ADVERTISEMENT
| View this email as a Web page | Please add HC_HomeCare Monday_ to your Safe Sender list. |
|
|
|
| A Penton Media Property | |
| March 30, 2009 | Volume 15, Number 13 |
|
ADVERTISEMENT
|
|
|
ADVERTISEMENT Medicare surety bonds are required. VGM Insurance can help. VGM Insurance is your Medicare Bond Expert and is committed to providing: Call the Bond Hotline, 1-866-497-0472, for questions or information.  Table of Contents - Industry Scrambles to Unite on Oxygen Reform - Medtrade Spring 2009: We’ll Manage the Changes, Providers Say - Florida HME Associations Mount Up: Now There Are Three - Disability Advocates Battle Medicare Waiting Period, Again - Gilbert Takes Over at ALS; Obama Nominates Two More - CMS Issues O2 Payment Instruction; President Declares Disaster in North Dakota - On the HME Calendar For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com. Headline News Industry Scrambles to Unite on Oxygen Reform LAS VEGAS--Some 450 attendees jammed a Medtrade Spring meeting room Wednesday to hear details of a Medicare oxygen reform plan hammered out by members of the New Oxygen Coalition. And according to Tyler Wilson, president and CEO of the American Association for Homecare, that plan has become "urgent" as the nation's health care reform effort picks up speed. “We are getting clear signals that Congress is set to cut the reimbursement rate once again,” Wilson said at the association’s Washington Update, noting new cuts could come out of reducing the oxygen cap from 36 to 18 months and/or simply lowering payments. “I think it is fair to say the home oxygen benefit is under siege, and now is the time for the industry to come forward with a unified proposal that we can take to Capitol Hill.” Congress plans to have a health reform bill packaged by June, and legislation on the President’s desk by August. But with lawmakers out soon for a two-week Easter recess and another recess over July 4, that doesn’t leave much time to get any oxygen plan into legislative language. In fact, said AAHomecare’s Walt Gorski, vice president of government affairs, as far as oxygen reform is concerned, “We look at the next 30 days as very critical.” Wilson said the NOC began working in February to “cobble together” consensus on a plan that “the broadest part of the oxygen community can embrace--and that we can sell on Capitol Hill. "It really is a two-part process," he said. "It’s got to be embraced, understood and supported by the industry, but it also has to address the concerns that Congress has about the benefit [being overpaid].” As outlined by members of the NOC, the plan would eliminate the oxygen cap and remove home oxygen from competitive bidding. It would also overhaul the way payments are made under Medicare's oxygen benefit. Patients would be classified in three categories based on ambulation and portability needs: Category 1 would include patients who are prescribed oxygen for nocturnal use only; Category 2, patients with standard portability needs (use of portable oxygen is less than or equal to 40 liter hours per week); and Category 3, patients with high portability needs (use at more than 40 liter hours per week). “Liter hours” is defined as the prescribed LPM multiplied by the estimated number of hours of use per week. Among other major components, the plan would:
NOC members include the Accredited Medical Equipment Providers of America (AMEPA); Apria Healthcare; the Big Sky Association of Medical Equipment Suppliers; Covidien; CQRC; the Georgia Association of Medical Equipment Services (GAMES); Invacare; Medical Service Company; the Midwest Association of Medical Equipment Services (MAMES); The MED Group; the National Association of Independent Medical Equipment Suppliers (NAIMES); Pacific Pulmonary; Philips Respironics; and VGM. The group called for feedback from state associations on the draft plan before the Las Vegas show, and Wilson asked the same of the Medtrade Spring audience. A conference call with state associations was set today to address the comments that had been collected and work through any final sticking points. There could be some involving payments, said Jason Rogers, president of GAMES. “I agree competitive bidding is a great evil that must be done away with. It will kill patients as well as businesses and jobs. But before we decide the elimination of competitive bidding is included in this [plan], we have to know what effect this is going to have on the allowable.” Rogers said he planned to bring up that issue and others on the conference call and was hoping they could be resolved. John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers, said he also had questions on payments. “It’s unfortunate that we won’t know the cost until the end,” he said. “As we define the services, are we on the front end of proposing to provide the equivalent of a new Cadillac in service and patient care only to turn around on the back end and be compensated for a used Chevy? “There’s no way of knowing,” Shirvinsky continued. “That’s the problem. We have to be able to make the best case we can that having this new three-pronged, service-based compensation structure makes sense … you‘re not going to be able to structure a compensation system in dollars and cents legislatively, so there is a high level of trust that is involved with this. “On the one hand, it is all very scary because this is a major change to a major source of revenue to the industry,” Shirvinsky