrive the extreme end of CMS’s radical reim-
bursement swing. The pendulum will swing back.
We’ll be here. So will you.
Karen Cavallo
Group Publisher
HME Media Group
David Kopf
Editor
HME Business
HME’s Big Swing
The home medical equipment industry swings like the pendulum do.
REACHING THE STAFFEditors can be reached via e-mail, fax, telephone, or mail. A list of editors and contact information is at www.hme-business.com.
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Corporate Phone: (818) 814-5200; Fax: (818) 734-1522
Ty Bello, RCCPresident and Founder
Team@Work
Georgie BlackburnVice President,
Government Relations and Legislative Affairs
BLACKBURN’S
Sandra CanallyPresident
The Compliance Team Inc.
Dave CormackPresident and CEO
Brightree LLC
Spencer Kay President and CEOFastrack Healthcare
Systems Inc.
Michael ReinemerVice President,
Communications and Policy American
Association for Homecare
Ron ResnickPresident
Blue Chip Medical Products Inc.
Kelly J. Riley, CRT , RCP Director
Nat. Respiratory Network
Tom RyanPresident and CEO
Homecare Concepts Inc.
John ShirvinskyExecutive Director
Pennsylvania Association of Medical Suppliers
Wayne E. Stanfi eldPresident and CEO
National Association of Independent Medical Equipment Suppliers
Peggy Walker, RNBilling & Reimbursement
AdvisorUS Rehab Division
of VGM Group
Carl WillSenior Vice President,
North American HomeCare Invacare Corp.
EDITORIAL ADVISORY BOARD
President & Neal Vitale Chief Executive Offi cer
Senior Vice President Richard Vitale & Chief Financial Offi cer
Executive Vice President Michael J. Valenti
Vice President, Finance Christopher M. Coates & Administration
Vice President, Erik A. Lindgren Information Technology & Web Operations
Chairman of the Board Jeffrey S. Klein
Editor David Kopf (949) 265-1561 Associate Editor Cindy Horbrook (972) 687-6753 Group Publisher Karen Cavallo (760) 610-0800
Group Art Director Dudley Wakamatsu Director, Print Jenny Hernandez-Asandas
& Online Production Production Coordinator Charles JohnsonSr. Dir., Audience Marketing Bill Ellis Dir., Audience Marketing Margaret Perry
Director of Online Marlin MowattProduct Development
Volume 20, Number 4April 2013
Opening Note
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8 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
More industry intelligence is available at hme-business.com.
Developing Stories — Monitor HME-Business.com regularly to stay on top of key industry stories unfolding in April, including the effort to launch new MPP legislation in the House, and overall efforts to stop competitive bidding.
Upcoming Features — We continue our ongoing coverage of how providers can leverage their information technology to opti-
mize their business performance, as well as look a how providers can move their home access business into the big leagues.
We’re Being Social — HME Business is tweeting, are you reading? You can fi nd us at twitter.com/hmebusiness. We’re also on Facebook, so make sure to like our page at www.facebook.com/HMEBusiness. Follow us on both services to keep up on the latest headlines.
Voice Your Opinion — Have an opinion on
how the industry is headed? Join the discussion between involved HME Business readers by posting your comments to any story on the site.
e-Source — Sign up for our weekly e-newsletter, e-Source, to ensure you stay up to date on the latest industry news, trends and developments.
Provider Polls — Participate in our regular online polls, which are always visible in the right-hand margin of our site.
Various representatives of the home medical equipment industry met with House and Senate staff in Mid March to brief them on problems with the Centers for Medicare and Medicaid Services’
competitive bidding program.The House briefi ng was hosted by Reps. Glenn Thompson (R-Pa.) and
Bruce Braley (D-Iowa). The panel included:• Former member of Congress Nancy Johnson,who is senior public policy
advisor for Baker Donalson, representing the National Coalition of Mail Order Diabetes Suppliers.
• Tyler Wilson, president and CEO of the American Association for Homecare.
• Brett Katzman, chair of the Department of Economics, Finance and Quantitative Analysis at Kennesaw State University, Kennesaw, Georgia.
• John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers (PAMS).
• David Lefkowitz of Stonebridge Medical, representing the National Association for the Support of Long Term Care (NASL).
• Kelly Buckland, executive director of the National Council on Independent Living.“… The intended goal of the program was to create cost savings,”
Thompson and Braley wrote in their invitation to legislative colleagues.
Industry Addresses Bidding Flaws at Congressional Briefi ngsVarious HME representatives brief House, Senate staff on competitive bidding’s fl aws, as Round Two approached implementation this summer.
“However, following a series of legislative delays and implementation snafus, DMEPOS providers continue to have signifi cant concerns with the program, which will threaten the quality of care for Medicare benefi ciaries and force smaller suppliers from the market.”
The Senate briefi ng was hosted by Sens. Joe Manchin (D-W.Va.) and Rob Portman (R-Ohio). That panel included Buckland, Katzman, Wilson and Johnson.
In his testimony to House staff, PAMS’s Shirvinsky said that because of the bidding program’s arbitrary median price; non-binding bid policy; and “suspect” standards for determining the fi nancial ability of small winning companies to serve many bid areas, CMS had created a process that “rewards irrational, suicide bidders and punishes rational bidding.”
“It is illogical to believe that an industry that averages a fi ve percent net profi t can sustain a cut as severe as 45 percent,” he explained in his briefi ng. “… A 45 percent reduction in Medicare revenues will transform such an enterprise from respectably profi table to dangerously and unsustainably unprofi table.
“The reality is that both state Medicaid programs and most managed care plans base their reimbursements off Medicare reimbursement rates, so the anticipated losses are likely to be even greater than those refl ected,” Shirvinsky added.
Shirvinsky also discussed reports of various small providers winning contracts despite an apparent lack of infrastructure to serve all the patients covered by those contracts. As an example, he noted a small, storefront provider that won contracts for fi ve categories across all eight bidding areas in the state of Florida.
“This company has no ability to serve all of the bid contracts that it won; and it never intended to serve these areas,” he said. “Their only goal was to submit unrealistically low bids in order to win CMS contract awards and then to fi nally sell their company. We are receiving reports of similarly situated companies that have won contracts in as many as 40 or 60 or even 90 bid areas with the sole intention of selling their company and their Medicare contracts.” ■
“It is illogical to believe that an
industry that averages a fi ve
percent net profi t can sustain a
cut as severe as 45 percent.”
— John Shirvinsky, Pennsylvania Association of Medical Suppliers
10 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
“The Compliance Team encourages and coaches you when you are doing the right things, and corrects and guides you when you are not,” Keith Diamond, an Exemplary Provider™ (EP) since early 2006, recently observed. “They are more like an advisor helping you succeed. A friend, not a foe.” The Compliance Team was the fi rst accreditation organization with CMS deeming authority to off er expert mentoring that helps to keep busy pharmacy DMEPOS operations like Keith’s on the right footing.
I’m an EP!
Keith Diamond, RPh, PresidentDermer Pharmacy & Surgical
Brooklyn, NYDale Pharmacy & Surgical
Richmond Hill, NYDMEPOS
The Compliance Team’s accreditation also features the industry’s fi rst set of simplifi ed product-line and service- specifi c quality standards along with customizable policy and procedure manuals, self-assessment checklists, corporate compliance/anti-fraud plans as well as access to electronic benchmarking. For detailed information about our industry leading Exemplary Provider™ accreditation programs for DMEPOS, please call us at 215.654.9110 or visit us at TheComplianceTeam.org.
HEALTHCARE ACCREDITATIONORGANIZATION
What percentage of your physician referral partners are enrolled in PECOS?
More than 75 percent . . . . . . . 60%Between 50 and 75 percent . . . 14%Between 25 and 50 percent . . . 10%Less than 25 percent . . . . . . . . 16%
Provider Poll:PECOS Enrollment
Results from a recent hme-business.com survey
CMS is working to soon implement the second phase of PECOS (see “PECOS Phase 2 Effective on May”).
While providers haven’t thought much about that Old West-sounding acronym for a little while, it can mean big trouble for them if their referral partner physicians aren’t registered in the system. Why? Medicare won’t approve claims prescribed by non-PECOS physicians.
Note: Due to the open nature of the Web, the results of this and other hme-business.com polls are instant opinion tallies and are not scientifi c.
PECOS Phase 2 Effective on May 1Medicare claims for DME must be prescribed by health professionals in the system.
Consider it a game of “now you see it, now you don’t, now you see it again.” After it briefl y announced in March that
Phase 2 of the Internet-based Provider Enrollment, Chain, and Ownership System (PECOS) would go into effect May 1, and then just as quickly retracted that announcement, the Centers for Medicare and Medicaid Services formally announced last month that the program will indeed go into effect on May 1.
As of that implementation date, any Medicare claims for home medical equipment (HME), Part B, and Part A home health agency that are prescribed by healthcare professionals who are not enrolled in CMS’s PECOS system will be denied.
The fi rst phase began Oct. 5, 2009 with CMS telling providers that any Medicare claims had to come from prescriptions issued by physicians and healthcare profes-sionals in the PECOS system. Due to the diffi culty physicians had enrolling in the system, the low initial number of physi-cians enrolled, and initial diffi culties providers were having checking to see if their referral partners were indeed enrolled, Phase 2 was delayed until now.
Come May 1, CMS makes the claims denials effective, so that physicians and other referring health professionals must be enrolled in the system and their record must specify they are eligible to order and refer Part B, DME, and Part A HHA claims. Otherwise Medicare will not approve those claims.
The full details of the CMS’s announcement can be read in MLN Matters SE1305. The MLN Matters offers various instructions on what providers making claims coming from referral sources need to do to ensure their claims go through. A key reminder is that they should use full names of physi-cians, and to use the referral’s individual NPI and not that of his or her organization.
CMS estimates that fewer than 1 percent of ordering physicians have not enrolled in PECOS. According to HMEB’s online survey (below), 60 percent of providers say 75 percent or more of their referring physicians are enrolled. ■
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12 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
Eagen Named Vice President of OPGATodd Eagen has been promoted to vice president of the Orthotic and Prosthetic Group of America (Waterloo, Iowa; www.opga.com), a network of independent orthotic and prosthetic patient care facilities, that comprises close to 1,200 locations.
Prior to the advancement, Eagen has worked as sales director for the past two years.
“Todd came to OPGA from the pharmaceutical industry, so he understands patient care,” said OPGA President Dennis Clark, CPO. “He has proved to be a tremendous asset to both OPGA and VGM.”
Eagen holds a bachelor’s and master’s degrees from the University of Northern Iowa, Cedar Falls, where he was an assistant football coach and recruiting coordinator for 12 years.
A division of the VGM Group, the OPGA provides services such as education; leasing and fi nancial programs; liability and property insurance; graphic design and print marketing; and website development and hosting for its members. ■
PEOPLE IN HME
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Complex Rehab Bill Re-introduced Into HouseBill calls for creating a separate benefi t for complex rehab mobility devices.
Representatives Joe Crowley (D-N.Y.) and Jim Sensenbrenner (R-Wis.) have intro-duced H.R. 942, the Ensuring Access To Quality Complex Rehabilitation Technol-
ogy Act of 2013, which would create a separate benefi t for complex rehab technology and equipment within Medicare
The bill revives the effort Crowley made with H.R. 4378, which was launched into the 112th Congress in hopes of creating a new benefi t.
The new bill covers complex rehabilitation power wheelchairs, highly confi gurable manual wheelchairs, adaptive seating and positioning systems, and other specialized equipment, such as standing frames and gait trainers, that enable individuals to maxi-mize their function and minimize the extent and costs of their medical care.
“The Medicare program should recognize the specialized nature of the CRT service delivery model, the required supporting processes and technology-related CRT services, the credentials and competencies needed by the providing suppliers and critical staff, and the related costs involved,” the bill’s text reads. “A separate benefi t category for CRT items would allow for unique coding, coverage, and payment rules and policies that address the unique needs of persons with disabilities and acknowledge the extensive service component.”
The amendments made by the Quality CRT Act would apply to complex rehab patients on or after Jan. 1, 2014, according to the bill. ■
DME Medicare Participation Enrollment ExtendedProviders must decide by April 15 if they want to continue participating in Medicare program.
The National Supplier Clearinghouse has extended to April 15 the 2013 participation enrollment for DME providers to update their Medicare participation agreements
with Medicare. By that date providers must decide whether they will continue to be participants in the program.
A provider’s decision impacts only future claims. Any change in status would not affect past claims. Also, providers that have been awarded and accepted contracts under competitive bidding are not impacted by the announcement because they must already participate in the program per their bidding contracts.
