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Headline News
Check on Elderly in Heat Wave, Authorities Advise
ATLANTA--HomeCare's hometown really was Hotlanta last week, with temperatures topping 100 degrees and a heat index of 110 for four days running. The city opened up more than 30 "cooling centers" for seniors and others without access to air conditioning.

As the nation sizzled under an extended heat wave through much of the week, with highs in the 90s from the East Coast to the western Plains, authorities urged the elderly to stay in air-conditioned buildings and take it easy.

"People don't realize it but heat is generally the number-one killer" among weather-related causes, National Weather Service meteorologist Ben Miller told the Associated Press. "We've gone all year without a serious heat wave so we want people to be aware of what to do to keep themselves safe."

Health experts caution that the elderly, young children and those who are sick or overweight are more likely to become victims of extreme heat, but note that spending at least two hours a day in air conditioning can cut down significantly on the number of heat-related illnesses.

According to the National Disaster Education Coalition, people living in urban areas may be at greater risk from an extended heat wave than people living in rural regions. Respiratory problems can worsen "when stagnant atmospheric conditions trap pollutants in urban areas, thus adding unhealthy air to excessively hot temperatures."

The NDEC also advised checking on those who spend much of their time alone, pointing out that a majority of deaths during the 1995 Midwest heat wave were persons who were alone.

For a list of precautions to take during a heat wave from the American Red Cross, click here.

CMS Delays NPI Registry until September
BALTIMORE--CMS announced last week that it will delay dissemination of data from the National Plan and Provider Enumeration System until Sept. 4.

In May, CMS had said its registry of National Provider Identifier numbers would be available June 28, then delayed its release until August, explaining that would give providers time to analyze their information for the new Internet database and to make any updates or changes. (See HomeCare Monday, July 2.)

The agency said it has once again pushed back release of the registry so providers "can view their FOIA-disclosable NPPES data and make any edits they feel are necessary prior to our initial disclosure of the data." To be available in a real-time, query-only database and a downloadable file, the NPI registry will include data from providers that are disclosable under the Freedom of Information Act.

Providers must submit their edits no later than Monday, Aug. 20, so that any problems with the edits can be resolved, the agency said.

The registry will become operational on Sept. 4, and the downloadable file will be ready approximately one week later, according to the announcement.

Each month thereafter, CMS will provide a full replacement file that reflects updates and changes to the NPPES records. Providing a replacement file instead of monthly updates will eliminate problems users might have in trying to link updates to records included in the initial file, the agency said.

Some of the key data elements that are FOIA-disclosable are:

• NPI
• Entity Type Code (1-Individual or 2-Organization)
• Replacement NPI
• Provider Name (First Name, Middle Name, Last Name, Prefix, Suffix, Credential(s), OR the Legal Business Name for Organizations)
• Provider Other Name (First Name, Middle Name, Last Name, OR 'Doing Business As' Name, Former Legal Business Name, Other Name for Organizations)
• Provider Business Mailing Address (First line address, Second line address, City, State, Postal Code, and Country Code if outside U.S., Telephone Number, Fax Number)
• Provider Business Location Address (First line address, Second line address, City, State, Postal Code, and Country Code if outside U.S., Telephone Number, Fax Number)
• Healthcare Provider Taxonomy Code(s)
• Other Provider Identifier(s)
• Other Provider Identifier Type Code
• Provider Enumeration Date
• Last Update Date
• NPI Deactivation Reason Code
• NPI Deactivation Date
• NPI Reactivation Date
• Provider Gender Code
• Provider License Number
• Provider License Number State Code
• Authorized Official Contact Information (First Name, Middle Name, Last Name, Title or Position, Telephone Number)

To read the CMS announcement in full, click here.

Applications Still Short of Accreditors' Expectations
ATLANTA--Despite CMS' extension of the accreditation deadline for HME providers wishing to participate in competitive bidding, accreditation organizations still are not seeing a surge of applicants, they told HomeCare last week.

On July 27, the previous deadline, CMS extended its bid window to Sept. 25. It also extended the accreditation deadline from Aug. 31 to Oct. 31. Providers must be accredited to be awarded a contract in the initial round of the bidding project.

"We're not seeing a flurry of activity right now. I think that individuals that [plan to bid] have already applied," said Robert Floro, R.R.T., newly promoted director of the home care accreditation program for The Joint Commission.