said. On the other hand, he added, “I understand what the sense of urgency is and I understand the risks that confront our industry if we fail to act in an appropriate and responsible way. “There is a very short timetable, and we are not in the driver’s seat on that timetable. Right now the goal is for all the parties to pull things together.” “Ideally you would like to get 100 percent support,” said NOC member Mike Calcaterra, Montana state chairman and legislative/DAC chair for Big Sky AMES. However, he said, “I don’t know that there’s any industry that could say they’ve got 100 percent support, but an overwhelming majority I think is a must. I think we’ve got that, but I know we’ve got some questions to answer. We want to make sure we’re getting those now so that it doesn’t set us back down the road.” Indeed, Wilson told Medtrade Spring attendees if the plan is endorsed by a “broad base” of oxygen stakeholders, a formal proposal will be put before Congress as quickly as possible so it can be incorporated in health reform legislation. And, he said, it won’t be a moment too soon as the Obama administration prepares to reshape the country’s ailing health care system. “The health care reform train is moving forward, and if we’re not on it, we’ll miss our opportunity,” Wilson said. How do you feel about President Obama’s plan/budget for health care reform? To vote in HomeCare's monthly Web poll, visit www.homecaremag.com. Medtrade Spring 2009: We’ll Manage the Changes, Providers Say LAS VEGAS--Three main issues were on the agenda and on providers’ minds as HME stakeholders gathered at the Las Vegas Convention Center for Medtrade Spring, March 24-26: the 36-month oxygen cap, the 9.5 percent cut and the revived threat of competitive bidding. Facing the reimbursement challenges is tough, some providers said, but they also said they plan to move their businesses forward--albeit in very different ways. Cliff Woolard, president/CEO of Home Med-Equip in Concord, Calif., opened a retail location two years ago that is now in full swing, and he is planning more. “It’s a great revenue source,” Woolard said at the Las Vegas expo. But Woolard, who attended the show with his brother John and cousin Joel, both also involved in the family business, said the company began preparing for the reimbursement cuts several years ago. “In 2004, we began to look at alternative oxygen systems from the standpoint of reducing delivery costs,” he said. “At that point we were heavily leveraged in liquid oxygen. That was our predominant ambulatory oxygen system, so we began the process of evaluating different types of oxygen systems that were out there.” The company settled on a home filling system, and “when the cap came along, it just proved we had made the right decision in going with the non-delivery method,” Woolard said. He has now converted 90 percent of the company’s oxygen customers to non-delivery, “so we didn’t take a huge hit,” Woolard said. “The amount our company was impacted by the cap was less than 10 percent.” Even so, he said, “it’s tough to lose 10 percent of your revenue at the start of the year plus take a 9.5 percent cut plus have the Medicare deductibles. January might possibly have been one of the worst cash flow months in the history of the business, but we made it through and here we are getting ready to start April.” That’s the good news, Woolard said. The bad news is “there are still other issues related to the cap,” the biggest being how to maintain service to patients who move. And if the cap should be cut further--to 18 months or under--“we probably cannot be in the oxygen business. It’s just that simple,” Woolard said, although he noted the company has diversified its income through other DME and enteral business. Laura Hafford of Texas DME in Cleburne, Texas, related what some might call a drastic approach in dealing with both the oxygen cap and competitive bidding. Hafford’s company bid in Round One but didn’t win. “When we saw how all that played out, we decided then we were going to streamline our company and focus on the things we do the best,” said Hafford, explaining the company now concentrates on complex rehab and non-Medicare disposable supply. “Oxygen wasn’t something we wanted to continue in making our company leaner,” she said, pointing to the possibility of a Round One rebid. The company is now in the process of downsizing, from three locations to one and from 40 employees to 18. “If you have an efficiently run company there is a lot of opportunity for growth,” Hafford said, “but if you are not run efficiently, you can’t grow.” For his company to absorb the 9.5 percent cut, complex rehab provider Tim Pederson, CEO of WestMed Rehab in Rapid City, South Dakota, turned that lemon into lemonade. “Maybe this won’t be the popular thing to say, but the 9.5 percent cut made us a better business,” Pederson said. “It forced us to do things that we wanted to do in the past to maximize efficiency but we didn’t want to go through the pain [to do]. Now that we’ve done those things, we are a much better business.” As an example, WestMed enacted purchasing formularies for complex rehab and products. “In each product and accessory code we have one or two options for our clinicians to use to fill orders, whereas in the past they could choose anything they wanted,” Pederson said. “Because we simplified that, limiting the variables by limiting choice has streamlined our entire order