“If a provider elects to be non-participating, they can choose to not accept assign-ment, fi le the claim and let the patient get reimbursed their 80 percent,” wrote Andrea Stark, DME consultant and reimbursement expert with Mira Vita LLC, in a blog posting this week. “Filing non-assigned is not an option available to partici-pating providers. Additionally, it should be noted that non-participating providers can still choose to accept assignment on other services for other patients on a case-by-case basis.”
Stark added that if a provider operates multiple lines of business or business units, they all must have the same participation status. For providers unsure of their business’s status or the status for a specifi c business unit, they can check online at the Medicare
Supplier Directory.The original Dec. 31, 2012 deadline for updated participation agreements was
extended to Feb. 15 before being extended to the April 15 deadline this week.Providers that need to request a change in participation status should send that
request via mail to: National Supplier Clearinghouse, Post Offi ce Box 100142, Columbia, SC 29202-3142. ■
14 HMEBusiness | April 2013 | hme-business.com
With the start of Round Two of the DME national “competitive”
bidding (NCB) program coming in just a matter of weeks, there
are several unintended consequences headed towards physicians
and hospital discharge planners that CMS has overlooked: Local Medicare
DME suppliers available to serve Medicare patients are being reduced by over
90 percent, and referral sources a supplier to serve their patients will soon
become a much bigger problem.
Every hospital and every physician has a long-standing relationship with
local DME suppliers who will take their orders and discharges at all hours
of the day, including weekends and holidays. Usually one phone call or fax
results in almost instant response to the needs of the patients. Physicians and
discharge planners have built a relationship over many years and know who
provides the quality care and prompt service they want for their patients. Soon
this will be no more.
Despite DME being only 1.4 percent of the Medicare annual expenditures,
this small industry plays a huge role in reducing healthcare costs by keeping
patients safe and comfortable at home. Consider only that a patient who stays
one extra day in the hospital will cost more than this same patient being sent
home with oxygen, a hospital bed, and a wheelchair combined. In fact, the
payment for all three of these products costs less than $15 per day. A patient
denied discharge because of the inability to fi nd a responsive DME suppliers
will cost more than one year of receiving these three products at home.
This is the almost certain scenario when “competitive” bidding begins on July
1, 2013. With the pool of local suppliers reduced by 90 percent and the vast
majority of companies winning bids in the 91 bid areas being outside the local
market, physicians and discharge planners will suddenly fi nd their ability to
order and receive DME products and services for their patient very complicated.
What Bidding Means for ReferralsNo more one-phone-call orders; there will likely be no local company who has
been offered contracts in all of the bid categories. Moreso in Round Two than
in Round One, reports so far indicate that few suppliers have won all product
categories in any given CBAs, except for a few small companies who do not
have the resources to meet these needs.
Physician staff and hospital discharge planners will be left with calling
Medicare to fi nd out what suppliers can serve patients with certain products.
Even though the losing bidders may grandfather their existing patients, they
cannot accept new ones, and many of these local suppliers will be unable to
help referrals sources fi nd a supplier to serve the patient. They may not know
who can provide what products, or they may simply not have the resources
to help considering the circumstances. Local suppliers who did not receive a
contract will be busy down-sizing and fi nding new sources of revenue just to
survive. Even if a supplier can remain in business with a 45 percent average
reduction in payment amounts, it will take fi ve times as much business to have
the same revenue.
Suppliers, whether offered contracts or not, should begin planning their
own education process for referral sources. It is wise to wait until after the
contract winners are announced to begin sending materials to patients or
referrals sources, but suppliers should not wait until June to begin planning.
When the contract announcement is made, then start letting your referring
physicians and hospitals know your status.
Many suppliers will create a fl yer to include with invoices and statements to
inform their patients, an effective way to keep patients informed. These fl yers
can also provide information on how to contact legislators so that patients can
express their concern with the bidding program.
Helping Our PartnersSuppliers will also need to create a briefi ng document that can be shared with
referral sources. Most physicians, discharge planners, and social workers have
no real idea about this fl awed program that will limit their referral ability and
force changes to how they serve their patients. When CMS sends out their edu-
cational materials, many will overlook them without realizing the importance.
Suppliers should develop their own effective education plan for all of these
referral sources, and this plan should also include advocacy materials. Plan
meetings with your referral sources and ask to speak at in-service training
sessions. Ask to be a presenter on their programs. Few will realize the disaster
that is coming and most will be grateful for the help.
This also gives you an opportunity to provide advocacy information so that
referral sources can help let Congress know this is bad policy and will have
a negative impact on patient care. Prepare an issues paper and talking points
that include the contact information for the Representatives and Senators
serving your district.
Make it easy for referral sources to make contact with Congress about the
impact of the bidding program on their patients. While the contractors may
have not been named, you know whether you were offered a contract. During
this advocacy discussion, tell them how this will impact you. If you are not
a contractor, explain your position and whether you will grandfather. If you
signed a contract, explain how services and extras will be limited and how the
program will affect your deliveries and timeliness.
Physicians and their staff, discharge planners, social workers, and there
employers can be strong advocates for stopping this fl awed program. Use the
opportunity to add power to our fi ght. Combining education and advocacy
could make the difference to our future. ■
An Unanticipated NCB TsunamiHospitals and physicians can become advocacy partners with DME suppliers.
Industry Advocacy
Wayne Stanfi eld
Wayne Stanfi eld is president and CEO of the National Association of Independent Medical Equipment Suppliers, as well as the executive director of the Home Care Alliance of Virginia Inc., a provider network with 63 loca-tions in 11 states. He can be reached at (434) 572-9457, or via email at [email protected].
15hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
The HME Crystal Ball
Product Spotlight
A new software tool offers providers a way to predict how they will perform in various business scenarios.
Business intelligence you can use predictively: this is the quest of any business, but perhaps no industry more than the home medical equipment industry needs business intelligence. This
is especially true in the era of competitive bidding. Providers must consider a number of scenarios, and how their
business could perform under those scenarios. What would happen if they increased their cash revenue 10 percent and decreased their Medicare funding by 20 percent? How could they pull it off? What would it do to their operations costs? What would it do to their profi tability? There are a multiplicity of questions for a multiplicity of possible outcomes that need answers.
Enter business analytics. Business analytics has been around as a subset of business intelligence in the information technology industry for roughly fi ve to 10 years, and over that time has gained some best practices in other industries that are now making their way to the HME industry, explains Gregg Timmons, president and CEO of MedAct Software.
Business analytics differs from traditional dashboarding tools and reporting tools offered by business management systems in that it lets providers truly analyze how their businesses could perform under different circumstances and scenarios.
“We think that there is a real need to have these analytics tools available at the time when providers are getting competitive bid amounts, because they’ll need to determine whether or not they can work with one of these contracts,” Timmons says.
However, typical business analytics systems are usually the domain of banks and large enterprises that hasn’t necessarily “trickled down” to HME. This is why MedAct unveiled its Business Manager solution last month. The Business Manager provides HME business owners and operators with a Software as a Service-based tools that give providers predictive analytics over aggregate data from multiple sources, including a provider’s existing MedAct database and QuickBooks.
This provides HMEs with a comprehensive overview of their business performance. The tool lets a provider accomplish various things, such as workfl ow visualization to identify bottlenecks and ineffi ciencies; performance forecasting; scenario planning to prepare for market changes; and analytics to strengthen cash fl ow.
Speed Is KeyThe key is that providers need a predictive forecasting tool that lets them rapidly respond to new opportunities. Say a private payor insurance company offers a provider a new contract for various product categories at various reimbursement rates. That insurance carrier isn’t going to wait forever while the provider wades through excel spreadsheets to determine if it can carry the business. It needs to act fast.
That’s where their existing tools might not be enough. Dashboards and reporting tools show a provider how their business is currently performing based on its current processes. Business analytics tools let them see how their business would perform under different circumstances, Timmons summarizes.
To accomplish that business forecasting under different circum-stances, MedAct’s Business Manager can tap into more than one data source to help make those projections. It also gives managers of provider businesses more fl exibility in the sorts of datapoints they want to examine and how they want to examine them.
“You need to be able to run your numbers very quickly, and do some scenario planning, based on those numbers, and determine if this is going to be profi table,” Timmons explains. “To do that, you need to have some sort of modeling capability. That’s where busi-ness analytics tools come in.” ■
MedAct Business Manager MedAct Softwarewww.medactsoftware.com
(800) 326-0314
By David Kopf
An example of how MedAct’s Business Manager can help providers determine how
different business scenarios will play out across their business.
16 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
Over the last 20 years, the prevalence of obesity in the United States has skyrocketed. According to the CDC, approximately 35.7 percent of adults
and 17 percent of children are obese. And a string of studies published over the last year point to Americans reaching an obesity rate of 75 percent to 80 percent by 2020. With that will come a rise in the number of bariatric patients. Supportive fi ndings from the November 2012 Bariatric Supplies Market Research report published by Novation include:• 38 percent of responding facilities have seen a slight increase in admissions of
morbidly obese patients in the last 18 months• 74 percent of the respondents have seen an increase in the number of bariatric
surgeries over the last 18 months. • 61 percent of the respondents have seen an increase in the number of related
reconstructive surgeries over the last 18 months. • 6 percent of the respondents indicate they offer bariatric programs specifi c for
pediatric patients. • 60 percent of the respondents indicate the average age of pediatric patients is
Under 12; 40 percent of the respondents indicate the average age of pediatric patients is 15 to 18. This unfortunate situation has created the opportunity for providers to expand
their business by selling additional products and services to bariatric patients.“Any products and service that can assist the homecare patient can be profi t-
able,” says Ron Resnick, President, Blue Chip Medical Products, Inc., and a former bariatric patient. “Due to competitive bidding, a lot of dealers are going to have to look at alternative sources of revenue. For bariatrics, whether it be in the long-term care market, acute care hospital or the Veterans Administration, there are a lot of opportunities out there.”
Bariatric patients can suffer from multiple co-morbidities. This equates to multiple product needs that HME providers can offer. Resnick lists some of the co-morbidities of bariatric patients: pseudotumor cerebri; lower-limb circulatory stasis; ulcers; dermatitis; thrombophlebitis; refl ux esophagitis; abdominal hernias: possibly, hypertension and nephrotic syndrome.
“These co-morbidities are physiological responses to obesity,” says Resnick. “Keeping the patients active, mobile and trying to increase their activi-ties of daily living is the key. Alternating pressure has been shown to relieve skin pressure and possibly increased perfusion to wounds. Kinetic therapy has shown to help with the oxygen exchange.”
Resnick points out that there is a big opportunity in the long-term and acute care market. “Many long-term-care facilities do not want to take in bariatric patients due to the high cost of the
products,” he says. “A homecare dealer can benefi t by renting bariatric equipment and then possibly providing the service if and when the patient is discharged. The same goes for the acute care market, as well. There are additional opportunities for bariatric wheelchair sales targeted to airports, museums, colleges and universities.”
Parker Humphreys, CEO, HB Rehab Supplies, Inc., sells and rents bariatric products, which make up approximately 30 percent of his company’s revenue. HB Rehab Supplies concentrates on the long-term and acute care market versus homecare because he says reimbursement is better. He also services some private insurance billing and workers comp patients.
Humphreys says that more people with ailments are coming out of their homes and joining the ranks of bariatric patients by going to nursing homes and hospi-tals for treatment. Therefore, Humphreys creates relationships with the discharge planners at the hospitals and nursing homes, as well as care plan nurses working for state Medicaid. He shows them products and services and lets them know that his company can take care of their patients.
He believes that for providers to be successful in the bariatric sector, they have to consider the quality of the products they are going to carry.
“One of the key things is carrying the better products,” he says. “Some of the products are big and you have to move them around a lot. Better products work better for bariatric patients. We’ve tried cheap products and they don’t work. Before long you have a service call and then you have to go out there in the middle of the night and your cutting your revenue even more.”
For providers who want to sell to homecare patients, where Medicare or Medicaid is going to reimburse, Humphreys suggests talking to the state Medicaid offi ce about the products and getting a good understanding about building a sustainable business model. He says that a lot of the nurses who are ordering products to the patients at home really don’t understand the costs and how hard it is to move the equipment.
Humphreys also points out that additional services can be found by solving a problem for the patients’ caregivers.
“We’ve provided patient transfer systems to hospitals and especially nursing homes,” says Humphreys. “A lot of people don’t want to take bariatric patients because they are scared of lifting them. They are scared that if the patient ends up on the fl oor, they are not going to be able to get them back up. There is a big workers comp issue with nurses trying to move these patients. A lot of times they are still trying to slide them using regular sheets. These transfer systems can allow you to take up to 1,000 pounds and move the patient easily.”