Terry Duncombe, president and CEO of the Community Health Accreditation Program, said phone calls regarding accreditation escalated after the announcement of the deadline extension. But overall, she said, "it hasn't been the numbers that anyone thought. We've had a fair amount of agencies already accredited. From January 2007, we've had 80 organizations that have started the process with us, probably 40 of them since April."

Like other accreditors, however, CHAP was prepared to serve many more applicants. "We're poised to take on quite a bit more," Duncombe said. "We could without a doubt handle another 65 to 75 agencies."

In announcing the bid program during an early April press briefing, then-acting CMS Administrator Leslie Norwalk said the agency had estimated "generally that we'll have maybe 20,000 bids, and about half of [those suppliers] would participate in this program." While CMS will not reveal how many bids it has received so far, stakeholders have surmised that the numbers are far below those anticipated.

Floro said he was not surprised that even after the deadline was extended, few new organizations have applied for accreditation. "If they weren't ready a month ago, what makes anyone think that organizations are going to be more ready for accreditation now? They haven't prepared to this point, so extending the deadline [is not going to make much difference]," he said.

Both he and Duncombe said they had contacted previous applicants who either tried to apply too late in the game or did not complete the process before the initial deadline.

"We've already reached out to those we had to turn away," Floro said, adding that initially there was "a significant collection of organizations" that applied for accreditation but did not complete the application process.

While it might not result in significantly greater numbers of applicants, Duncombe said the deadline extension could help cut down on the number of deferrals. "As [providers] try to rush and get ready [for onsite visits], we are seeing an increase in our deferrals because they are not quite ready," she said.

Mary Ellen Conway, president of Capital Healthcare Group, Bethesda, Md., said the biggest help with the accreditation extension "is that everyone who is trying to get a survey now can do a better job on what they are pulling together."

She said the extended deadline would likely eliminate "heavy, expensive follow-up" because providers would have more time to prepare. "It's really intended to give people more time to do a better job at what they are doing," she said.

Conway did call the extension a "huge win" for those companies who got their money back from accrediting organizations because they had applied too late to meet the initial deadline. If they act immediately, they can still be a part of competitive bidding, she said.

Duncombe also cautioned that providers wishing to bid in the first round can't wait. "They need to do it now. If they are not in our pipeline in the next 30 to 45 days, [the extension] is not going to matter," she said.

While accreditors are generally giving priority to providers in the initial 10 CBAs, there is only so much latitude, they said.

"We have 1,500 organizations that need resurveying, as well," pointed out Floro, referring to those providers that are already accredited but must be resurveyed in order to maintain their status.

The accrediting bodies are also mindful that there could be an onslaught of new applications next year. Not only will providers be preparing for the second round of competitive bidding, but CMS is expected to implement a requirement in the near future that all HME providers be accredited.

Tom Derrick, director of public relations, marketing and professional discipline for the American Board for Certification for Orthotics, Prosthetics and Pedorthics, said his agency's applications in 2007 have tripled in number in comparison with previous years. "We expect the pace to pick up even more in 2008," he said.

Floro noted that providers wishing to do business with Medicare soon won't have a choice. "CMS will announce the date shortly when all the [HME providers] will have to be accredited. So it's a matter of do you do it now or do you do it later," he said.

Contractor Report Card Shows Good Marks
BALTIMORE--Results of a CMS satisfaction survey conducted earlier this year show that a majority of health care providers gave their Medicare contractors relatively good grades, although DME contractors received the lowest marks.

With data collected from January through April this year, CMS' second Medicare Contractor Provider Satisfaction Survey showed that on a six-point scale--with 1 representing "not at all satisfied" and 6 representing "completely satisfied"--the national average across contractors was 4.56.

Of four contractor types in the survey, fiscal intermediaries received an average score of 4.66; regional home health intermediaries received 4.77; carriers received 4.42; and durable medical equipment contractors received 4.34. Scores fell slightly for all of the contractor types from those in the 2006 survey; last year DME contractors also received the lowest average score at 4.43.

In the survey, CMS asked a random sample of 36,359 Medicare providers about seven business functions of the provider-contractor relationship: provider communications, provider inquiries, claims processing, appeals, provider enrollment, medical review and provider audit and reimbursement. The agency said the survey is one way it can gauge provider satisfaction with key services performed by the contractors, which process and pay more than $280 billion in Medicare claims annually.