intake process and our fulfillment process. “Now,” he continued, “our patient service representatives have fewer balls to juggle when they are creating a chart for these individuals. My clinicians can spec out a product, put it on a formulary sheet printout, mark the proper boxes, put the patient’s name on there and then turn it over to customer service and let them input all the orders. Before, my well-paid clinicians were doing administrative drudgery work instead of being productive in what they do. So [the cut] actually made us a better business and a much more effective provider of complex rehab.” The formulary initiative has been so successful, in fact, that Pederson said he may do the same thing to streamline his company’s respiratory and prosthetics sectors. Still others are looking to get into the HME business despite the industry’s circumstances. Jeff Parenteau, owner of Sunshine Senior Care in Denton, Md., was scoping out both Medtrade Spring’s educational sessions and the variety of products on the show floor. “We’re already providing in-home care, from companion care through end-of-life. We’re in a very rural area, and many of our clients are asking us for equipment and supplies and we just end up sending them somewhere else,” Parenteau explained. “Whenever there are changes in the industry, it may be a negative for people who have already been in the business for 20 years. But if you’re just starting out, there may be opportunities there if you set yourself up to work under the new conditions versus the old conditions.” Consultant Wallace Weeks of Weeks Group also noted an interest in the industry from "sophisticated money," or private equity investors, who were walking the show. "It bodes well for the industry. I think it means they recognize things can be done differently," Weeks said. "From time to time, providers are probably going to have to adjust their business to new models that will come into this industry, but the world seems to recognize that the demand is not going away." Florida HME Associations Mount Up: Now There Are Three ORLANDO--A third home medical equipment association has entered the picture in Florida, this time a for-profit corporation headed by the previous executive director of the Florida Association of Medical Equipment Services. Heather Allan, executive director of FAMES for nine years, said last week she has formed the Florida Home Medical Equipment Association Inc., which is based in Orlando. “The goals of the organization are to provide cost-effective, affordable education, information and a certain amount of advocacy,” Allan said. “One of our concerns is that greater attention needs to be paid to what the Florida legislators and pertinent state agencies are doing. National issues are certainly important and will receive an appropriate amount of our attention, but those issues are very well covered by national organizations such as [the American Association for Homecare]. Some of the state issues have a tendency to fall through the cracks, and that can’t happen.” She added, “We want to have a more proactive approach to state issues as opposed to reactive and we really want to have less antagonistic relations with state entities.” Allan said that a Web site is in the works, as are some Webinars. “We’re looking forward to the challenges the industry faces, and we are looking forward to working with providers in Florida on the issues they face--both the big ones and the small ones,” she said. Randy Schluter of Parker, Colo., is secretary/treasurer of FHMEA. Allan said the vice president had not been confirmed, although the association's Articles of Incorporation list her mother, Elizabeth M. Moran, director of the Medical Equipment Suppliers Association, as the vice president. The news comes in the wake of the announcement that FAMES, which closed in January, was restructuring and had named long-time HME provider and former president Joan Cross of C&C Homecare in Bradenton as the new executive director. Greg Sims of Gator Mobility in Gainesville is president. (See "FAMES Regroups: Joan Cross Is New Executive Director," March 23.) In addition, the newly launched Florida Alliance of Home Care Services, or FAHCS, is headed by Roger Ribas of Hometown Medical Supply in Doral as president with Sean Schwinghammer, an advisor to the Accredited Medical Equipment Providers of America, as executive director. (See "Florida Providers Form New State Association," March 23.) Both of the groups are non-profit organizations. Of her new corporation, Allan said, “we structured it in the way we did to avoid the pitfalls of non-profit corporation structures and limitations.” She added that FHMEA “certainly is not intending to work against any other organization based in Florida. I think it is too soon to tell how things will go in the state and whether or not there will be any type of interaction or cooperation among any of the entities that exist or will exist.” For more information on FHMEA, call Allan at 407/421-6118. Disability Advocates Battle Medicare Waiting Period, Again WASHINGTON--Advocates working to end the two-year delay in Medicare coverage for people with severe disabilities are hoping the third time will be the charm. On Wednesday, Rep. Gene Green, D-Texas, introduced the Ending the
Medicare Disability Waiting Period Act of 2009 (H.R. 1708) in the House
with a companion bill (S. 700) introduced by Sen. Jeff Bingaman, D-N.M.,
in the Senate.