Humphreys suggests that providers visit their local hospitals and nursing homes and see if transfer systems and similar products solve problems for the healthcare facility.
Humphreys calls offering bariatric products and services “a growing industry.” “There are still many people in the homes who nobody even knows about, people
who haven’t left their homes in two or three years,” he says. “They aren’t using prod-ucts; they are just coping with their situation until they get sick enough and they have to go to the hospital. It would be great if our government recognized what was going on with these people.”
Resnick agrees: “The federal government needs to get serious because it’s not just the size of the equipment that should determine reimbursement, it’s the size, weight and clinical needs of the patient that should be the determining factor.” ■
Serving the Bariatric SpectrumHow can providers offer a complete array of bariatric services?
by Joseph Duffy
Problem Solvers
Resnick provides is a list of common health conditions associated with bar-iatric patients a list of products that ailing bariatric patients may need dur-ing the course of their disease. Please note that many of these products can be used for many of the health conditions listed, depending on the state and severity of the bariatric patient. Neither list intends to be complete.
Health conditions Products
Metabolic SyndromeType 2 diabetesHypertensionDyslipidemiaCoronary heart diseaseOsteoarthritisStrokeDepressionNon-alcoholic fatty liver disease (NAFLD)Infertility (women) and erectile dys-function (men)Gall bladder diseaseObstructive sleep apneaGastroesophageal refl ux disease Some cancers (endometrial, breast, colon)Asthma
Bariatric pressure redistribution sup-port surfaces and seating and position-ing systemsOxygenNebulizersRespiratory medicationsWalkersCommodesWheelchairsTransfer liftsHover matsShower chairsGrab barsIncontinence padsWound dressing and suppliesSkin care productsBIPAPCPAP
Joseph Duffy is a freelance writer and marketing consultant, and a regular contributor to HME Business and Respiratory & Sleep Management. He can be reached via e-mail at [email protected] or [email protected].
17hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
had to happen worked diligently together to present an alternative in the Industry’s Six-Point Plan. Industry consolidation with the merger and acquisition fury ensued. The BBA 1997 further reduced reimbursement and increased regulatory oversight and decreased reimbursement and the cuts continued with each passing budget crisis.
Today, as we are faced with the biggest challenge of our life with a fl awed government program that is about to threaten my company’s 25-year longevity, cost thousands of jobs and decimate an industry, the industry has a viable solution: Much like the collaborative work on the Six-Point Plan, our legislators and CMS should listen to the MPP solution. We must stop this train wreck, save this industry, and see a market-based solution.
Cara Bachenheimer, senior vice president of Government Relations, Invacare Corp.Take almost any year, and we can identify at least one, often more, signifi cant legislative or regulatory change that happened that year. Twenty years ago, Congress passed the Omnibus Budget Reconciliation Act (remember all those OBRAs?) of 1993.
That law amended OBRA 1987 and the so-called Six-Point Plan which defi ned in law six classes of DME and their Medicare payment rules. OBRA 1993 also deleted nebulizers and aspirators from the statutory list of items that require frequent and substantial servicing, and reduced TENS payments by 45 percent, among other things. In 1993, CMS’ predecessor HCFA was issuing its fi nal rule implementing the Six Point Plan.
While the targets may have changed, the tune remains the same. The government continues to scrutinize our industry, lower payment levels, and impose increased regulatory burdens. There’s no better reason to make sure that your Senators and Representatives know you, your company, and the important products and services you provide in your community.
Tyler Wilson, president of the American Association for HomecareThe homecare community is seeing unprecedented change on many fronts. The industry is facing parallel threats of a dysfunctional competitive bidding system and a regulatory onslaught in the form of audits and signifi cant new policy requirements, such as PECOS and the face-to-face-exam requirements.
It is in times of turmoil that trade associations like AAHomecare become even more important. Providers need to know about and understand the shifting landscape and they need to have questions answered quickly so that they can adjust their business strategies.
The Medicare program is under increasing fi nancial pressure and legisla-tors want to reduce expenditures. Home medical equipment companies will benefi t in the long run by the need for Medicare to save money because homecare is cost effective, but the industry must get through the near-term challenges.
Thomas Ryan, president and CEO, Homecare Concepts Inc.I have worked in this Industry for over 30 years and have seen it evolve. My fi rst exposure was as a Respiratory Therapist doing IPPB/ Intermittent Positive Pressure Breathing treatment follow-ups part time while attending school for Health Administration. Soon after, I started my business, and today I am a 25-year business owner of Homecare Concepts Inc.
The progression of the industry hit its stride in the 1980s as the “Golden Commode Age” soon brought government oversight and the industry accepting that change
Homecare and the home medical equipment industry has changed considerably over the past two decades. As HME Business magazine celebrates its 20th anniversary, we asked various industry veterans to share their thoughts on where the industry has been, where it is headed, what providers should be considering, and how they should be shaping their strategies and business plans to face the challenges of today and tomorrow.
18 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
HME Then and NowRon Bendell, president, VGM & Associates Ltd.The one thing that has been consistent in this industry is change. When I fi rst started in this industry in 1985, it was a rental marketplace. That changed to a purchase market, then back to rental. Now we have the 36-month cap and NCB.
The market has been and will continue toward lower reimbursements. Competitive bidding and consolidation of insurance carriers will continue to put pressure on reimbursement. That sounds very negative. The bright side is there will be many more people who will require our services. The providers need to supply a lot more customers a lot more cost effectively.
I spent a number of years with Invacare in the late ’80s and ’90s. Pricing pressures were already occurring. Manufacturers have spent a great deal of resources lowering their costs to meet the pricing pressure. In my opinion, they’re pretty much near the end of signifi cant cost reductions if we have an expectation of reasonable quality product that is available when we need it from someone who can back it up.
We’re at the beginning of the “new HME provider.” I mentioned becoming more effi cient, and that is already evident in a great percentage of the VGM membership. As we move forward, diversifi cation is the key. Non-reimbursed, cash sale products are fi nally catching on. The industry has talked about this for years, and fi nally the trend is here.
Georgie Blackburn, vice president of Government Relations and Legislative Affairs, BLACKBURN’SI’ve been with BLACKBURN’S since 1978, and can honestly say I’ve never felt like I was “going to work,” regardless of my post in Rehab, Compliance, or Government Relations.
Our industry is comprised of tremendously gifted and caring people who are fulfi lled by helping others to achieve their health potential. Whether it’s facili-tating a little one from a stroller to captaining his own power chair, fi nding the right respiratory device to enhance endurance and independence, anatomically positioning a person in a wheelchair to aid poor digestion and respiration or fi ghting for insurance coverage for a device, ours is the perfect intersection of product innovation and provision.
Over the years, we’ve staunchly marched through HCPC coding changes, policy requirements, audits challenges, Round One of Medicare competitive bidding, and prevailed. We’re tough, tenacious and know how to succeed in business. Securing hearings to illuminate Round Two’s illogical outcomes must be our top priority. This program has the capacity to destroy our industry of the past. If ever there was a time to dedicate time, energy and fi nances to expose the brewing situation to Congress, it is now.
We can’t accept policy that disintegrates what we’ve built and everyone we’ve helped over the years.
Seth Johnson, vice president of Government Affairs, Pride Mobility Products Corp.The complex rehab and mobility industry have seen a complete overhaul of the coding, coverage, and payment policies over the last eight years. Based on these changes, manufacturers needed to become more innovative with product development to increase effi ciencies, performance and quality
while maintaining value. To a large degree, the industry is still evolving due
to increased regulatory pressure at the federal and state level. However the demographics alone, 10,000 baby boomers turning 65 a day, will provide for a strong market over the next 10 years. This will lead to an opportunity for more retail related product and focus. While the near term challenges with Round Two Competitive Bidding and changes to Medicaid are signifi cant, we are confi dent that the industry will continue to persevere and emerge stronger.
Ron Resnick, president and CEO of Blue Chip Medical ProductsWe’ve all struggled through the good times and the bad times. These are the changing times. What once was, is no longer. I live in New York City, where 9/11 happened. Our city got bombed; we had never seen that before, but we all stuck together. That was a very dark time for our country — who had ever bombed the United States? It’s not the same any longer. The same can be said for HME. Things have changed, and we have to change with them — even though some of those changes are not good.
We can learn a lot from the patients we serve. Say someone has been in a car accident and becomes a paraplegic, or someone has been diagnosed with a long-term disability, they can say, “Oh poor old me,” or they can belly up to the bar and say, “I have to deal with this, and I have to be as optimistic as I can.” Likewise, for the dealers that don’t want to deal with issues like competitive bidding, they need to get out and make way for the dealers that really do want to do a good job.
This is still a great business. There are still going to be patients. There are still going to be people who require our services (the big question is who is going to pay for it), but the fact remains that we are an aging society that is still going to need HME services. And it’s not going to be the least expen-sive product, because there are going to be a lot of private-pay people, and they’re going to want quality.
Mike Mallaro, CFO, VGM Group Inc.What’s the value of a year or two, or six? It’s priceless when you consider our limited time on Earth. Over the past 20 years, home medical equipment tech-nology – oxygen, wheelchairs, scooters, walkers – has extended the quality of life of 60 million Americans.
A quality life is one lived at home, seeing grand-kids, playing cards with friends, going to church and comforting loved ones. It’s made possible through the tireless, often thankless, effort put forth by HME companies and their employees and the extraordi-nary advances created by HME manufacturers investing in development of new products and technology.
My mother, Pat Mallaro, lived for six years with the assistance of home oxygen. The doctors at one of the nation’s elite hospitals failed to stem the advance of her disease, despite several hundred thousand dollars of proce-dures. But a seemingly simple oxygen concentrator, lots of portable tanks diligently refi lled and delivered to her home and an extraordinary, small town HME provider, extended her quality of life. Such is the history of HME, and the future.
19hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
Because of our leading capabilities for helping HME providers improve profi tability, every month more providers switch to Brightree than any other software.
The advantages are clear — Brightree delivers unique capabilities that enable you to increase cash fl ow and optimize operations. Automation, business insight, and ease of use are at the core of Brightree.
Brightree automatically fi les electronic claims for you, dramatically increasing the effi ciency and accuracy of your billing process. The platform provides easy access to your key performance indica-tors and underlying information, so you can act on timely data concerning billing, referral sources, products, and customers. And, everything your billing, purchasing, and customer service teams do in Brightree is intuitive and built to reduce steps through No-Touch™ workfl ows.
With Brightree, you have a new way to operate your business – a platform for success. Providers report that, with Brightree, profi ts increase up to 18-20 percent, cash collection improves by 20-25 percent, and resupply revenue grows, on average, 38 percent.
To see how Brightree can help you adapt to Competitive Bidding and other industry pressures, visit www.brightree.com/demo or call 1-888-598-7797 ext. 5.
Since CEO Dave Cormack joined Brightree in 2005, the company has become the industry’s billing and business management solution of choice. With a focus on customer service and developing inno-vative technology for providers, it’s no surprise that more than 40,000 HME users rely on Brightree.
Today, Brightree has grown to be the largest provider of cloud-based software for the post-acute care industry. Our 500 employees serve nearly 3,000 companies in the HME, home health, hospice, O&P, HME pharmacy, home infusion, and rehab home care segments.
Company Profi le
Brightree
www.brightree.com
1735 North Brown RoadSuite 500
Lawrenceville, GA 30043
Phone: (888) 598-7797 x 5
Contact Information
Key Personnel
Dave Cormack, president and CEOStephen Andrews, GM, customer services
Suzanne Henderson, chief technology offi cerGary Long, chief revenue offi cer
Paul Rowand, chief fi nancial offi cerChris Watson, chief marketing offi cer
Other Information
SoftwareBilling
Inventory/ ePurchasingReporting/analytics
Patient contactDelivery
Documentsand more
ServicesOutsourced billing
BenchmarkingBest practices
Training
A Platform for Success
20 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
Dave Cormack, president and CEO, Brightree LLCThe industry is at a turning point as it faces the perfect storm of audits and competitive bidding. Despite the diffi culties that lie ahead for many providers, I think the cup is half-full if we get it right.
When I talk to providers, I often think back to 2004, when I fi rst invested in Brightree. I looked at this new venture differently than others — I was very hopeful and confi dent we could create something. Back then, the business was new, it was losing money. The founders who preceded me did not have the right team together. But I brought in new people, we took a fresh look at things, and we turned it around at a time when others thought it was impossible.
