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Headline News
California Providers Go Above and Beyond in Responding to Massive Fires
SAN DIEGO--Wildfires fanned by ferocious winds charred much of Southern California last week, leaving behind death and massive destruction--and stories of efforts by home medical equipment providers to care for their patients.

In San Diego, even as their own location was threatened, Apria employees managed to deliver hundreds of products, including oxygen, to patients before having to flee the area themselves. In Santa Clarita, Shield Healthcare staff tracked down shipments of vital enteral nutrition products and delivered them to patients who had been displaced. In Santa Monica, Wishing Well Medical staff ramped up oxygen deliveries to those severely affected by the choking smoke and provided oxygen to patients who had been evacuated from their Malibu homes to lodging in hotels.

San Diego manufacturer SeQual Technologies loaned 35 of its Eclipse units to evacuees at the city's QualComm stadium--and sent a manager to train people on using the portable oxygen concentrator.

The fires, the first of which started in Malibu on Sunday, Oct. 21, raged across the southern part of the state and along the Mexican border, consuming more than a half-million acres and reducing about 2,000 homes to ashes. More than 500,000 people were evacuated from their homes; others experienced lengthy power outages brought on by the Santa Ana winds, which in some mountainous areas reached 100 mph.

As of Friday, seven people had died in the fires, and damage estimates topped $1 billion.

For HME providers in the affected areas, concerns centered on taking care of patients.

"We service more than 20,000 patients in the areas impacted by the fires, most of whom have been directly affected in some way, either by being displaced or having extreme smoke conditions around their home," said Apria's Steve Foreman, regional vice president of operations for Southern California, who coordinated the response from the company's 22 branch locations affected by the fires.

Apria implemented its disaster preparedness plan, which calls for contacting all critical care patients throughout the area. "We reviewed the evacuation shelter list and equipment needs with them, such as assessing the status of their back-up batteries and portable suction units. Then we contacted or attempted to reach all respiratory patients to make sure that they had adequate supplies until we could get to them," Foreman said.

At Apria's Riverside branch, which services many patients in the fire-stricken mountain community of Lake Arrowhead, "we did a pretty good job of reaching everyone," said branch manager Diana Castro. "We told them to take as much equipment as they could--but safety first--and whatever they didn't have, we'd take care of them."

One man who had been evacuated called the office in a panic. He'd fled with his CPAP but had forgotten his mask. "How am I going to sleep tonight?" he asked.

"You're going to come here and we're going to take care of you," was the reply. The man was given a mask.

At the San Diego Apria location, the situation was even more dire. "Our San Diego staff worked through the night to ensure that all deliveries were made and patients had an emergency contact," Foreman said. "This included making over 375 deliveries on Monday before our branch was given a mandatory evacuation order by fire authorities."

Forced to leave their business location, employees kept on, however. "Even though we had to close our San Diego office, we were able to handle our site, and we were still able to handle the phone calls," Foreman said, noting that Apria uses a Nextel communication system that allowed continued tracking of patients.

The San Diego fire even affected Apria's Tustin branch. An assisted living facility in Laguna Hills had contacted Apria for help. The facility had a sister complex in San Diego that needed to be evacuated. Patients would be transported to the Laguna Hills site, but they needed beds. Could Apria provide those beds?

"At first, I wasn't sure if we could fit the delivery into our schedule given the magnitude of the emergency facing our existing patients, but as soon as I mentioned it to my team, they wanted to help," said Foreman.

Tustin's branch manager, Kris Fishman, and his team took on the job. In three-and-a-half hours on Monday morning, he and four other employees assembled 30 beds; 15 others were ready to go. "We went down there and took care of it," Fishman said, adding that his team not only delivered the beds but prepared the rooms for the evacuated patients.

"The drivers delivered the beds well into the night and the patients were all transferred safely and without incident," Foreman said, noting that without the help of Fishman and his team, those patients might have had to be hospitalized or sent to an emergency room.

So many Apria patients were affected in the eastern part of San Diego County that the company staffed an Escondido shelter with a logistics manager and equipment to help its patients as well as some who were originally serviced by other providers, officials said. Ironically, Apria's own headquarters in Lake Forest were evacuated.

Meanwhile, in Santa Clarita, Paul Collins, director of client services for Shield Healthcare, found his corporate headquarters in the center of three fires. Forty to 50 percent of his workforce couldn't get to the office either because of road closures, evacuations or because all daycare services were closed.

"The good news is, we have a solid workforce of people who really care about our patients," he said, and everyone who could get there was there, willing to work the phones.

Because Shield handles ostomy and incontinence supplies, enteral nutrition and some wound care products that are regularly shipped directly to the patient, employees needed to ensure that those shipments had reached their destinations. "They really allow our customers to live their lives at home; without our products, they have to go to the hospital," Collins said.

