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| A Penton Media Property | |
| August 20, 2007 | Volume 13, Issue 39 |
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ADVERTISEMENT Is your billing software ready for the 21st century? MedAct for Windows from Dynamic Energy Systems, an award winning software company, increases your company's productivity and profitability with our state of the art HME billing software. Take your business to the next level with our fully integrated Document Imaging and Inventory Management solutions. Don't waste another dollar on inadequate solutions. Check it out today at www.dynamicenergy.com or email us at dessales@dynamicenergy.com for more info.  In This Issue: HHS, DOJ Target Fraudulent Infusion Therapy Providers Registration Deadline Set Next Week; Bidder Response Unknown Key Industry Bills Await Congressional Action Providers Must Head Off SCHIP Provisions, HME Lobbyists Say Invacare Enters Portable Concentrator Market Pulse Oximetry Market to Grow 150 Percent by 2013 NSC Introduces the PTAN In Brief For more industry news, features and highlights from our latest issue, please visit our Web site at www.homecaremag.com. Headline News HHS, DOJ Target Fraudulent Infusion Therapy Providers WASHINGTON--The Department of Health and Human Services and the Department of Justice are joining forces for a demonstration project to eliminate fraudulent infusion therapy providers, officials announced late Friday. The agencies will review prosecutions by a joint strike force and reveal details of the demonstration during a reporter conference call today with Herb Kuhn, CMS acting deputy administrator; R. Alexander Acosta, United States attorney for the Southern District of Florida; and Kimberly Brandt, CMS director of program integrity. "The demonstration project will have an immediate effect in South Florida," according to a media advisory. In what it has called "the first step in a protracted effort to eliminate the potential for fraud," HHS and the DOJ formed a multi-agency Medicare Fraud Strike Force earlier this year to investigate fraudulent suppliers (see HomeCare Monday, May 14). During a three-month period, the effort yielded 56 arrests and "stopped companies who collectively billed more than $258 million to Medicare," HHS said. The agency also has begun demonstration projects focused on preventing sham DME and home health companies from operating in South Florida, Southern California and the Houston area. And last month, CMS proposed a rule to help limit Medicare's risk by requiring all DMEPOS providers to supply a $65,000 surety bond (see HomeCare Monday, July 30). Check future issues of HomeCare Monday for coverage of the infusion therapy fraud project. What is your opinion of HHS' proposal to require a $65,000 surety bond from DME suppliers? To vote in HomeCare's monthly Web poll, visit www.homecaremag.com. Registration Deadline Set Next Week; Bidder Response Unknown ATLANTA--HME providers in the initial 10 competitive bidding areas have only a week left to register for their user IDs and passwords--and the registrations will determine whether CMS gets the number of bidders it had expected. Providers who want to participate in the first round of Medicare bidding must register by Aug. 27 in order to access CMS' Internet-based bid submission system. On July 27, the previous bidding deadline, CMS extended its bid window until Sept. 25. Bidders must be accredited or be in the process of becoming accredited to submit a bid; first-round bidders now have until Oct. 31 to become accredited in order to win a contract. According to its updated timeline, CMS will conclude bid evaluation and begin its contracting process in January 2008, with winning suppliers to be announced in February. The agency will conduct an education campaign for beneficiary and referral agents from April 1 to July 1, when the competitive bidding rates are scheduled to go into effect. Thus far, CMS has been mum about the numbers of registrants or bids it has received. "[The American Association for Homecare] has asked for that information but has been told it would not be released," said Walt Gorski, AAHomecare vice president of government affairs, adding that there is a need for much more transparency in the competitive bidding system. "Not only should the government tell us how many people are bidding, but the industry should know the criteria that CMS will use to evaluate bids before the evaluation takes place," Gorski continued. "And it should know the financial measures it is being judged by ... Not knowing these measures is like playing a football game where you don't know where the end zone is." Already, industry sources are questioning CMS' estimates related to the bidding program. In its final rule, published in the April 10 Federal Register, the agency estimated that: --Of the approximate 28,960 suppliers providing DMEPOS items in the
initial CBAs, 15,973 will place bids;