Competitive Bidding is a different situation, but the same lesson. Often, you have to take a dramatically different approach to fi nd what works. Now is that time for most HME providers. Some will look to new business models, others to technology and process, but I believe many will fi nd ways to be profi table and deliver excellent patient care.
Peggy Walker, RN Billing & Reimbursement Advisor, VGM/US RehabThe audit contractors are defi nitely the greatest threat to our industry today. The face-to-face rule in July just does not make sense and will cause many benefi ciaries harm, PECOS denials, coding changes and frequent revisions of LCDs that are being retro-active is a great concern as well.
Providers are looking at moving away from Medicare billing in all jurisdictions and again this is going to cost the benefi ciary. Suppliers have to learn to say no and not keep giving equipment away, increased education of referral sources and trying to get them involved in the issues.
So many issues across the board — we have to get more suppliers to join the advisory committees and POE teams so they have a voice. Putting issues in writing — follow up and document specifi c concerns, Join groups and speak out with the media. We have suppliers that are doing radio shows and contacting media in their areas.
John Shirvinsky, executive director of the Pennsylvania Association for Medical Equipment SuppliersWe’re an industry that’s under assault — certainly by CMS. We’re also under assault by state Medicaid programs. There are congressional allies, and there are congressional opponents, as well.
So, this is a time when folks involved in our industry really have to do a “gut check,” and have to deter-mine exactly where they want to be in the future. We’re not talking long-range planning; we’re talking where they want to be a year from now, two years from now. Because reimbursement rates are changing that dramatically; the relationship with the auditors and the regulators is changing that dramati-cally; the ability to meet payroll and provide adequate care is changing that dramatically. Everything is under assault in our industry, so it is critical for everyone to pull together.
I don’t know if any industry has ever undergone anything like this. We
have to say, “enough,” and we have to say it loud, we have to mean it, and we have to gather together. That means we have to belong to our state associations; we have to belong to our national associations; we need to talk to every decision-maker; we need to talk to the media; and we need to talk to our employees, our family, our friends, and our patients. We need everyone engaged.
Brad Heath, vice president of Operations and Marketing, Family Medical SupplyI wake up early, stretch out good and grab my morning joe.Not much sleep, but time waits for no one, and neither does this show.
Boston and has its marathon and there is always an “Iron Man” to race, But those are mere sprints compared to the daily “Medicare Chase.”
There are sales calls to make, doctors to see and moving rules to be kept to date,Orders to fi ll, genuine deliveries of love, with enough paperwork to fi ll an estate.
Compliance is checked, the billing released and now the real fun’s belayed,Running down denials, hurdling audits and needing a judge to get paid.
The profi t is lost, but the patient is served and we avoided every pitfall.What’s that you say? An order by the FDA? We must do it again as a recall?
Ryan Bennett, president and CEO of Providacare Medical SupplyThe medical equipment industry has been an industry that has been focused on taking care of the patients with local customer service experts. The biggest change is the amount of audits and govern-ment oversight that has been implemented by CMS.
That said, the are several opportunities in which the medical equipment industry can participate in the continuum of care. Payers, physician groups, and health care systems are looking for partners that can help with the preventative care initiatives that are being focused on in the health and wellness space.
The industry should prioritize providing all stakeholders in the continuum of care with data that supports the value of the products and services. It will no longer be good enough to say “we take care of the patient”. If so the payer wants to see the clinical and fi nancial data that proves a better outcome, so they will pay for the product and/or service. To get there, providers need to have a strategy in place with the structure, talent, and capital to execute.
Sandra Canally, RN, president of The Compliance TeamDespite all of the changes that providers are facing today, I know one thing for certain: the HME/ DMEPOS industry is comprised of smart visionary entrepreneurs who are passionate about how they can best serve their patients and community.
A provider who remains passionate will fi nd a way to get around the barriers that they face. That’s true for providers from Ocala, Fla. to Olalla, Wash., and everywhere in between.
Much like the HME/ DMEPOS providers The Compliance Team accredits, we are faced with challenges from much larger organizations that have far deeper pockets than us. As a nurse entrepreneur business owner I know fi rst-hand that the fi ght is far from over.
HME Then and Now
21hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
In 2011 CAIRE expanded its portfolio to the concentrator market through its acquisition of SeQual Technologies, boasting the most innovative POC on the market, the Eclipse. The addition of the SeQual Eclipse and Integra market-leading portable and stationary oxygen concentrators allowed CAIRE to expand its patient solutions to new heights.
Eager to advance its portfolio even further, CAIRE proudly announced its acquisition of AirSep Corporation in September of 2012. Product offerings include the lightest in lightweight oxygen concentrators including the FreeStyle™ and Focus™ POCs. CAIRE now also boasts the VisionAire™ and NewLife™ stationary concentrators, which provide the reliability your patients need at home.
Today, CAIRE ® has evolved to become a leading respiratory care products provider for the home health care market. Manufacturing a full line of liquid oxygen systems, portable oxygen concentrators, and stationary oxygen concentrators, CAIRE combines product expertise and consulting to bring a unique approach to the home respiratory and long-term care market. CAIRE continues to remain dedi-cated to giving you reliable, innovative, and high quality products for all of your respiratory needs.
Since the founding of Chart Industries, one thing has always remained - our commitment to innovation and customer service.
In 1999, Chart acquired its fi rst venture into the respiratory market, CAIRE, a small branch special-izing in liquid oxygen equipment. Thus, the legacy of CAIRE was born. CAIRE acquired its fi rst expan-sion at the end of 2009 with the acquisition of the Covidien line of oxygen products, including the leading Companion® and HELiOS® brands. This addition allowed CAIRE to evolve into the leading manufacturer for liquid oxygen products.
Company Profi le
CAIRE
www.CAIREmedical.com
2200 Airport Industrial Drive, Suite 500
Ball Ground, GA 30107
Contact Information
For AirSep Products: [email protected]
800-874-0202For CAIRE Products:
[email protected] 800-482-2473
Key Personnel
Norman R. McCombs, Senior Vice President at AirSep Corporation was awarded The
National Medal of Technology and Innovation on February 1st, 2013. The National Medal
of Technology and Innovation is the nation’s highest honor for technological achieve-ment, bestowed by the President of the
United States of America’s leading innova-tors. Products stemming from Mr. McCombs
inventions can be found all over the world in various applications, including portable
oxygen delivery systems for fi eld hospitals in Iraq and Afghanistan, personal portable units greatly improving the quality of life of Chronic
Obstructive Pulmonary Diseases (COPD) patients, and the medical clinic at the base
camp on Mount Everest, among others.
Other Information
CAIRE is the leading manufacturer of portable oxygen concentrators for use on the
battlefi eld by the United States Military.
CAIRE: The Powerhouse of Oxygen
22 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
What keeps us going is our passion and commitment to improve on what we consider the best accreditation experience available for the money. I’m confi dent that a similar passion and commitment is what will help HME/DMEPOS providers survive these uncertain times.
Spencer Kay, president and CEO of Fastrack Healthcare Systems Inc.As HME providers continue to provide an incredibly valuable service the roadblocks they constantly face makes obtaining a fair compensation for their service harder and harder.
At Fastrack, despite reimbursement cuts and more regulation, we are seeing providers that are very successful in part due to their ability to seek different revenue streams beyond traditional Medicare and Medicaid as well as the utilization of soft-ware with innovative integrated technologies. These providers are realizing greater effi ciencies leading to increased productivity thereby allowing them to accomplish more with less staff.
Implementing the right technology is clearly a key answer going forward as it has the potential to reduce operating costs. The potential risk for many providers is to respond to reimbursement cuts by failing to invest in technology allowing other providers a signifi cant competitive advantage. Fastrack is extremely optimistic about the industry’s future despite the diffi -cult challenges we face as ultimately demographics (aging population and people living longer), and new innovation is on our side.
Ty Bello,RCC, president of Team@Work LLCTo state the obvious, changes in our industry with competitive bidding, accreditations, caps, and the like is not where I want to focus our attention. Let’s look at the way we were with sales and marketing, and where we will need to be for the future.
The sales call used to be full access, any place at any time, now we have Rep Trac’s (and the like), and offi ces not permitting sales reps. The future will produce continued limited accessibility.
Quality of the sales call used to be heavier on the social side, but we have grown into a full scope sales force which understands, products, services, diagnosis, and medical documentation. This will only increase and the personal sales call will still be a part of the future.
Marketing has had the greatest change. For the most part we could not spell “retail” or “consumer marketing” 10 years ago, and now it is an ever increasing part of our daily marketing strategy. Consumerism has arrived in our industry and will increase in the future.
The way we were, regarding sales and marketing? We are better now — and will be in the future.
Wayne van Halem, president, The van Halem Group LLCI had a different start in the DME industry than most. It started 17 years ago after graduating college and going to work for Medicare. The next decade was spent as a Fraud Investigator investigating DMEPOS suppliers across the country. At some point, the frus-tration of being forced to recoup money on legiti-
mate suppliers because a “T” was not crossed led to the creation of The van Halem Group.
Over the past few years, the intensity and irrationality of these audits has increased dramatically. With accreditation, surety bonds, competitive bidding, and now the unreasonable audits, CMS is making it clear they want to limit the number of DME suppliers and will only do business with the most compliant of organizations. The ACA also now mandates a more formal and comprehensive compliance program.
To be successful in this environment of strict regulatory oversight, compliance must be a dedicated constant focus for suppliers in the future, certainly much more so than in the past.
Richard Mehan, president of Noble HouseProviders are diversifying and breaking away from Medicare. It feels like Medicare is dissipating, and it’s survival of the fi ttest right now.
A lot of our clients ask how will Nobel House survive the competitive bidding storm, and my response is that the majority of the clients that we are going to lose, we have actually already lost. They’ve sold, they’ve retired, they’ve merged — whatever the case may be, they’re gone. Come July, with Round Two, there will be another fallout, but it won’t be as bad as what has happened over the past two years.
Meanwhile, our existing base is growing, thriving, they’re expanding, and they’re fi nding alternative sources of revenue, such as pharmacy, point of sale, retail, and they are breaking away from Medicare and expanding into other avenues.
The biggest concern that I’m hearing now is the private carriers typi-cally follow suit with Medicare a few years down the road. So, if we come back here a fi ve years from now, where are we going to be? Will there be a comparable implementation of competitive bidding in the private sector? The privates have already followed Medicare’s lead, so we’ll see how that plays out in the next fi ve years.
Ron Richard, CEO of the Americas, REKA Health Inc.The homecare markets continue to experience change and are evolving rapidly based on competi-tive bidding and the infl ux of Medicare benefi ciaries coming into the system. As Einstein once said, “Not everything that counts can be counted, and not everything that can be counted counts.”
It appears with constant and growing pressure on the health care system, specifi cally reimbursement, want counts and is being counted is primarily focused on economics. This personally concerns me because the homecare industry has struggled with sepa-rating the services from the products and this is refl ected in the reim-bursement models. Competitive bidding is like seeing who can dive to the bottom of the pool the fastest with little concern about how to return to the surface for air. The prices that are being bid can’t sustain quality services nor consider the key issues of how manufacturers can then deliver the best in class medical devices that produce effi cacious results.
My hope as having received the Home Care Person of the Year award in 2004, that the industry remain focused on outcomes and providing the very best patient care in the home environment. I have been in health care for over 30 years and remain committed to the core values that clinicians do the best they can for the patients they care for on daily and personal basis. ■
HME Then and Now
23hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
The Compliance Team was the fi rst nationally recognized HME/ DMEPOS accreditation organization (AO) to offer expert mentoring as well as a complete preparation manual and the use of more than 200 sample documents; from policies and procedures to Plans of Care and everything in between.
In addition, The Compliance Team was the fi rst AO to develop Corporate Compliance/ Anti-fraud quality standards and evidence of compliance as well as the fi rst AO to provide participants with product-line and service specifi c self-assessment checklists.
Going back to 1998, The Compliance Team was the fi rst HME/ DMEPOS AO to tally and benchmark patient outcomes. (Starting in 2010, our HME/ DMEPOS outcomes tracking and benchmarking moved to a web portal on www.thecomplianceteam.org) Another industry and AO fi rst.
Most notable and in keeping with the ideals that anchor our Exemplary Provider-brand of accredita-tion, The Compliance Team, as the nation’s fi rst Medicare approved, certifi ed woman-owned, nurse-led, for-profi t, HME/ DMEPOS accreditation organization, requires a participant score of 90% or better in order to receive our Certifi cate of Accreditation. After all, every patient deserves exemplary care. We’ll help you.