Even as the flames flared visibly outside their windows, Shield employees tracked down and reshipped the vital products, Collins said. Sadly, he said, some of the original shipments had been lost along with the patients' homes.

In Santa Monica, Donny Albrecht, vice president of Wishing Well Medical, sought to get oxygen to Malibu patients who had been evacuated and also worked to care for those who live in Santa Monica.

"The air quality for people on oxygen is really tough for them," he said about the acrid smoke that lay heavy over the area. "It's increasing their need for oxygen."

It was also sparking a run on masks, he said, as healthy people sought to protect their lungs from the smoke-polluted air.

But even as the inferno raged, there were some heartening times.

"We had many people who called to see how our employees were doing," Collins said. "That really lifted their spirits and kept them motivated."

For his part, Foreman, who was once a firefighter, said, "I am so proud of our entire Southern California Apria team right now. It's the same kind of feeling I used to get when we beat back a wildfire--to know we are helping people cope with this crisis makes everyone feel good."

Others participating in the meeting included Alan Landauer of Landauer Metropolitan, AAHomecare chairman; Georgie Blackburn from Blackburn's Physicians Pharmacy, AAHomecare treasurer; and provider Don Bates from Fuller Rehabilitation in Ringgold, Ga.

SBA Appeal a Lost Cause, Provider Says
MIAMI--A Miami HME provider who appealed to the Small Business Administration for help in fighting competitive bidding said last week he is giving up on getting any support from that agency.

Rob Brant of City Medical Services in North Miami Beach said that he and other providers involved in the effort are now striving to generate support for H.R. 1845, the Tanner-Hobson bill, which would allow qualified providers who do not win a bid to continue to do Medicare business under the new competitive bidding rates.

"There is no place to go with the SBA," said Brant, who earlier this year mustered the support of more than 70 other small Florida providers and filed a formal complaint with the SBA ombudsman against the implementation of competitive bidding. The complaint charged that "CMS improperly interpreted the congressional mandate and did not provide the appropriate protection of small suppliers." (See HomeCare Monday, May 22.)

The agency has responded with form letters, including one from CMS, Brant said. "They say the complaint is unfounded, that it's fair for everyone," he said.

So Brant and his peers are taking another tack.

"We've been very focused on visiting congressmen and women about Tanner-Hobson and getting the word out to our patients about [the bill] and giving patients the toll-free switchboard line to Congress to say we are not happy about what is happening," Brant said.

"In every state where there is competitive bidding, I think every congressperson should sign on to Tanner-Hobson," he added. The bill has picked up 130 cosponsors, but needs more to move forward.

Like other HME providers in the first 10 cities where the bidding program is being implemented, Brant, who did bid, is in a holding pattern until the winners are chosen and the new allowables are revealed by CMS. Bid winners will be announced in March or April of 2008, the agency said at a recent meeting of the Program Advisory and Oversight Committee. The resulting reimbursements are set to take effect in July.

"We are just waiting to see what the allowables will be compared to other areas," Brant said. "Right now, we are trying to do as much business as we can while we still can."

Already, though, he is seeing an impact from competitive bidding. Some smaller providers have closed down, Brant said, and whether his company wins a bid or not, he anticipates big reimbursement cuts. So he is looking everywhere for business economies, even at service. "We used to visit patients every week. We can't do it anymore. We've told about three patients a month that we can't service them the way they are used to being serviced," he said.

Brant recognizes, he said, that the providers in the first round of MSAs are essentially guinea pigs. "The next 70 MSAs will benefit so much from the knowledge of what happens to us," he said. "They are having time to get accredited, trim the fat, gobble up the customers from businesses that are closing."

Still, he is hopeful that Tanner-Hobson will eventually pass and competitive bidding's impact can at least be blunted.

"We're going to keep plugging away and do what we can," Brant said. "We have eight months left 'til the end of the world."

HME Experts: Industry Must Shape the Future of Equipment Reuse
ATLANTA--It's an issue that can be sharply divisive in the HME industry: equipment reuse.

On the one hand, reuse can be viewed as a way to get much-needed equipment to people who would otherwise go without. On the other are warnings about the dangers of faulty equipment and undermining innovation from manufacturers who could be pushed out of the marketplace from payers who are not buying new.

Jeremy Buzzell, a program specialist for the Washington-based Rehabilitation Services Administration, works with grants and programs designed to help more people with disabilities get assistive technology through statewide programs. The RSA is a division of the Office of Special Education and Rehabilitative Services under the U.S. Department of Education.

Buzzell notes equipment reuse has been going on for a long time in many parts of the country, in some cases for up to 25 years. "It's something that vendors and manufacturers of durable medical equipment should be aware of," he said.