Most stakeholders believe that the number of bidders is far fewer than CMS had anticipated. In recent weeks, accrediting organizations have said the number of applications they have received thus far is much lower than expected. (See HomeCare Monday, Aug. 13.) Gorski said he thinks CMS was forced to extend the bidding process in order to correct problems with its online bidding system. But he said he does not believe that extending the bid deadline to Oct. 31 will result in a rash of new bidders. "I don't think extending the time period [will make] a significant difference in the number of folks who plan on participating," he said. For information on bid registration and deadlines, visit the Competitive Bidding Implementation Contractor Web site at www.dmecompetitivebid.com. Key Industry Bills Await Congressional Action WASHINGTON--A handful of home medical equipment-related bills awaits action from Congress when legislators return from their August recess on Sept. 4, and that action--if there is any--could change the face of the industry. Here's what lawmakers will grapple with when Congress is back in session. --H.R. 1845 and its Senate companion, S. 1428: The Durable Medical Equipment Access Act seeks, among other things, to ensure beneficiary access to quality items under CMS' competitive bidding project and to protect home care providers, particularly small businesses. The bills would:
The House version of this bill, known as the Tanner-Hobson bill, also calls for Congress to reauthorize competitive bidding after completing its rollout in the first 10 bidding areas before it can be implemented elsewhere. In other words, Congress would specifically have to pass a law for it to continue. With 109 cosponsors, the bill has been referred to the House Subcommittee on Health. Its Senate companion, known as the Hatch-Conrad bill, has 12 cosponsors and has been referred to the Senate Finance Committee. --H.R. 2231: The Medicare Access to Complex Rehabilitation and Assistive Technology Act would exempt complex rehab and assistive technology from competitive bidding on the basis that it is highly individualized, would not result in significant savings for Medicare and beneficiary access would likely be compromised. Consistent with H.R. 1845, this bill recognizes that competitive bidding would have negative impacts on consumers by limiting their choice of provider and limiting access to high-quality products and services. So far, H.R. 2231 has garnered 18 cosponsors. It has been referred to the House Subcommittee on Health. --H.R. 621 and its Senate companion, S. 1484: The Home Oxygen Patient Protection Act would amend provisions in the Deficit Reduction Act to eliminate the 36-month oxygen rental cap and restore ownership of equipment to home oxygen providers. The DRA, which moved Medicare home oxygen from continuous rental to a rent-to-purchase model, requires beneficiaries to assume ownership of equipment after 36 months of rental. "Under the Deficit Reduction Act of 2005, Congress merely considered the economic issues of home oxygen therapy, and not the clinical aspects. This legislation to repeal this provision of the DRA is in the best interest of patients, the medical community and Medicare," said Rep. Tom Price, R-Ga., a physician who introduced the House bill. "Home oxygen therapy provides an essential benefit to our seniors. Medical oxygen is complex and highly regulated, and requiring Medicare beneficiaries to own this equipment for their therapy raises numerous health and safety concerns." Cosponsors for H.R. 621 currently number 112; the bill has been referred to the Subcommittee on Health. The Senate bill has five cosponsors and has been referred to the Senate Finance Committee. --H.R. 2567 and its Senate companion, S. 870: The Home Infusion Therapy Medicare Coverage Act would amend the Social Security Act to extend coverage for home infusion services to Medicare beneficiaries, a benefit currently available to most patients in the private sector. This measure would require infusion supplies, equipment and professional services to be covered under Part B, with drugs covered under Part D. When Congress passed the Medicare Modernization Act in 2003, lawmakers added coverage for home infusion drugs. But according to advocacy groups, CMS interpreted the law to cover only the drugs and not the services and supplies associated with home infusion. The House bill has 28 cosponsors and has been referred to the Subcommittee on Health. Its Senate companion bill has been referred to the Senate Finance Committee. --H.R. 1809: The Medicare Independent Living Act of 2007 would eliminate Medicare's "in the home" restriction for coverage of mobility devices for individuals with expected long-term needs. Its authors, Reps. Jim Langevin, D-R.I., and Jim Ramstad, R-Minn., said the bill would improve community access for beneficiaries with mobility impairments by removing a restriction that bases coverage of mobility devices solely on an individual's mobility needs inside the home. According to Langevin, the "in the home" statutory language was originally meant to define durable medical equipment as devices that were provided outside of a hospital or skilled nursing facility and, therefore, warranted separate reimbursement under Medicare Part B rather than Part A. However, Langevin said, over time Medicare "has chosen to interpret this language in a way that restricts coverage of mobility devices to only those that are reasonable and necessary in the individual's home." The bill has bipartisan backing from 29 cosponsors and has been referred to the Subcommittee on Health. For the full text of these bills or others from the 110th Congress, click here. Providers Must Head Off SCHIP Provisions, HME Lobbyists Say ATLANTA--When Congress returns to Washington in September, the House and Senate will put together a conference committee to hammer out a compromise bill on the State Children's Health Insurance Program, or SCHIP. Just before adjourning for their August recess, House members passed the Children's Health and Medicare Protection Act (H.R. 3162) to expand the children's insurance program, which covers