For all contractor types, the survey showed the key predictor of a provider's satisfaction was the contractor's handling of provider inquiries, with claims processing coming in at No. 2.

All four DME contractors received scores below the national survey average: Jurisdiction B's National Government Services scored the highest of the group at 4.50; Jurisdiction C, Palmetto GBA, came in at 4.44; Jurisdictions D and A, which both were served by multiple contractors during the survey period, received scores of 4.21 and 4.20 respectively.

Of the service functions surveyed among DME contractors, providers gave them the highest scores on claims processing at an average of 4.47, and the lowest on appeals at 4.07.

Of 18 Part B carriers in the survey, the highest scores went to Blue Cross Blue Shield of Kansas and HealthNow New York, which both received 4.66. The lowest scores in the group went to Noridian Administrative Services at 4.12 and Jurisdiction 3, which was served by multiple contractors during the survey, at 3.91.

As required by the Medicare Modernization Act of 2003, the survey will enable CMS "to begin establishing provider satisfaction performance standards for its contractors," the agency said, noting that the results provide a "tangible benchmark" that contractors can use to support process improvement efforts.

For a PDF of the survey, click here.

Collaborative Tracks 70 Percent Reduction in Pressure Sores
PRINCETON, N.J.--After nearly two years of applying best practices and preventive techniques, 150 hospitals, nursing homes and home care agencies in New Jersey tracked a 70 percent reduction in the incidence of new pressure ulcers in their patients.

Ranging from redness and irritation to extensive destruction of tissue, muscle and bone, pressure ulcers, commonly known as bed sores, affect more than 1 million patients annually. Costs associated with their treatment exceed $1.3 billion, according to the New Jersey Hospital Association.

More important, the association said, "the human toll of pain, depression, altered self-image, infection and increased mortality is immeasurable."

Of the organizations taking part in the NJHA's Pressure Ulcer Collaborative, 48 reported achieving results of no new pressure ulcers for a period of three months or more. In addition, data showed that the prevalence of existing pressure ulcers as patients moved from one care setting to another was reduced by 30 percent.

Data was tracked from September 2005 through May 2007.

Improvement techniques used by staff across care settings included:

--a complete skin evaluation within eight hours of admission;
--an evaluation of the risk of skin breakdown;
--implementation of preventive strategies, such as proper positioning and use of assistive devices; and
--ongoing observation of the condition of patients' skin, particularly for those identified as being at high risk for developing a pressure ulcer.

As part of the bundle of interventions for home patients, "once an individual was identified as being at risk for development of pressure ulcers, we wanted [the care provider] to strive for implementation of some kind of preventive intervention within 24 hours of that risk being identified," said Theresa Edelstein, NJHA's vice president of continuing care services.

The organizations taking part in the project were given a review of various positioning and support surface devices to help "understand the principles behind each of those different types of devices and how they are utilized with different patient populations, such as critical care and hospice," Edelstein said. No specific type or brand was recommended, she added, but educating the organizations about the preventive devices led many "to take a look at their protocols and how they are making use of these devices with a better understanding of what they are meant to do."

As a result, Edelstein said, some of the home care agencies involved "documented a significant reduction in rehospitalization rates related to wound infection and wound care in general. The agencies have seen that they made a difference, and that's a very exciting and positive result for them and for their patients."

A second phase of the project is being planned, Edelstein said, because there are many different facets of dealing with pressure ulcers, and not all of them are avoidable. The sores could be nutrition-related, medication-related or dressing-related, "and all of those things intertwine," she said.

"We want to know what is the best way to get the best results for those patients who develop a pressure ulcer in spite of our best efforts."

Strike Force Arrests Pharmacy Owner in 'Massive' Kickback Scheme
MIAMI--In the latest Medicare Fraud Strike Force action in South Florida, a pharmacy owner has been charged with paying out more than $1 million in kickbacks in what investigators called "a massive kickback network" involving pharmacies, DME companies and physicians, federal officials announced Aug. 3.

According to the U.S. Attorney's Office for the Southern District of Florida, Juan Carlos Castaneda, who owned and operated International Surgical-Med Pharmaceuticals, a Miami pharmacy, paid illegal kickbacks to numerous DMEs for patient referrals from 2000 to 2004.