In November 1998, The Compliance Team (TCT) launched the Exemplary Provider™ Award accredi-tation program for HME/ DMEPOS; the nation’s fi rst healthcare improvement program designed to foster patient care excellence while at the same time dramatically simplifying the accreditation process through the use of plain language product-line and service specifi c quality standards.
Free-of-charge since 1998, an industry fi rst, and weighting in at 36-pages long, The Compliance Team’s Safety-Honesty-Caring® Quality Standards and Evidence of Compliance remain the most complete and concise as well as easy-to-understand healthcare delivery quality standards on record.
Company Profi le
The Compliance Teamwww.TheComplianceTeam.org
P.O. Box 160Spring House, PA 19477
Phone: (215) 654-9110Fax: (215) 654-9068
Contact Information
Key Personnel
Sandra C. Canally, RNFounder and President
Richard (Rick) CanallySenior Vice President
Steve SimmermanVice President—Operations
Lesa MerchantDirector—Field Operations
Accreditation Programs
DMEPOS (Medicare Deeming Authority)
Critical Access HospitalRural Health Clinic
Pharmacy: Infusion/Specialty/LTC/DMEPOS
Sleep Care ManagementHome Health/ Hospice
Private Duty Home CareOcularist/Anaplastologist
Exemplary Provider™ accreditation leadership
Sandy Canally,
RN—Founder and
President of The
Compliance Team
presenting Phil
DiLernia of Cornell
Health Corp. Flem-
ington, New Jersey
with the 1st Exem-
plary Provider™
Award Certifi cate
of Accreditation at
Medtrade in 1999.
24 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
The explosive growth of portable oxygen has helped redefi ne the HME oxygen industry. Not only are patients enjoying a higher quality of life, but also it has helped HME providers to rethink business and work through
some of the cuts, caps and competitive bidding pervading home healthcare.According to Medicare
HCPCS claims data, the portable oxygen concen-trator (POC) code E1392 has been in use since 2007, giving the industry fi ve years of claims data (2011 data is the last complete year). In 2007 there were an estimated 1,500 patients receiving a POC billed to Medicare and in 2011, approximately 26,000 patients. Payments for POCs in 2007 were about $2 million and almost $16 million in 2011.
“This is signifi cant growth, which includes the impact of the cap in 2009,” says Joe Lewarski, BS, RRT, FAARC, Vice President of Clinical Affairs, Invacare
Corp. “It’s important to note that these data only include the POCs billed as a portable system to Medicare. This does not include the thousands of POCs sold directly to self-paying patients, as well as the many POCs provided by HME companies solely for travel.”
Bob Hoffman, Vice President, Nationwide Respiratory, VGM Group, says POCs have become an integral part of the HME oxygen business model.
“They have provided options and effi ciencies that were not possible with the tank delivery systems,” he says. “In addition, many providers are looking at the POCs as a retail opportunity, thus providing an additional cash fl ow stream. Providers are getting better at showing their patients options that can make dealing with their disease more manageable and knowing that many are willing to spend the money to accomplish this.”
So arguably off to a good start, portable oxygen begins to breath some life into the HME industry, adding business value to providers and a higher quality of life to patients. But as Dave Baxter, President, Medical Necessities, aptly points out: portable oxygen is still evolving. Companies manufacturing POCs, home fi ll systems, and different conserving devices are still fi ghting for market share to prove their products are better than others and their modality is the best for the industry. How will it all shake out and where will this evolution take these devices? Our experts weigh in on the future of POCs and portable oxygen in general.
Oxygen TodayUnderstanding the future of POCs starts with knowing where they are today.
Hoffman says that just by looking back 10 years and then fi ve years and then fi nally to the present, it’s easy to see the tremendous gains that continue in all areas of POCs. Today, they are smaller, lightweight and more durable; have longer battery life; are easy to carry; and offer continuous fl ow with 92 percent plus oxygen concentration. These qualities, he says, are all on the forefront of POC development.
“The role of innovative, portable oxygen devices continues to be a central element of long-term oxygen therapy (LTOT),” says Lewarski. “Clinically, improved compliance to therapy in conjunction with increased activity and
Portable oxygen concentrators have ushered in a revolution, with use having skyrocketed over the last fi ve years, but what does the future hold? Industry experts are optimistic about the future of portable oxygen in general.
By Joseph Duffy
A look back, and a look ahead for HME.Oxygen has evolved to an incredible degree over the past 20 years, with patients going from stationary concentrators and tanks, to hav-
ing portable oxygen concentrators and home fi lling systems that help them get out and live life to its fullest. Not only have portable oxygen advances helped patients become more ambulatory, which can help their overall treatment outcomes, but it has helped providers develop business plans that substantially drive down delivery costs — an absolute necessity due to Medicare’s 36-month rental cap, as well as competitive bidding.
25hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
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Company Profi le
CPR+www.cprplus.com
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Phone: (866) 277-4876Fax: (614) 543-8878
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Key Personnel
Jeff Johnston, Co-owner
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Marcus Banks, Director of Sales & Business Development
Other Information
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26 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
ambulation has been shown to increase the life expectancy for LTOT patients. Modern LTOT patients are more active and more informed about their choices, as are many of the physicians prescribing oxygen. Of the portable oxygen device options available today, POCs defi nitely get the most attention. The
popularity among patients, prescribers and providers continues to grow. Although there is no accurate data regarding the number of HME providers using POCs in their business, I think it is safe to say that nearly every HME company owns and uses POCs in some way.”
“The next step in driving oxygen technology will be patient-based maintenance. With reimbursement falling more and more, companies are offering fewer and fewer services to make up for the cuts.”
— Caleb Umstead, 1st Class Medical Inc.
Portable Oxygen: The Next Step
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According to Robert Jacobson, vice president of CAIRE Sales, North America, the POC market is the fastest growing segment within the oxygen therapy market, and there is sustained high demand and double-digit growth for the smallest and lightest POCs.
“Oxygen patients are extremely sensitive to the weight of portable oxygen systems, and lighter POCs provide greater patient acceptance,” he says. “Wearable POCs, less than fi ve pounds, are in the most desirable class. Transportable oxygen concentrators (TOCs) can supply both pulse and continuous oxygen delivery, but they are substantially larger and heavier (by a factor of four to fi ve times) than wearable POCs. Therefore, carts are a requirement for moving these 15-pound to 20-pound devices. Since most COPD patients are not using continuous fl ow during ambulation, TOCs burden the oxygen user with unnecessary weight.”
Baxter says that he feels only 20 percent of providers use POCs currently.
Caleb Umstead, Director of Customer Education, 1st Class Medical Inc., says POCs are very much still in its genesis, but every day they become more popular.
“As technology becomes more reliable and more compact, the number of users on POCs will increase,” he says. “Many providers are looking to POCs as a new model of business; however, given the current state of healthcare reimbursement and the decline in the number of providers, these have put a serious damper on many providers paying the rather costly investment of POCs.”
Another benefi t for providers, says Lewarski, is that POCs empower HME providers to eliminate nearly all of the non-value added operational costs associated with the provision of portable oxygen therapy, without compromising patient care and quality of life. POC oxygen users get unprecedented independence and are no longer limited to the capacity of the device, he says, and access to a power source means access to oxygen.
“For HMEs it is about economics, patient acceptance and marketability,” says Jacobson. “POCs can represent
27hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
the lowest cost model for providing portable oxygen while the technology can better satisfy patient requirements. Reliability and overall equipment costs are also driving factors. POCs provide HMEs with a marketing advantage over other portable equipment due to added patient benefi ts, including overnight travel,
Hoffman. “Technological advances cost money. As oxygen reimbursements decrease, providers are looking for the least costly means of providing the service. So if the cost of new technology exceeds reimbursement, there poten-tially could be some great innovations that could help patients better deal with
“POCs provide HMEs with a marketing advantage over other portable equipment due to added patient benefi ts, including overnight travel, air travel, and being able to stay out longer without the fear of running out of oxygen.”
—Robert Jacobson, CAIRE
air travel, and being able to stay out longer without the fear of running out of oxygen.”
Oxygen TomorrowPortable oxygen technology is ever-evolving and improving, with POCs at the heart of advancement. But even as demand for these devices grow, it seems advancement will come with a give and take.
“When you talk with patients and clinicians, they all want smaller, lighter, quieter devices with higher oxygen output and longer battery life,” says Lewarski. “Providers want all of that and demand more durability, reliability and of course, a lower cost. For the moment, many of these requested features are often confl icting; as you move in one direction it adversely impacts another feature. POCs offer a unique technological challenge; they live the brutal life of an oxygen cylinder, yet have the technological sophistication of more complex and expensive medical devices. I often refer to them as laptops that make oxygen.”
For patients, Umstead says that their desire for freedom will continue to guide the future of oxygen technology. He calls the independence that the POC affords the patient as the biggest benefi t — the freedom to fl y, drive, or boat without worrying about running out of oxygen. Freedom also comes from not waiting on deliveries from the oxygen supplier. He says all this gives patients the chance to feel normal again.
But inhibiting the growth that Umstead says most providers are expecting from portable oxygen tech-nology is a number of factors, including low reimburse-ment, competitive bidding, and audits. He says the good news is that POCs are here to stay and even though reimbursement is lower than before, people are buying them and every day there are more POCs in use. And this helps to drive the cost down to the provider, allowing more patients access to portable products.
“The competitive bid environment puts both the manufacturer and provider in a diffi cult position,” says
28 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
costly non-valued-added activities.The main driving force for patients is the weight of the portable oxygen
system, says Jacobson, and manufacturers are addressing this with lighter weight models. Lighter weight portables reduce the physiological burden for the patient and improve compliance.
“Either directly from the consumer or from the insurance provider, reim-bursement will play a huge role in what manufacturers will be working on,” says Umstead. “Just like DME depends on insurance, these manufacturers depend on DME companies for revenue. I believe the next step in driving oxygen technology will be patient-based maintenance. With reimbursement falling more and more, companies are offering fewer and fewer services to make up for the cuts.”
Also, Umstead cites patient accountability with regards to patients’ own healthcare and equipment as another driving force for technology. He points out that this is already happening with a POC that has quick change sieve beds, which patients can change instead of having to take it to a provider or sending it back to the manufacturer. “I believe we will see more reduction in repair time and cost with patient-based maintenance,” he says.
Future TreatmentThe global trends in chronic lung disease will continue to create demand for home oxygen therapy, says Lewarski.
“Early identifi cation and treatment of chronic lung and cardiopulmo-nary disease will reveal more patients with untreated hypoxemia,” he says. “Intervening and treating these patients earlier will help reduce morbidity, mortality and the overall costs associated with managing chronic disease.”
At the end of the day, the most important message is to ensure that the selected oxygen technology meets the patient’s clinical and lifestyle needs. Lewarski says that the signifi cant variability in device performance (maximum oxygen output, pulse-dose methodology, etc.), particularly among POCs and oxygen conserving devices means providers and clinicians need to use their knowledge and clinical expertise to ensure that patients receive a clinically appropriate and effi cacious device.
At some point we have to get Medicare on board to support a code for batteries,” says Baxter. “POC use is great but the batteries do not last the full fi ve years so you have to fi gure a replacement battery into your acquisition cost, which is unfortunate because Medicare allows for new batteries for power chairs and scooters annually.”
Umstead says he strongly believes that the future of oxygen includes a consolidation of manufacturers and suppliers all in an effort to reduce cost.
“Trends will depend on our ability as suppliers and manufacturers to juggle costs and benefi ts of new technology in an effort to reduce the overall cost of providing oxygen,” he says. “This is where I see POCs on the surface doing well because they can establish a static monthly cost to a patient. This is generally good; however, the problem that suppliers are facing with the POC model is that they are afraid to take the risk of a $250,000 investment of a non-delivery model with the ever-reduction in reimbursement and the audits that never seem to stop. So I believe the trends of many oxygen suppliers will be to remain doing business as usual until the storm runs out of rain and we can get back to patient-centered care and not cost reduction care. On the fl ip side of this, I see the trend of patients or family members just paying cash for healthcare. This is a trend we see with doctor concierges and we are seeing this more and more with oxygen users and people in need of medical equipment. This is a trend that I see growing big. Baby Boomers and others a like want the best and are willing to pay for it.” ■
their disease state, becoming inaccessible.”Baxter hopes to see the size of POCs continue to get smaller and battery life
longer. This is critical, he says, because in his opinion, the units on the market now that offer continuous fl ow are not as portable as they could be for end-stage COPD patients.
Hoffman agrees that POCs are still in their genesis but the ultimate goal is to have the ability for the POC also to be the primary oxygen concentrator for the majority of patients. However, he says, the word “portable” inherently makes this diffi cult due to the banging and dropping and other associated hazards when dealing with portable equipment.