low-income children whose families don't qualify for Medicaid. (See HomeCare Monday, Aug. 6.) Known as the CHAMP Act, the $50-billion bill would be financed by a 45-cent tobacco tax and Medicare cuts. Within the latter, the bill carries two onerous provisions for HME providers: an 18-month cap on oxygen rental (with the exception of new technology) and elimination of the first-month purchase option for power wheelchairs. The Senate also passed a version of the bill, but its $35-billion SCHIP expansion would be financed by a tobacco tax of 61 cents and includes no Medicare issues. According to Cara Bachenheimer, senior vice president of government relations for Invacare, Elyria, Ohio, it's unlikely that a workable compromise can be reached because of the vast political, policy and budget differences in the two versions of the bill. In addition, President Bush has said he will veto any version of SCHIP expansion that costs more than $5 billion. That means, Bachehheimer said, the more likely outcome in Congress' wrangle over SCHIP could result in a small reauthorization of the program, which is set to expire Sept. 30, funded by a small tobacco tax. However, she stressed, that doesn't mean the industry is off the hook. Along with SCHIP, all of the industry-related bills Congress may consider are critical to the health not only of Medicare beneficiaries but also HME providers (see "Key Industry Bills Await Congressional Action" in this issue). Bachenheimer urged stakeholders to seize the opportunity to educate lawmakers about HME while Congress is in recess. In terms of legislators' understanding of the issues, she continued, "There is no question that as an industry we are light years ahead of where we were five years ago, but you can never do enough." The target on the industry's back won't go away until "policymakers are sure they are paying appropriately" for DME, she said. Seth Johnson, vice president of government affairs for Exeter, Pa.-based Pride Mobility Products, said now is the time for HME providers to attend the town hall meetings legislators traditionally sponsor during the recess or invite lawmakers to visit their businesses so they can learn more about the products, the industry and the people it serves. Because it is hard to predict what might happen when Congress takes up the SCHIP legislation, Johnson said, it is crucial that providers talk to their legislators about getting the HME provisions excluded from the bill that will emerge from the conference committee. Both Johnson and Bachenheimer said federal lawmakers pay attention when they hear from a number of constituents on any issue. "When they get 20 phone calls, it can make a difference," Bachenheimer said. "The future of our industry and the future of this legislation is dependent on our grassroots efforts during August," Johnson said. To contact members of Congress, call the U.S. Capitol switchboard at (202) 224-3121. Invacare Enters Portable Concentrator Market ELYRIA, Ohio--While its HomeFill oxygen system has gained 12 percent of the transfilling sector, according to Invacare officials, the company plans to launch an alternative this fall with its first portable oxygen concentrator. Acknowledging that it is coming late to the market, Nancy Smoot, product manager, said the new Invacare Portable will be attractive to users because "it is small, lightweight and inconspicuous." Providers may take to the product, she said, because of its clinical performance and reliability. The new Portable has a five-year warranty, and its compressor is designed to last 15,000 hours. Pricing for the unit will be similar to that of the HomeFill, Smoot said. While the new POC can be sold for cash, Invacare will apply for both portable and stationary coding. "It was devised so providers can use it as they want," Smoot told reporters during a press briefing last week. At six pounds, the unit has a pulse dose delivery system with an integrated conserver that will keep patients saturated at all settings, Smoot said. The company decided not to incorporate continuous flow delivery in order to keep the unit's size small, an important feature to patients. But "there's more bolus at each setting," Smoot explained, which means the concentrator should keep up with oxygen demand at any setting or activity level. Simple operation, which patients want, and minimal components, which providers want, should also boost the product's appeal, she added. Invacare plans to conduct a study comparing its new portable to others already on the market, including AirSep's FreeStyle, Inogen's Inogen One and Respironics' EverGo. The company will also conduct a study to determine whether the unit is appropriate for nighttime use. Because clinical profiles for patients choosing a transfilling system or a POC may be similar, Smoot said, it could come down to a lifestyle decision for the patient or a business decision for the provider. Classified as "oxygen-generating portable equipment," both products would be exempt should either President Bush's proposal for a 13-month rental cap on traditional oxygen technology, or the House proposal for an 18-month cap, make it through Congress. Once the new portable receives 510(k) clearance, Smoot said, the company will begin taking orders and shipping could start before year's end. Invacare will also apply to the FAA and airlines for clearance of the unit in flight. Joe Lewarski, Invacare's vice president, respiratory products, said consumerism is playing a definite role in development of all the company's new products. In the