Castaneda allegedly had International Surgical employees deliver respiratory medications to the referred patients on a monthly basis, then billed Medicare for the medication cost. Castaneda would kickback about half of the Medicare payment to the DME owners as a referral fee.

To get cash to pay the kickbacks, Castaneda had relatives cash checks from accounts of Medicare funds, authorities said.

Castaneda faces one count of conspiring to violate the Medicare anti-kickback statute and two counts of paying illegal kickbacks.

For more on the Strike Force, see HomeCare Monday, May 14.

Manufacturer News
Chad Secures $3.5 Million for Sleep Product Rollout
CHATSWORTH, Calif.--After launching its new Bonsai pneumatic oxygen conserver at Medtrade Spring, Chad Therapeutics announced last week the company would unveil its initial products for the sleep disorders market in the fall.

A $3.5-million financing package completed with a private investor will fund development of the products, the company said, as well as enhance its working capital.

The financing package is comprised of a $750,000 convertible term note and a $2.75-million revolving credit line secured by the company's assets. A portion of the financing was used to pay all outstanding obligations on the company's factoring arrangement with a commercial bank.

"As previously announced, we currently are launching several new products for the oxygen market and expect to launch our initial products for the sleep disorder market this fall," said Earl Yager, Chad's president and CEO. "We also are pursuing outsourcing and other cost-cutting measures to reduce manufacturing costs for many of our established products.

"We believe this financing package gives us the resources to complete these programs while maintaining our current operations."

Medline Goes After Enteral Nutrition Contract
MUNDELEIN, Ill.--Medline, a major supplier of enteral nutrition to nursing homes, announced last week that it will bid for a Medicare contract in that product category in all 10 of the initial competitive bidding areas and, should it win, employ HME providers as subcontractors to distribute the product.

"Medline has been billing Medicare for more than 20 years for its enteral nutrition supplies on behalf of patients in nursing homes across the country, with a significant percentage located in the 10 chosen competitive bidding areas," said Tim Dundon, Medline president of health care sales, in a statement issued Tuesday. "Because CMS did not exclude this sector, we consider it appropriate to attempt to protect our current base of business."

With 2006 revenue of $2.45 billion, Medline manufactures and distributes more than 100,000 products to hospitals, extended-care facilities, surgery centers, home care providers and agencies.

Medline does not sell to people in their homes, but under the terms of competitive bidding, winning contractors are required to service all patients in their product categories in any care setting. Dundon said Medline is proposing to use HME providers as subcontractors to distribute enteral nutrition to patients outside nursing homes.

The plan won approval from Waterloo, Iowa-based buying group VGM. "We are pleased that Medline has indicated its intent to use a distribution system that includes independent HME providers if its bid in the initial CBAs is successful," said Ron Bendell, president of VGM and Associates. "These providers are the primary and essential front line of home-based care and will be a valuable link in any supply distribution system."

The deadline for first-round bids is Sept. 25. Contracts will be awarded in February 2008 and will be effective beginning July 1, 2008.

PaperPak Changes Name to Attends
GREENVILLE, N.C.--PaperPak Products has announced its official name change to Attends Healthcare Products effective Aug. 1.

"Attends Healthcare Products more accurately describes who we are as a company," CEO Michael Fagan said in a statement. "Attends is the brand that created the adult disposable incontinence market over two decades ago. We are proud of our history, our contributions to quality of care and the valued distributor relationships we have built over the years."

PaperPak purchased Procter & Gamble's Attends line in 1999, then sold the business to management in 2002. The company later restructured, splitting its North American and European operations (see HomeCare Monday, April 4, 2005). In January of this year, investment company KPS Capital Partners acquired PaperPak with Fagan continuing in his role as CEO.

The transaction gives the company access to funds for further development of the Attends brand name "to capitalize on the enormous growth opportunity presented by the adult incontinence market," according to a press release. The company estimates that as many as 25 million people in North America are affected in varying degrees by some kind of incontinence, with higher occurrences for women and the elderly.

Primarily focused in the acute care, long-term care and home care markets, products sold under the Attends name include briefs, protective underwear, pads, washcloths and tissue, underpads, pants and maternity pads.

Fagan said the company plans to build on its heritage "by offering our distribution partners and consumers superior value."

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