“Making the POC bullet proof is a daunting task,” he says. “Providers have all dealt with equipment abuse when it comes to, for example, wheelchairs, but replacing an armrest or a bolt is much more manageable then sending a POC in for repair.”
In addition to incremental improvements in performance, Jacobson says that standards requiring the disclosure of oxygen delivery methodology will make it easier to compare devices for important characteristics, including triggering sensitivity and oxygen delivery time.
A Changing BusinessThe biggest drivers of the next steps in the evolution of oxygen technology and POCs are very much like many other technology companies.
“We are constantly looking to improve the performance, quality, clinical effi cacy and cost effectiveness of the devices we produce,” says Lewarski. “The changing global healthcare environment, the growing population of patients with COPD and other cardiopulmonary conditions, healthcare consumerism and the shifts to provide healthcare outside of the walls of the hospital are some of the key drivers.”
According to Lewarski, future oxygen technologies will continue to be focused on clinically sound therapy but may incorporate much more software and intelligence in the design. In a future clinical world of evidence-based care, compliance and outcomes, data will continue to gain importance. Concurrently, as providers face higher operational costs and lower payments, the technology will need to be more intelligent and continue to eliminate unnecessary and
Joseph Duffy is a freelance writer and marketing consultant, and a regular contributor to HME Business and Respiratory & Sleep Management. He can be reached via e-mail at [email protected] or [email protected].
“POCs offer a unique technological challenge; they live the brutal life of an oxygen cylinder, yet have the technological sophistication of more complex and expensive medical devices. I often refer to them as laptops that make oxygen.”
— Joe Lewarski, BS, RRT, FAARC, Invacare Corp.
“The competitive bid environment puts both the manufacturer and provider in a diffi cult position. … If the cost of new technology exceeds reimbursement, there potentially could be some great innovations that could help patients better deal with their disease state, becoming inaccessible.”
— Bob Hoffman, Nationwide Respiratory, VGM Group
Portable Oxygen: The Next Step
29hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
In 1998 Chad Williams bought a small vehicle lift company with two products--an Inside and an Outside Auto
Lift. Today, Harmar accessibility and mobility solutions number over 130 products plus related accessories.
In the process, Harmar developed a lengthy list of industry favorites. The fi rm introduced Hybrid Auto Lifts
and created a comprehensive line of Outside and Inside Lifts second-to-none. Its Pinnacle Stair Lift is still the
industry’s narrowest. And, they launched residential and commercial Vertical Platform Lifts and the Sierra
Residential Inclined Platform Lift to transport rider and mobility device up a level together.
In the last year alone, Harmar introduced its Everest line of residential elevators, the Helix Curved Stair Lift,
and its ADA-certifi ed Pool Lift series. Their auto lift line-up grew in both directions, from lighter weight Profi le
Auto Lifts designed to fi t today’s compact vehicles to additional Heavy Duty Auto Lifts with 400 lbs. capacity for
oversized scooters and power chairs.
Harmar is headquartered in Sarasota, Florida. Its products are sold through authorized dealers throughout the
U.S., Europe, the United Kingdom, Australia, New Zealand, Mexico, the Caribbean, South America, and Asia.
When Chad Williams founded Harmar, his goal was “to be the dealers’ #1 choice for vehicle lifts.” To achieve his
goal, Harmar emphasized innovative design in a comprehensive range of both accessibility and mobility prod-
ucts. Their simplicity, functionality, and value met a growing need and phenomenal growth followed. Harmar
became one of INC Magazine’s “America’s Fastest Growing 500 Private Companies” multiple times. The growth
continues as Harmar meets new needs and expands its products, services, and network of professional dealers
that now stretches around the world.
Company Profi le
Harmarwww.harmar.com
2075 47th StreetSarasota, FL 34234
Phone: (800) 833-0478
Contact Information
Key Personnel
Chad WilliamsFounder, President & CEO
Paul JohnsonVP Sales, Marketing & Service
Todd WaltersCFO
Mark WelcerCOO
Other Information
Harmar is the leading manufacturer of top quality accessibility and mobility products
for home and commercial use with over 3000 dealers in the U.S. and worldwide. Headquarters are in Sarasota, FL with European offi ces in the Netherlands.
Growing Access & Mobility in U.S. and Beyond
30 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
When it comes to audits, solid documentation is a provider’s only defense. The HME industry continues to work in order to convince CMS to reign in its out of control audits, while
providers continue to put into place documentation processes that make sure their claims are rock-solid.
“If they [providers] don’t have strong documentation, then they have no defense,” says Wayne van Halem, CFE, AHFI, president of The van
Halem Group LLC, a fi rm that helps providers respond to and appeal audits. “With the very strict adherence to the policies, it’s not enough just to have documentation. It’s got to be documentation that shows that the criteria for coverage from the LCD have been met or else it will result in a claim denial, and the more denials you get the more scrutiny you’re under.”
So while the HME industry continues to convince CMS that it must reign in its out of control audits, providers must continue to put into place documentation processes and procedures that will ensure they have clean claims from the get-go.
“You almost have to put yourself in their shoes. It’s not that we always agree with what the LCD says, the hoops that you have to go through,” says Georgie Blackburn, vice president of government relations & legislative affairs for Blackburn’s Pharmacy. “The bottom line is we’re contracted to provide under their guidelines, and until the guidelines change, and that’s my job now trying to impact healthcare policy, but until we can get guidelines changed then we have to certainly abide by them if we want to keep the money that we earn.”
By Cindy Horbrook
As providers are beset by a fl ood of audits, they must ensure clean claims documentation. Here are some key considerations.
A look back, and a look ahead for HME.Documentation has been a work in progress for the HME indus-
try. Obviously, good documentation is a must for ensuring claims
are funded, but as CMS ramped up its pre- and post-payment audits through the
RAC, CERT and ZPIC, documentation has become absolutely critical. No providers
are having to completely overhaul their processes and procedures; workfl ows; and
referral relationships to ensure their claims are properly documented.
31hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
CMS’s Audit SurgeVan Halem cites the implementation of the Affordable Care Act as a key reason for the increased CMS audits.
“We saw the budgets for program integrity activities increased just prior to that, and part of it is that the administration wants the legislation to be budget neutral, so the way to do that is to increase the number of audits that are recouping on claims that they determine to be paid incorrectly,” he explains.
Another issue is the signifi cant error rates in the audits, as much as 70 to 95 percent in some instances.
“The way in which they’re doing these reviews with very strict adher-ence to policies and no clinical judgment being used, it’s causing these high error rates and when they see high error rates then clearly we have to audit more to try to improve that because it’s a refl ection of them too,” van Halem adds.
And there is the issue of how the audit contractors are compensated by CMS.
“Obviously there’s an incentive for them to do audits, but then the ZPICs have been awarded contracts, in some cases, in excess of $100 million and they have to show CMS a return on that investment in order to keep that contract,” van Halem says.
As a result, many providers have gone into a combination preventa-tive-defensive mode when it comes to documentation. Blackburn’s is one of them
“We do as much as we can upfront to make sure it is absolutely accu-rate,” she says. “If we were signing the check on behalf of Medicare, we think this is a clean claim.”
Education Is EssentialTo ensure those clean claims, providers are taking a variety of steps to ensure they have the right documentation processes and procedures in place. At the foundation of those processes and procedures lies a solid foundation in education.
“Education, every day,” stresses Peggy Walker, RN, billing/reimburse-ment adviser for U.S. Rehab/VGM.
“You must know the Medicare policies,” adds Blackburn. “You must know the local coverage determination policies inside and outside and that refl ects your training.”
“I’m hopeful that at least some reasonableness will enter the process. As of right now, there isn’t any.”
—Wayne van Halem, CFE, AHFI, The van Halem Group LLC
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32 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
Steps to Rock-Solid Documentation“They need to be a part of their state association because Medicare
is not all,” explains Walker. “Their state association keeps them up on Medicaid and other insurances as well.”
Recognizing the Signs of Fraud and AbuseCummins also stresses the importance of knowing about fraud and abuse, to alleviate potential red fl ags in documentation.
“Know that if you’re writing off patients’ balances and you’re not documenting that it’s a hardship and you have some criteria in your practice of what a hardship is and you have a hardship letter in place—that becomes abuse, so make sure you know what is fraud and abuse so you’re not accidentally caught up into doing it because you think you’re doing the right thing when it actually really isn’t,” Cummins says.
Getting it Right from the Referral SourcesFrom illegible documentation to missing signatures, sometimes it’s the physicians and other referral sources that can make getting the right documentation a challenge.
And since many denials are due to administrative errors, providers should know what type of signatures are needed, what forms need to be date stamped and which items need a written order prior to dispensing so they can make sure they get it right the fi rst time.
“If the documentation is illegible, that’s a key piece because if you can’t read it, the auditor can’t read it,” Cummins says.
The experts agree that getting the referral sources on board with making sure documentation is correct goes back to training and educa-tion. That means educating the doctors before the information is needed and keeping an open line of communication with the physician’s offi ce to be able to retrieve information when necessary.
“We have a program development manager that works with all the different managers that sets up wound care seminars, rehab seminars, that type of thing, where we’re educating and facilitating understanding, trying to answer questions,” Blackburn says. “And those questions we don’t have the answers for we try to get it from the right sources, but we defi nitely want to be the conduit to information for our referral sources and that has helped us to protect our documentation process.”
Walker recommends making sure that the referral sources are aware of the CMS check off sheet.
“This is one page check off sheet that they can hand to the physi-cians and it’s actually in the LCD policy,” she says. “Take those into your training courses when you’re working with referral sources. It’s an educa-tion issue all the way around.”
Leveraging TechnologyUtilizing the data generated by their software and technology systems can help providers identify anomalies is extremely important, such as the same provider all of the time, the same referral sources all the time, a big spike in claims submitted or a big spike in denials processed.
“If there is an anomaly in your business, you’re able to identify that anomaly quickly and remedy it within your own operation so that it doesn’t happen again,” says Steve Andrews, general manager of customer services at Brightree LLC, an HME software company. “Or just be on notice that ‘this is a real something that happened, and I should know that I’m probably on an audit radar at this point in time.’ Just be prepared for it and have all your documents and processes tight so that when you do get audited, you’re able to respond quickly and
Training is important to every single person in an organization—from the person who answers the phone in the back offi ce to the employee who sees a customer at the counter. “If that employee doesn’t know the policy, then they may give a wrong answer and that starts the process,” Blackburn explains.
One aspect of Blackburn’s training is emphasizing to staff to read what they receive.
“It’s not a matter of ‘Gee whiz, the doctor wrote a lot of stuff, so we’ve got a great medical record here. It’s three pages long.’ It’s what the content is,” she explains. “The training goes in to absolutely learning how to interpret as though you are a COTA (certifi ed occupational thera-pist assistant) or you are an RN. You have to learn medical terminology. You have to understand the etiology of the disease process. It’s a puzzle and you have to make sure all the pieces add up before you dismiss a piece of equipment.”
Blackburn says staff should understand the policies from any payor source, but especially Medicare because providers are so prone to get audited by Medicare.
“It’s absolutely necessary for every fi rm that wants to bill to Medicare to ensure that they do the optimal amount of training. Otherwise their dollars are not protected,” she says.
Every provider should also have a supplier manual from their jurisdic-tion and encourage staff to reference it frequently, according to Nancie Cummins, RMC, CMCO, CMC, accreditation advisor for The Compliance Team Inc.
“When I go into an offi ce or a DME company, I want to make sure they have a supplier manual there, whether they access it online or they have it printed out because that’s a valuable tool,” she says. “If we’re talking about documentation in a written order, you can go to the supplier manual and it’s going to tell you what the seven elements are.”
In addition, Walker and Cummins both recommend taking advantage of the many online resources such as listservs for every jurisdiction, webinars, Web-based training and podcasts. Attending events such as Medtrade or VGM’s Heartland Conference can provide a wealth of information.
“There are a lot of things we can do to prevent denials on the second time around if we pay attention to what we’re doing.”
—Peggy Walker, RN, U.S. Rehab/VGM
“There is a correlation between the speed at which you respond to audits and the success or failure you have in being targeted for another one.”
— Steve Andrews, Brightree LLC
33hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
For more than four decades, Mediware has been recognized as a leader in specialized healthcare solutions. We’ve
been applying our rich health IT heritage to home care since 2008. Recognizing the need for more advanced
management capabilities in this rapidly growing market, we strategically expanded in ways that brought the
home care industry’s best products and brightest people to our company.