case of the Invacare Portable, for example, "we still have a large ... COPD population moving into the Medicare ranks," he said, noting that patients or family members might buy a POC simply "to make life a little easier." At its annual Media Day Aug. 15, Invacare also unveiled a raft of other new products, including additions to its TDX line of power wheelchairs, along with its new marketing campaign: "Impossible Stops Here." According to Lou Slangen, senior vice president of worldwide market development, the campaign highlights the company's newest products and programs, which are designed to help providers survive HME's trying times. "You hear a lot of times from providers that 'This is impossible' and 'I can't get through any more under the new reimbursement," he said, but "to survive requires action." Pulse Oximetry Market to Grow 150 Percent by 2013 PALO ALTO, Calif.--The U.S. market for pulse oximetry is set to grow more than 150 percent over the next six years, with both hospitals and alternative markets like home care driving the expansion, according to a recent report. Frost & Sullivan's "U.S. Pulse Oximetry Monitoring Equipment Market" found that the market earned $201 million in 2006 and estimates that it will hit $310 million in 2013. According to the report, miniaturized pulse oximeters with telemetry and/or data recording capabilities will generate revenues in non-traditional segments like home monitoring, while versatile bedside oximeters are likely to grow in hospitals' low-acuity floors. "The home monitoring market is witnessing a boost in demand for handheld and finger pulse oximetry," said Frost & Sullivan research analyst Mike Arani. "Also, due to the low cost and ease of use, finger pulse oximeters are being promoted in non-clinical markets such as fire rescue and military." The low prices of OEM SpO2 boards and reduced replacement rates of hand-held and finger units could limit the total market revenue growth, the analysis found. The market may also be restricted in the hospital segment by a high level of maturity coupled with budget limitations. Looking into niche markets outside traditional health care and offering cost-optimized monitors will help improve oximeters' uptake, the research firm said. High-end products like modular monitors were noted as promotable because they are highly versatile as well as upgradeable. New modular monitors can be used as bedside or portable systems with telemetry data communication capabilities, and also by hospitals to control costs in the long run, the report said. NSC Introduces the PTAN COLUMBIA, S.C.--In its latest newsletter, the National Supplier Clearinghouse introduced the Provider Transaction Access Number, an identifier that suppliers will use when contacting the NSC or the DME Medicare Administrative Contractors with general inquiries. "Just when you thought there could not possibly be another acronym to memorize, here comes the PTAN," the NSC said. The NSC explained that the PTAN--previously known as the supplier number or legacy number--will no longer be used in billing because CMS will soon require suppliers to bill Medicare using only their new National Provider Identifier, or NPI. However, the NSC said it will continue to issue supplier numbers called PTANs that will be used "to access various IVR functions and should be referenced when submitting written inquiries to or contacting the NSC or DME MACs." To access the newsletter, which also explains differences in the DMEPOS enrollment and accreditation processes, click here. In Brief Earlier this month, Tevi Troy was sworn in as HHS' 23rd Deputy Secretary. Troy had been Domestic Policy Council Deputy for President Bush. According to reports, in previous roles in the government's executive and legislative branches, Troy has led initiatives related to health IT, public health and childhood obesity, food and drug safety, welfare and family and community service programs. Life expectancy in the United States has slipped below that of people in 41 other countries, according to an Associated Press report. While Americans now live to 77.9 years, that life expectancy ranks 42nd, down from 11th two decades ago. The report said factors contributing to the slide include a lack of health insurance for 45 million Americans, the nation's high obesity rate and the high percentage of babies that die before their first birthday, among others. Andorra has the longest life expectancy at 83.5 years, the report said, while Swaziland has the shortest, at 34.1 years. Other countries that surpass the U.S. include Japan as well as most of Europe, Jordan, Guam and the Cayman Islands. As hurricane season begins, forecasters are already predicting a stormy and active year. To help seniors take the proper safety measures, the American Geriatrics Society urges developing an emergency plan, including knowing where to turn for medical care. The AGS also advises stocking an emergency medical kit that includes a two-week supply of medications in original packaging; any medical equipment that might be needed, such as a blood sugar monitor, a blood pressure cuff, hearing aid batteries, an extra pair of eyeglasses, ice packs or an insulated bag for medications that require refrigeration; and basic necessities including water, non-perishable food, a complete change of clothes, blankets, phone numbers and identification papers, cash and basic hygiene products. To revisit this news any time during the week, go to www.homecaremonday.com. ADVERTISEMENT |
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