Currently, people deemed disabled by the Social Security Administration due to incapacitating health problems are not eligible for Medicare until 24 months after they receive their first Social Security disability income benefit. The two-year waiting period, originally established in 1972 when Medicare was expanded to include people with disabilities, today has two exceptions: people who are disabled due to amyotrophic lateral sclerosis (ALS) or end-stage renal disease. (For more, see "Patient Groups Ask for End to 'Cruel and Arbitrary' Medicare Wait," April 16, 2007.) This time around, the bill is backed by more than 120 advocacy
organizations and provider groups that have formed the Coalition to End
the Two-Year Wait for Medicare. Following introduction of the bill, the
coalition addressed a letter
to Green and Bingaman supporting the legislation.
With health reform on the horizon, the coalition wrote, "there is a unique opportunity to close this unjustifiable gap in health care coverage for people with disabilities. Nearly 40 percent of people with disabilities are without health insurance coverage at some point during their wait for Medicare; 24 percent have no health insurance during this entire period. We support your legislation, which will phase out the waiting period for all people with disabilities over 10 years, while immediately eliminating the waiting period for people with life-threatening conditions." Members of the coalition include, among others, the Alzheimer’s Association, the American Medical Rehabilitation Providers Association, the COPD Foundation, Easter Seals, the National Multiple Sclerosis Society, Paralyzed Veterans of America, the Spina Bifida Association and United Cerebral Palsy. Newsmakers Gilbert Takes Over at ALS; Obama Nominates Two More Jane H. Gilbert has been appointed president and CEO of The ALS Association. Gilbert joins the association after serving as the senior vice president for chapter operations for the American Red Cross. In her new position with ALS, Gilbert has responsibility for the strategic direction and operations of the association and will oversee its activities in research, advocacy, finance, development, community services, patient services, communications and operations. ALS (amyotrophic lateral sclerosis), commonly known as Lou Gehrig's disease, is a progressive, neurodegenerative disease that afflicts 30,000 people in America. Obama Nominates Two More The White House announced last week that President Obama plans to nominate Yvette Roubideaux, an assistant professor at the University of Arizona's College of Medicine, as director of the Indian Health Service. Roubideaux, a member of the Rosebud Sioux tribe, had previously worked for IHS as a medical officer and clinical director on the San Carlos Indian Reservation and in the Gila River Indian community. Obama has also nominated Dr. Margaret Hamburg to serve as the next U.S. Food & Drug Administration Commissioner and has named Dr. Joshua Sharfstein as principal deputy commissioner. Hamburg was a New York City health commissioner and an assistant secretary of HHS during the Clinton administration. According to press reports, Sharfstein has pushed the FDA to ban over-the-counter cold and cough medicines for children younger than 6, and in the past worked for now House Energy and Commerce Chairman Henry Waxman, D-Calif. In Brief CMS Issues O2 Payment Instruction; President Declares Disaster in North Dakota In a March 20 transmittal, CMS published additional post-cap instruction about billing for the six-month maintenance and service payments for oxygen equipment. The agency said it is "reasonable and necessary to make payments for periodic, in-home visits" to inspect certain oxygen equipment for calendar year 2009. According to the transmittal, payment can only be made every six months beginning six months after the cap period ends, as early as July 1 for some patients. The allowed payment for each visit is equal to the 2009 fee for code K0739, multiplied by 2, for the state in which the in-home visit takes place. There is no decision yet on coverage for maintenance and service beyond Dec. 31, 2009. CMS said providers should use the HCPCS code for the equipment E1390, E1391, E1392, and/or K0738 along with the MS modifier in order to bill and receive payment for these visits. For all oxygen equipment furnished after the 36-month rental cap, providers are responsible for repairs or maintenance and service "necessary to ensure that the equipment is in good working order" for the remainder of its five-year reasonable useful