Today, Mediware automates administrative, clinical and fi nancial processes for home care companies of
all types and sizes, including full-service, multi-site providers. Built from the latest technology, our software
delivers scalability, fl exibility and the most advanced billing and operations management capabilities avail-
able. With Mediware, home care providers get a comprehensive solution, including our best-in-class customer
support, that will last for many years to come. To learn more, visit us at www.mediware.com or call (888)
633-4927.
Demand is rising for home medical equipment, but growing your business gets more challenging every
day. Mediware understands the complex issues you face, and we offer solutions to fully support your HME
operations.
Increased referrals, customer retention, full mobility capabilities, preparing and submitting competitive bids,
tracking new business and our unrivaled support from industry experts are just a few of the benefi ts our solution
offers. Plus, full functionality across other home care business lines, including home infusion therapy and home
health, means you can expand with ease.
Company Profi le
Mediware Information Systems, Inc.
www.mediware.com
11711 W. 79th St.Lenexa, KS 66214
Phone: (913) 307-1000Fax: (913) 307-1111
Contact Information
(888) [email protected]
Key Personnel
Kelly Mann, President & CEO
Steve Sedlock, Vice President, Sales & Business Development
Jonathan Seiter, Vice President, Marketing & Communications
Jennifer Keiser, General Manager, Home Care Solutions
Comprehensive HME Software Designed to Move Your Business Forward
34 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
stance, to be in existence, and if that certain circumstance is not in exis-tence, then put a fl ag out to me so I don’t let a claim go out the door,” he explains.
Many software programs provide electronic document storage, which gives providers the ability to quickly and easily access documentation
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“It’s absolutely necessary for every fi rm that wants to bill to Medicare to ensure that they do the optimal amount of training. Otherwise their dollars are not protected.”
—Georgie Blackburn, Blackburn’s Pharmacy
Steps to Rock-Solid Documentationeffi ciently.”
Another way that technology can help with the audit process is by installing what Andrews calls “payor product rules” for specifi c payors.
“This example would be obviously Medicare, whereby you’re able to say for this particular product I need for something, a certain circum-
needed in the event of an audit.“You’re not scrounging through a bunch of
boxes of paper or trying to go after things that are not current, that you don’t currently have in your facility,” says Andrews.
Having electronic data storage also allows providers to correspond quickly with Medicare through their esMD (Electronic Submission of Medical Documentation) system.
“There is a correlation between the speed at which you respond to audits and the success or failure you have in being targeted for another one, so being on top of that is extremely important,” says Andrews.
No End in SightWith no indication of audits coming to an end or even slowing down, it’s more important than ever for providers to have all their ducks in a row before an audit letter darkens their doorstep.
“I’m hopeful that at least some reasonableness will enter the process. As of right now, there isn’t any in the pro cess,” says van Halem. “The claims get audited. They have to go to appeals and because of the volume of audits that are being conducted, the appeals workload has signifi cantly increased, so it takes about a year or more to get to an ALJ (administrative law judge), and ALJs are still overturning a signifi cant amount of claims because they can tell that it’s reasonable that these patients need the equipment.”
If an Audit Letter ArrivesThere are simple steps and tasks that providers
35hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
“When I go into an offi ce or a DME company, I want to make sure they have a supplier manual there … that’s a valuable tool.”
— Nancie Cummins, RMC, CMCO, CMC, The Compliance Team Inc.
can take to make sure their documentation is clean, organized and easy to understand should an audit letter come their way. One of the fi rst things to do is read the letter and understand exactly what the auditor is asking for.
“They want to make sure that they organize their paperwork, make sure their paperwork is very concise very detailed, very in order,” says Walker. “I always suggest number one they want use a cover letter explaining everything that they’re sending and put it in the order of the request from the reviewer.”
Providers should also make sure the pertinent parts of the medical documentation are clear and easy to identify.
“One of the things I see a lot of is the documentation wasn’t there, but then you look at it, it’s there, it’s just that maybe it’s on the third page of the physician’s progress notes rather than the fi rst page,” she says.
For example, with a power chair claim Medicare may be looking for manual muscle testing.
“They need to underline where the manual muscle testing is, asterisk it and say on page three of the PT notes is manual muscle testing,” she adds.
In addition, providers should number all the pages, page 1 of 30, page 2 of 30, etc… and put the patient’s name, Medicare number and date of service on the top of every page in bold letters. Then be sure attach the audit letter back with the response.
“Denial rates are ridiculous, and these denial rates, some of them are
even going up in some of the jurisdictions, so you’re looking at these denials and there’s something going on, so what can I do as a supplier to decrease my denials, what do I have complete control of?” says Walker.
Providers have control tasks such as the home environmental evalua-tion, organizing the paperwork and date stamping the paperwork when received.
“So these are the things I can do--making sure the signatures are legible, if they’re not, get an attestation statement before you send the paperwork in,” she says. “There are a lot of things we can do to prevent denials on the second time around if we pay attention to what we’re doing,” she says. ■
In 1989, Noble House created Noble*Direct software,
with two goals in mind- to design a software with
functional, operational and analytical capabilities,
as well as to become known as the best, top notch
technical support team in the industry. Noble House
has achieved both!
Noble*Direct is a fully functional billing and claims
management Windows software. Our software helps
DME/HME companies manage their business by
providing detailed reports for performance analysis and
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Company Profi le
Noble House, The Comprehensive Remedy
www.NobleDirect.com
828 S.E. 8th. AvenueDeerfi eld Beach, Florida 33441
Phone: (800) 749-6700 (954) 418-0828
Fax: (954) 418-9631
Contact Information
DME/HME Electronic Claims & Billing Windows Software
36 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
By Cindy Horbrook
HME providers looking to drive increased retail revenue often fi nd a gem in compression products, because while they are generally
not covered by Medicare, there are many patients that need them. Compression products cover a large patient population and don’t require a steep learning curve, making them among the easier retail items for providers to sell.
Doctors use compression to treat various conditions, including foot swelling, mild edema, varicose veins, thrombosis, varicosities of varying severities, and circulation problems from diabetes. Geriatric patients, those with diabetes,
lymphedema and post-surgery patients often depend on compression therapy. Providers need to have a basic understanding of how graduated compres-
sion works and how to recommend various types of hosiery to customers. Compression garments, such as socks, stockings and wraps, deliver support and increased circulation to affected limbs and other areas of the body. Compression is graded in millimeters of mercury and can range from 15-50 mmHg; the higher the compression, the tighter the garment. Here are some offerings avail-able on the market. ■
CompressionProduct Solutions
Economical Compressionassure by medi• Consists of high-quality compression
stockings designed to meet the needs of today’s insurance driven reimbursement system, and/or the needs of patients seeking a lower-cost alternative for treating their venous health.
• Features two lengths, a softer feel, improved durability and a larger foot area.
• Available in two colors: beige & black; fi ve styles: calf, extra-wide calf, thigh w/silicone topband, panty and maternity panty; two leg lengths: standard and petite; and three compression classes: 15-20, 20-30 and 30-40 mmHg.
medi (800) 633-6334www.mediusa.com
Stays in PlaceCotton Series • The closed toe calf product is available
with a grip-top in two color options, black and crispa for men and women.
• For patients with edema (swelling) around the knee area, the new grip-top feature can ensure that the Cotton Series socks stay in place all day.
• Constructed with 25 percent Supima Cotton for all-day comfort, breathability and durability. The product is suitable for those with sensitive skin and allergies, as only cotton touches the skin.
SIGVARIS(800) 322-7744www.sigvarisusa.com
Fits Feet CorrectlyDynamic Cotton Sock for Men• Designed to fi t men’s feet correctly with a
bigger foot portion, this new compression sock provides relief during activity and non-activity.
• Features cotton lining that is breathable and comfortable against the skin.
• Available in several styles for casual or dress attire, including an opaque knit with a special ribbed design, plus a choice of colors, including black, navy, khaki and brown. Compression options include 15-20, 20-30 and 30-40.
Juzo USA(800) 222-4999www.juzousa.com
Cools and ComfortsCoolVent• The ready we ar Juzo Expert compression
glove features a new CoolVent option that is designed with new technology that allows it to breathe, cooling hands as it comforts and manages swelling.
• Allows patients to go on with their daily routines — without being held back.
• Suitable for exercising, gardening, cleaning, winter gloves, warm climates and hot fl ashes.
Juzo USA(800) 222-4999www.juzousa.com
Aid helps patients put on, take off compression garmentsThe Doff & Donner • Device, designed to increase patient
compliance, aids users in putting on and removing compression socks, stockings and arm-sleeves.
• The device can don a garment over any size or shape of leg, as well as over wet, slippery with lotion, or bandaged legs with no struggle.
• The device also uses the same conveying action to safely doff the garments from the leg.
Doff N´ Donner(866) 936-6637www.doffanddonner.com
Compression with an eye toward designer fashion Class 1 Medical Support Stocking• Created to provide designer styling while
still being an FDA-registered Class 1 Medical Support Stocking.
• Compression levels available range from 15-20 mmHg (mild support) to 20-30 mmHg (moderate support) and many in between.
• Available styles include: knee high (calf high), thigh high, pantyhose and leggings.
RejuvaHealth(877) 773-5882www.rejuvahealth.com
37hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
Nonin Medical is proud of its longstanding partnerships with World Family Doctors (WONCA), the National Heart, Lung, and Blood Institute, and the International Primary Care Respiratory Group (IPCRG) for physicians and patient education programming. In addition, Nonin supports such initiatives as the Global Initiative for Chronic Obstructive Lung Disease (GOLD) and the International COPD Coalition (ICC). During the past two and a half decades, Nonin has sold more than 1.2 million oximeters to discerning healthcare professionals, patients and home respiratory monitoring equipment providers like you. Learn more about pulse oximetry performance differences, and download your free DME Pulse Oxim-etry Report at nonin.com/homecare today.
Nonin Medical invented fi ngertip pulse oximetry and is a U.S. medical monitoring company with global distribution. Nonin offers one of the most complete lines of noninvasive medical monitoring solutions available for homecare respiratory monitor-ing, including: Fingertip, handheld, tabletop and wrist-worn pulse oximeters that are American made, environmentally safe and free of
hazardous materials like lead, latex and BPA and DEHP chemicalsComfortable, reliable, latex-free sensors in reusable and disposable varieties for neonates to adultsCapnography systems that deliver consistent, accurate readingsClinically proven accuracy in the most challenging patients and conditions
Company Profi le
Nonin Medical Inc.nonin.com/homecare
13700 1st Avenue NorthPlymouth, MN 55441-5443
Phone: (800) 356-8874 (763) 553-9968
Fax: (763) 553-7807
Contact Information
Key Personnel
Bill Wood, Key Accounts ManagerNonin Medical, Inc.
Other Information
See the Nonin Performance Difference
38 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
HME InventoryCompiled by Cindy Horbrook
New interface automates electronic record transfer between Authentidate and Fastrack systemsAuthentidate Holding Corp., a provider of secure, Web-based software applications and tele-health systems and services for healthcare organizations, and Fastrack Healthcare Systems have entered into an agreement to provide ongoing develop-ment updates and support for an interface between Authentidate’s Inscrybe Referral and Order Management solution and the Fastrack Enterprise System. The interface automates electronic record transfer between the two systems and has already been successfully implemented at some client locations. Together, these two complimentary solutions form an electronic practice manage-ment solution with enhanced workfl ow capabilities for online referral and order management. Fastrack Healthcare Systems Inc.(800) 520-2325www.onlyfastrack.com
Lightweight mounting system affi xes switches, devices to wheelchairsAbleNet’s Hover mounting system is made from ultra-light and super-strong carbon fi ber. At 1.1 lbs., the system weighs 60 percent less than the company’s Friction Knob or Lever Universal Mounting Systems and 50 percent less than the Latitude Arm Mount. Users can select from a variety of options to mount a switch, iDevice or just about anything else that is compatible with an AbleNet mounting plate. Three separate locking joints allow for fl exible use and easy set up.AbleNet Inc.800-322-0956www.ablenetinc.com
Enhanced pediatric wheelchair offers improved seating and support
Convaid’s enhanced EZ Rider pediatric wheelchair combines improved seating, support and cushioning with durability and aesthetic fl air. New foot-operated wheel locks are designed to provide safer locking and unlocking. The chair’s optional One Piece Adjustable Stroller Handle lets parents or caregivers adjust the
angle and height of the handle for easier and more comfortable pushing. The chair’s back height has been changed to more accurately refl ect
the anatomical dimensions of users.Convaid Inc.