According to a study by the Rehabilitation Engineering and Assistive Technology Society of North America, there are 154 assistive technology reuse programs across the country this year. Of those, 60 refurbish assistive technology, 45 reassign it and 26 run an exchange program. Of the remaining programs, 11 refurbish, reassign and exchange devices; for the other 12, information is incomplete.

From October 2005 through September 2006, according to the RSA, 24 states reported the reuse of 5,602 devices. Of those, 678 were exchanged, 4,482 were reassigned and 442 were on long-term loan.

Buzzell said while reuse has been around for decades, what's new is RSA's focus on it, beginning in 2004 with the reauthorization of the Assistive Technology Act. The department also works in conjunction with President Bush's 2001 New Freedom Initiative, which, among other things, is intended to help people with disabilities get access to assistive technologies and promote increased access to community life.

Buzzell, who participated as a panelist in a Medtrade 2007 seminar on equipment reuse, said one of the concerns he hears from DME suppliers and manufacturers is that reuse will hurt their bottom line, not only by impacting new sales but from the fear of liability issues.

As far as DME reuse hurting provider sales, Buzzell said, "A majority of folks who go to a reuse program are uninsured, aren't qualified for Medicare or Medicaid or have no other option for DME, so [they] wouldn't be able to purchase DME anyway."

Regarding liability, Buzzell said his department shares that concern, which is why it has focused on ways to facilitate reuse correctly and build partnerships with DMEs.

According to Buzzell, there are many advantages to DMEs getting involved in equipment reuse. One is that they can collaborate with reuse programs to ensure outgoing equipment is in good condition. Another is that the programs offer a way for providers to get rid of excess stock.

They're also a donation venue: Providers can refer people who need equipment but can't pay for it to the programs, or donate equipment that was given to the provider because someone no longer needed it.

"Some of these programs benefit from vendors and manufacturers who just volunteer their time and their expertise," Buzzell says. "The most successful ones that we have seen are ones where there is some collaboration with the vendor community."

A national collaborative for reuse is the Pass It On Center, based in Atlanta. The center is also home to a national task force on the matter that includes members from universities and industry associations with a goal of "finding solutions to issues in AT reuse."

Rita Hostak, vice president of government relations, Sunrise Medical, Longmont, Colo., and president of the National Coalition for Assistive and Rehab Technology, was also a panelist at the Medtrade session. She said initiatives like the Pass It On Center will ensure that "issues are thoroughly investigated, data is gathered to support informed decisions and guidance is published that will go a long way in ensuring that reuse of DME is performed in a responsible way, a way that is sustainable, and that strives for a positive clinical outcome of each individual."

In addition, Hostak said, "The Department of Education, Office of Special Education and Rehabilitative Services is dedicated to making sure steps are taken to identify good service/delivery models."

It's not that simple, however. While noting the positive aspects of reuse--that, for example, valuable and useful equipment that might otherwise be abandoned somewhere can be given to people who are uninsured or under-insured--Hostak also identified "a number of logistical and financial issues" with the concept.

"If medical devices are not reassigned through a model that ensures positive clinical outcomes for the individuals it serves, then the good intentions are completely lost," she said. "In addition, there are FDA regulations that apply to medical devices which cannot be overlooked. Moreover, if re-issuing is used as a way to reduce health care budgets related to the provision of DME, then there is a whole new set of negative consequences for consumers, suppliers and manufacturers."

According to Hostak, the HME industry must be proactively involved in shaping the future of reuse.

"Reuse has the potential for doing harm to consumers as well as suppliers and manufacturers," Hostak says. "While there are dedicated and thoughtful people like those involved in the Pass It On Center and the national task force who are dedicated to investigating all of the important issues and gathering the type of data that will be necessary in controlling how reuse is applied, the industry must be engaged and equally as dedicated to ensuring the right outcome."

Hostak said "now is the time" to work to ensure that, if equipment is reused, it is "done appropriately and only in the right circumstances."

"We cannot just say no to reuse," she said. "It is already happening today to a much greater extent than most people are aware."

To find a state reuse program, click here.

To visit the Pass It On Center Web site, go to www.passitoncenter.org.

Coalition Says Health IT Legislation Needs Privacy Protections
WASHINGTON--Legislation introduced in the Senate and the House to hasten the implementation of a national health information technology system doesn't have enough privacy protections, a group of advocates said Thursday.

The Coalition for Patient Privacy said in a statement that the Wired for Health Care Quality Act (S. 1693), pending consideration by both chambers last week, "does not recognize or protect Americans' right to health privacy."

"In fact," the group continued, "the bill authorizes the Secretary of Health and Human Services to issue standards eliminating the individual's right to health privacy without even providing an opportunity for public comment."