lifetime. Providers may not charge beneficiaries for any repairs, parts or servicing required for the remainder of the equipment’s reasonable useful lifetime, the transmittal said. Further instructions will be published regarding payments for dates of service on or after Jan. 1, 2010. Disaster Declaration in North Dakota Quantum Rehab Heads West MAMES Members Attend Iowa Health Care Forum The forum was the third in a series of five regional health care summits scheduled by the White House around the country. A fourth is set for Durham, N.C., tomorrow with NCAMES invited to attend, and the fifth and final forum is set for Los Angeles on April 6. For more, see "State Associations Seek a Say at Health Care Summits," March 16. NSC March Newsletter
Report Finds 5.3 Million (and Counting) Have
Alzheimer’s Coming Up On the HME Calendar CMS has scheduled its next Home Health, Hospice & DME Open Door Forum on Wednesday, April 1, from 2-3 p.m. ET. To participate by phone, dial 800/837-1935 and reference conference ID 88151741. The New York Medical Equipment Providers (NYMEP) annual conference is set for April 1 in West Point, N.Y. For more information, call 518/436-9637 or visit www.nymep.org. As a preamble to the meeting on Tuesday, March 31, NHIC Corp., the Jurisdiction A DME MAC, has partnered with NYMEP on a full day of education. Visit www.medicarenhic.com/dme/dmerc_seminars.shtml for more information. The American Pharmacists Association (APhA) annual meeting and expo will be held April 3-6 in San Antonio. For more information, call 202/429-7593 or visit www.aphameeting.org. The Virginia Association for Homecare and Hospice (VAHC) annual conference and trade show will be held April 6-7 in Portsmouth, Va. For more information, call 804/285-8636 or visit www.vahc.org. The Big Sky Association of Medical Equipment Services will hold its quarterly meeting April 10 in Butte, Mont. Call 406/777-7301 or visit www.bigskyames.org for more information. The Midwest Association for Medical Equipment Services (MAMES) will hold its spring conference April 15-17 in Overland Park, Kan. Call 651/351-5395 or visit www.mames.com for more information. The American Occupational Therapy Association (AOTA) annual conference and expo will take place April 23-26 in Houston. Call 301/652-2682 or visit www.aota.org for more information. The American Telemedicine Association’s (ATA) annual meeting will take place April 26-28 in Las Vegas. For more information, call 202/223-3333 or visit www.americantelemed.org. The Pennsylvania Association of Medical Suppliers (PAMS) will hold its annual convention April 26-28 in State College, Pa. Call 717/795-9684 or visit www.pamsonline.org for more information. VGM's U.S. Rehab is offering “Assistive Technology for the ATP,” a review course for the RESNA ATP exam. Session dates are April 28-29 in Sacramento, Calif., and Sept. 15-16 in Richmond, Va. For more information, visit www.vgmeducation.com or call 800/987-7342. The DME MACs are offering a number of upcoming educational sessions and events, including the following: Through its Medicare University, National Government Services, the
Jurisdiction B DME MAC, is now offering updated computer-based training
courses that have been revamped to reflect the intake and billing
processes. For information on Medicare University, visit the NGS Web site.
To revisit this news any time during the week, go to www.homecaremonday.com. ADVERTISEMENT |
||
About this Newsletter You are subscribed to this newsletter as #email# To unsubscribe from this newsletter go to: Unsubscribe To subscribe to this newsletter, go to: Subscribe To visit HomeCare's Web site click here For information on advertising in this newsletter, please contact Kent Peterson, National Sales Manager/Western Region Sales at kpeterson@homecaremag.com, or John McNamara, Regional Sales Manager/Eastern Region Sales at jmcnamara@homecaremag.com. |
||
|
|
||
|
To get this newsletter in a different format (Text or HTML),
or to change your e-mail address, please visit your profile
page to change your delivery preferences.
For questions concerning delivery of this newsletter, please contact our
Customer Service Department at: Penton Media | 249 W. 17th Street | New York, NY 10011 Copyright 2009, Penton Media. All rights reserved. This article is protected by United States copyright and other intellectual property laws and may not be reproduced, rewritten, distributed, re-disseminated, transmitted, displayed, published or broadcast, directly or indirectly, in any medium without the prior written permission of Penton Media. |