(888) 266-8243www.convaid.com
Low bed position helps eliminate injury fearsBig Boyz Industries’ fully-electric Low Bed 800 (Model: LB3848) offers multiple positions and convertible bed decks for easy transfers through doorways. The low position helps eliminate the fear of injury while being free of restraints. The bed features a weight capacity of 1,000 lbs. with no need to subtract accessories to acquire the bed’s true working capacity.Big Boyz Industries Inc. (877) 574-3233www.bariatricbeds.com
Wheelchair folds fl at for convenient, compact storage and transportCarex Health Brands’ Classic Wheelchair is designed to provide safe and comfortable transporta-tion with no assembly required. The wheel-chair features a large 20-inch seating area, fold-down back with storage pouch and adjustable swing away footrests. The wheelchair’s desk-height arms allow users to conveniently pull up to a table without disruption. Users can easily remove the arms for side transfer, and the entire wheel-chair folds fl at for conve-nient, compact storage and transport.Carex Health Brands(800) 526-8051www.carex.com
Redesigned lifts feature reduced ramp angleBruno Independent Living Aids’ redesigned Out-Sider lifts (formerly known as the Meridian) are now lighter, stronger, smoother, more adjustable and easier to use. The platforms feature an increased width of 28-and-a-half inches. Models include the ASL-250A (with Hold-Tite Foot for scooters), the ASL-250HTP (with Hold-Tite Arm for power chairs) and the Model ASL-250B (with three retractable/self-tensioning belts for either scooters or power-chairs). All units feature a reduced ramp angle for a smoother, more gradual drive on/off.Bruno Independent Living Aids(262) 567-4990www.bruno.com
39hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
HME Inventory
Height-adjustable walker features oversized 6-inch wheelsCarex Health Brands’ Two Wheeled Walker with Seat and Backrest is designed to help those who need assistance with walking maintain a more active and inde-pendent lifestyle. The height-adjustable walker features oversized 6-inch wheels and auto glide rear tips that double as an easy-to-use brake wh en pressed down for added safety. Its 10.36-lb. frame can support up to 300 lbs. and can be quickly folded by lifting up on the seat for compact storage and transport.Carex Health Brands(800) 526-8051www.carex.com
Cushion designed for individuals with mild skin protection needsThe Simplicity GP cushion from Quantum Rehab’s Synergy Cushions and Backs provides comfort and support. The cushion is designed for indi-viduals who have mild skin protection needs. It provides lateral support for users in need of mild positioning and reduces moisture build-up. Features include a deep contoured, molded foam base; coccyx and sacral relief; and a two-way water-resistant cover.Quantum Rehab(866) 800-2002www.quantumrehab.com
System tests patients for sleep apnea at homeThe SleepView Monitor Home Sleep Testing System, manufactured and trademarked by Cleveland Medical Devices Inc. and exclusively distributed by Roscoe Medical, enables patients to be tested for sleep apnea in the comfort of their own bed and the convenience of their own home for a more natural sleep rather than in an overnight lab setting. Its cloud-based data management solution combined with nationwide scoring and interpretation services provide a home sleep testing solution directly to referring physician practices and sleep labs.Roscoe Medical(800) 376-7263www.roscoemedical.com
Tank TotesTM
Three
Sizes
For More Information Or To Place Your Order
Call 1-800-659-9110
Tank Tote Features(1) Improves delivery times to patients.(2) Eliminates the missing cylinder problem with a
convenient cylinder management system.(3) Provides a convenient low budget storage
container to the patient as a value added service.(4) Stores flat and ships flat.(5) Available for M-6, C, D, and E size cylinders.(6) Meets Compressed Gas Association
guidlines for cylinder storage.
AUDITSARE OURBUSINESS
The real audit experts at The van Halem Group can help:
Call today for references or a free consultation.
Proven Experience. Sound Counsel.
www.vanHalemGroup.com [email protected]
(404) 343-1815
esMD solution enables clients to respond electronically to requests
Licensed and accredited auditors and clinicians from Medicare
Collaborative relationship with Medicare contractors
Our efforts have saved clients millions of dollars
40 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
ADVERTISER INDEX
COMPANY NAME PAGE
ACHC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Blue Chip Medical Products Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3Brightree . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Brightree Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19CAIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5CAIRE Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21CPR+ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2CPR+ Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Dr. Comfort . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Family Pharmacy, Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Fastrack . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9Harmar Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29HQAA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .12HQAA Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Inova Labs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .11Invacare . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7Juzo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Medi USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .13Mediware Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Mountain Aire Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Noble House Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Nonin Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Philips Respironics Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43The Compliance Team . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10The Compliance Team Company Profi le . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23The van Halem Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
Advertiser Index
Contact the Editor:David Kopf(949) [email protected]
HME Business welcomes comments and suggestions from readers. For editorial archives and subscription information, including how qualifi ed HME professionals can sign up for HME Business, visit us online: www.hme-business.com
Group PublisherKaren Cavallo(760) 610-0800 [email protected](866) 779-9095 Fax
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Sales AssistantLynda Brown (972) 687-6710 [email protected]
DIRECTOR/DMEGrowing, fast-paced, family-owned company in SW MO seeks DME Dir. 10+ yrs. experience in DME plus strong track record of mgmt. jobs
reflecting sound leadership skills. Possess understanding of all aspects of DME
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re: Medicare/Medicaid. Include Salary History.
APPLY TO: DME SEARCH
HR DIRECTOR4101 N. STATE HWY NN
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EDITORIAL INDEX
PRODUCT SOLUTIONS
COMPANY NAME PAGE
SIGVARIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Juzo USA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Doff N´ Donner . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36RejuvaHealth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36medi . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
HME INVENTORY
COMPANY NAME PAGE
AbleNet Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Big Boyz Industries Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Bruno Independent Living Aids . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Carex Health Brands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38, 39Convaid Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Fastrack Healthcare Systems Inc. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Quantum Rehab . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Roscoe Medical . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
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It’s safe to say that while Round One of CMS’s national competitive bidding represented a storm that
providers in the affected bidding areas are still trying to weather, Round Two providers are bracing themselves for an Old Testament-style flood.
While the impact of Round One seemed huge, the impact of Round Two will be felt industry-wide. Round Two affects an additional 91 metro-politan statistical areas, pushing the total number to 100, while covering the same nine product categories as before. This makes NCB an ines-capable fact of life, and the bidding window opens this month. How are providers preparing for it? How can they bid wisely? What can HMEs learn from mistakes made in Round One? What do the do if they don’t win a bid?
Moreover, regardless of how they deal with Round Two, providers must still fight to stop the flawed program and save their industry. That fight hasn’t been easy. Despite the indus-try’s best efforts to repeal the program, Round Two of competitive is rolling forward like some kind of ill-conceived bureaucratic juggernaut. Faced with a cost-conscious Congress, the industry has changed tack to seek a replace-ment of the program with the Market Pricing Proposal. What are providers doing to ensure NCB gets swapped out for the MPP?
Round Two Reality Check . . . . . . . Page 16
The Industry Braces Itself for CMS’s Round Two Flood
February 2012Volume 19, Number 2
hme-business.com
What’s Inside:
News, Trends & Analysis . . . . . . . . . . 8
Software and CMS Audits . . . . . . . . 22
Provider Strategy: Home Access . . . 13
Clinician Talk: LTOT Options . . . . . . 14
Product Solutions: Beds . . . . . . . . . . 29
Observation Deck: Sales Planning . . . . 34
BONUS MAGAZINE INSIDE!
42 HMEBusiness | April 2013 | hme-business.com Management Solutions | Technology | Products
Medicare released the Round Two payment rates in late January, which were shockingly low and a direct result of the Centers for Medicare and Medicaid Services (CMS) ignoring recommendations
from over 200 economists and auction experts, serious concerns from provid-ers and consumers, and even a bipartisan mandate from Congress to fi x the program prior to implementation.
While CMS is continuing to move forward with the ten-fold expansion of their fl awed Competitive Bidding program, many in Congress recognize that while payment changes within the DME fee schedule are needed in certain areas, a 45 percent average reduction for home medical equipment (HME) will result in thousands of jobs lost and seriously compromise benefi ciary access to the care they need.
At the time of writing this article, industry stakeholders were continuing to meet with our champions and the key committees in the House and Senate to discuss the best pathway toward advancement of an alternative prior to implementation. A few state and national organizations have held lobby days on Capitol Hill and meetings back in the legislators’ states/districts, which are extremely important in order to compel legislators to act in a timely manner.
While a signifi cant amount of support exists for the industry’s Market Pricing Program (MPP) alternative, which was designed to address the fundamental fl aws of Medicare’s bidding program, challenges do subsist with regard to its CBO score and budget neutrality. That said, options exist to stop the program as long as the House and Senate committees are compelled to act prior to implementation and replace it with a workable alternative. So what does the industry need to do to see an alternative advanced prior to July 1 implementation?
That’s simple: Harness the passion and serious concerns with the program and take it to Capitol Hill to share with senators and representatives. Specifi cs need to be provided, such as how the program structure is fl awed and incen-tivizes low ball bids, how the Medicare payment methodology used to deter-mine the single payment amounts takes the median of the median which is no refl ection of a market based price, and what types of companies were awarded and accepted contracts simply in order to try and sell the contracts.
Here are a few of the key talking points highlighting the problems with the Medicare bidding program to help guide your communications with legislators:
Non-binding bids• Any contract winner can refuse to sign a contract.• Bids from those offered contracts but rejected are still included in the
payment calculations.• This process encourages DME providers to “game” the bidding system to try
and win a “lottery ticket” to sell, rather than provide a market based price.
Manipulated median used to determine payment rates• CMS manipulates the median by assigning a capacity (quantity to be
provided) to each bidder.
• CMS further manipulates the establishment of the single payment amounts by taking the median of the median in their payment methodology, which is no refl ection of market based prices.
• This makes the program an arbitrary pricing process instead of a trans-parent auction.
No transparency• CMS continues to deny industry and even congressional requests for specifi c
information pertaining to the factors used not only for Round Two, but even for the Round 1 rebid, which has been in place for over two years. This begs the question, why all the secrecy if Medicare has nothing to hide?
Detailed examples, talking points, and other resources are available by contacting the American Association for Homecare (www.aahomecare.org). The tools are updated regularly and used weekly in meetings with legislators, which seem to be strengthening our case for some kind of congressional action prior to July 1.
Constant EffortIt is important to keep in mind that contacting your legislators once will not be
enough. Persistence and ongoing dialogue with your legislators between now
and when Congress takes action to stop the program will be necessary. Build-
ing in an hour a week for follow up with your legislator’s offi ces via phone or
email is a good place to start. It is also good to engage the district offi ce and
request to be added to the mailing list for upcoming local events where the leg-
islator will be present in order to continue to share the impact of the Medicare
bidding program on your business.Do not forget to personalize your message and talk about the area(s) you
serve and the impact of Round Two on your business, your employees, and the benefi ciaries you serve. In addition, highlight the fact that MPP was developed by experts in the fi eld of government auctions, addresses the critical fl aws of competitive bidding, and sets fair, sustainable market prices.
While it is good to know the clear pathway toward victory on this, many times when dealing with Congress and the administration, the road is not clear. That said, if we as an industry stay focused and continue to raise real concerns and questions with regard to the program and the impact it will have on jobs and benefi ciary access to care, we can and will replace it with an
alternative prior to implementation. ■
Harnessing the Industry’s PassionCMS has released the Round Two payment rates. What is needed to advance an alternative?
Seth Johnson
Observation Deck
Seth Johnson is the vice president of government affairs for Pride Mobility Products Corp.. He is a board member of the National Coalition for Assistive and Rehab Technology (NCART), a former chairman of the AAHomecare Complex Rehab and Mobility Council (CRMC), and is active within several state associations and various other industry stakeholder organizations and coalitions. Seth can be reached at 800-800-8586, and by visiting www.pridemobility.com.
43hme-business.com | April 2013 | HMEBusinessManagement Solutions | Technology | Products
Caregivers worldwide count on Philips Respironics for an unsurpassed level of service and support. In fact, the
company has become known for it. Working as an ally throughout the entire care cycle– from awareness and
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while providing the long-term benefi ts of fi xed pressure. Complementing the portfolio of products are programs
and business resources including the Fit for Life program that offers resupply services with the purchase of a
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are just a few of the ways Philips Respironics is working toward solutions that address evolving business chal-
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For more than three decades, Philips Respironics has been a leading global provider of innovative solutions for
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Company Profi le
Philips Respironicswww.philips.com/Respironics
1010 Murry Ridge LaneMurrysville, PA 15668
Phone: (800) 345-6443(724) 387-4000
Fax: (724) 387-5012
Contact Information
Allies in Better Sleep and Breathing
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