S. 1693 was introduced by Sen. Ted Kennedy, D-Mass., chairman of the Senate Health, Education, Labor, and Pensions Committee. The committee approved the bill June 27. A companion bill was introduced in the House on Oct. 10.

Earlier this year, Kennedy and Sen. Patrick Leahy, D-Vt., introduced the Health Information Privacy and Security Act of 2007, a bill designed to create tighter HIPAA rules, giving patients the power to decide when, and to whom, their health information is disclosed (see HomeCare Monday, Aug. 27).

The coalition wrote in a letter last week to Rep. Neil Abercrombie, D-Hawaii, senior member of the House, that, "despite the good intentions of the Health Insurance Portability and Accountability Act and its 'Privacy Rule,' the current regulations leave all Americans' personal health information completely vulnerable and exposed.

"State laws, common laws and the Constitution are there for protection," the letter continued. "Yet the HIPAA 'Privacy Rule' is really a 'Disclosure Rule' that authorizes more than 4 million entities to use and disclose an individual's health information. This disclosure is without the individual's consent and over their objections."

The letter references a 2006 Markle Foundation survey that found three-fourths of Americans "want Congress to ensure that our right to health privacy is protected in electronic systems and that electronic health databases and systems are truly secure." It also notes a Health Industry Insights Poll that found 86 percent of American consumers "are somewhat or very concerned about the health industry's ability to protect the privacy of personal health information in deploying electronic health records (EHRs)."

"Medical care is one of the most intimate, personal services in every individual's life ... Infringements on that relationship are among the most destructive things the state can possibly do to its citizens," William Westmiller, national chairman, Republican Liberty Caucus, one of the advocacy groups involved in the coalition, said in a statement regarding the bill. "Every patient has a right to absolute privacy and totally confidential treatment, just as fundamental as the right to their own life."

To view the text of S.1693, go to http://thomas.loc.gov.

In Brief
With less than three months to go before the first presidential primaries, a Kaiser poll found the top issues Americans most want to hear the candidates talk about are Iraq (44 percent), health care (38 percent), the economy (18 percent) and immigration (12 percent). While Democrats, Republicans and Independents all ranked health care as a top priority, the poll did find a gender gap over its importance: Nearly half (45 percent) of women named health care as one of the top two issues in the race for the nation's top job compared with only three in 10 men. The split exists among Republicans and Democrats alike, according to the poll.

A Wall Street Journal report last week noted that IBM plans to offer employees a financial incentive for their children to take part in obesity education. The company said it will pay $150 to its employees whose children complete the 12-week online program of diet and exercise.

Click here to view a transcript from the Sept. 12 meeting of the Medicare Evidence Development and Coverage Advisory Committee, which convened to hear public comments on changing CPAP coverage criteria to allow home testing. A proposed recommendation from MedCAC is expected on Dec. 14.

Coming Up
Have lunch with Louis from 11:30 a.m. to 1 p.m. ET on Nov. 1, 8 and 15! Grab a sandwich (or morning coffee if you're on the West Coast) and gather around the speakerphone for the first complete Sales Training Strategies program presented as a live teleconference series with HME sales training guru Louis Feuer, Dynamic Seminars & Consulting. Don't let competitive bidding and constant industry changes allow you to lose focus on what builds business--a well-trained sales team. With three individual sessions, it's never been easier and more convenient to train your sales staff. You need them now more than ever. Sponsored by HomeCare. For more information, click here or call (954) 435-8182.

The West Virginia Medical Equipment Suppliers Association (WVMESA) will hold its Fall Conference Nov. 6-7 in Charleston, W.Va. For more information, call (304) 344-5320.

The Ohio Association of Medical Equipment Services (OAMES) will hold its 27th Annual Meeting Nov. 7-8 in Columbus, Ohio. For more information, visit www.oames.org or call (614) 876-2424.

November 14 is World COPD Day. For details, visit the Global Initiative for Chronic Obstructive Lung Disease at www.goldcopd.org.

The American Physical Therapy Association (APTA) will hold its Preview 2020 conference Nov. 16-18 in Phoenix. For information, visit www.apta.org or call (800) 999-2782.

National Family Caregiver Month is observed each November to draw attention to the challenges facing more than 50 million family caregivers across the nation and to advocate for stronger public policy to address family caregiver issues. For more information, visit www.thefamilycaregiver.org or call (800) 896-3650.

November is National Home Care and Hospice Month, "to honor health care administrators, nurses, clinicians, therapists, aides, homemakers, chore workers and companions who make a remarkable difference in the lives of patients and their families," according to the National Association for Home Care and Hospice. For information, visit www.nahc.org.