HME News is the monthly business newspaper for home medical equipment providers. This controlled circulation publication reaches 17,100 home medical equipment services providers, including traditional HME dealers & suppliers, hospital- and pharmacy-o
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Rx and Specialty Providers 16 hme news / August 2015 / www.hmenews.com DOJ investigates Liberator Medical 1 Study criticizes bidding program 16 Q&A;: Telcare CEO Andy Flanagan 16 NHIA pushes back on ASP 16 ■ ■ Advances in technology have enabled advances in home care, says Roy Maynard of Pediatric Home Service. See story page 17. By Theresa FlaherTy, Managing editor WASHINGTON – The House of Representatives on June 17 passed a bill that included a provision that would switch payment for Part B home infusion drugs to an average sales price model—a model that is unsus- tainable, say infusion stakeholders. "The services that are associated with Part B infusion drugs are not refected in the policy lawmakers are moving forward," By Theresa FlaherTy, Managing editor WASHINGTON – Higher rates of hospitaliza- tions and deaths among Medicare benef- ciaries whose access to diabetes supplies was disrupted in Round 1 competitive bid- ding areas is a "tragic" outcome of the pro- gram, say stakeholders. "It's clear that the disruption of access has thrown many chronically ill seniors into non-compliance with their self care," said Tom Milam, an industry consultant and former provider. "It's tragic." A study recently presented by the National Minority Quality Forum found the number of deaths was nearly twice as high in bid areas compared with the rest of the Medicare population (102 vs. 60), and nearly 1,000 benefciaries in bid areas were admitted to the hospital compared to 460 benefciaries in non-bid areas (at a cost of $10.7 million vs. $4.7 million). The study uses CMS's data but comes to a vastly different conclusion than the agency, Milam says. "Using CMS's own data, these scientists By Theresa FlaherTy, Managing editor T eCHNology IS changing the way people manage their health, says Andy Flanagan, Ceo of Telcare, which recently received FDA clearance for its cellular blood glucose meter with cloud functionality. HMe News spoke with Flanagan recently about the ben- efts of technology and how he sees it bending the cost curve for diabetes care in the U.S. HME NEws: How does the Telcare sys- tem work? Andy Flanagan: As soon as you pull the blood glucose strip, the device trans- mits the data to the cloud, which imme- diately sends the data back to a mobile app on your phone. There's no synch- ing, no cables. It could show up on your family phone; it could be sent to your physician or your spouse. our app also allows you to input exercise, carb counts and dosage, and take input from other sources, like Fitbit. We're trying to simplify life for somebody living with diabetes with as few touches as possible. HME: Is it easier to intervene when data is viewed in real time? Flanagan: The real value is when there's a data point that indicates a pattern of high low glucose or someone is just having a hard time. It arrives in a period of time where you can do something to intervene and prevent a hospitalization. It also reinforces the connection that, if someone's watching, I'll behave differ- ently than if no one is watching. HME: Are payers willing to pay for technology? Flanagan: More often than not, payers are paying more for value adds, espe- cially in diabetes, and trying to be more proactive. We're not trying to do some- thing foreign; we have reinvented the legacy blood glucose meter for the next generation. HME: Telcare recently conducted a sur- vey in which 63% of respondents don't know the difference between Type 1 and Type 2 diabetes Did that surprise you? Flanagan: I was surprised it was so high. We want to make this an open topic. That kind of percentage shouldn't exist when we are talking about $245 billion in medical costs and reduced produc- tivity. HME: How can technology reduce costs those costs down the road? Flanagan: I do believe that this type of innovation provides both direct medi- cal expense reductions for the U.S. and increased awareness of the costs of dia- betes. People are open to the idea of innovative technology to help close this gap. HME By Theresa FlaherTy, Managing editor E veRyoNe AgReeS there need to be changes to the vent product category, but they don't agree on how. "CMS uses a blunt tool to cut, indiscrimi- nate of care," said gregory loPresti, Ceo of Upstate Home Care in Syracuse, N.y. "We know that in the case of AlS and other neu- romuscular patients, non-invasive vents keep them out of the hospital longer." CMS in June announced that it wants Bidding study rallies diabetes stakeholders Technology targets better blood glucose Vent category needs work, providers say NHIA pushes back on ASP have looked at the data and have come to the same conclusions we predicted four and fve years ago," he said. Competitive bidding not only fails to save money, but the program's low reimbursement means benefciaries, in many cases, must use lower quality products, which can affect compliance, says provider gene Ray. " W h y d i d these benefi- ciaries die?" said Ray, presi- dent of South- ern Diabetic in Memphis, T e n n . " W a s it because they couldn't get the products or they got non-quality products? Who's responsible?" The study also found that the number of benefciaries who experienced access diff- culties increased 23% in bid areas vs. 1.7% in non-bid areas. "By eliminating 90% of the suppliers they have restricted and limited access," said Milam. "It's not a coincidence." HME "Using CMS's own data, they have come to the same conclusions we predicted years ago." tom milam to overhaul the product category by creating two new codes for vents (one for non-invasive and one for invasive) and discon- tinuing fve existing codes (e0450, e0460, e0461, e0463, e0464). While some providers say switching to two codes could stream- line certain processes, others worry that grouping products with varying degrees of sophistication under one code could make it harder to get the best equipment said Kendall van Pool, vice president of legislative affairs for the National Home Infusion Association. "If this becomes law, home infusion providers would be drasti- cally under-reimbursed." Home infusion drugs are currently paid using an average wholesale price model. An April report from the offce of Inspector general stated that CMS could have saved $251 million over 18 months if it used an Revising codes, establishing guidelines good place to start v e N T S S e e pa g e 1 7 I N f u S I O N S e e pa g e 1 7 Greg LoPresti Briefs heritage Valley offers infusion patients choices BeAveR, Pa. – Heritage Valley Health Sys- tems has teamed up with Chartwell Penn- sylvania to offer home infusion therapy, according to a story in the Beaver County Times. The partnership will give patients more choices when it comes to care, Bryan Randall, CFO of Heritage Valley, an integrated healthcare delivery network, told the newspaper. Based in Crafton, Pa., Chartwell offers infusion therapy and spe- cialty pharmacy services in Pennsylvania, West Virginia and Ohio. sleep portal seeks users WASHINGTON – Web-based community portal MyApnea.org is recruiting patients, caregivers and those at risk for sleep apnea to share information, support and research about the disease. Initially, researchers will focus on questions and results that are most important, practical, and empower- ing to those impacted by sleep apnea. "By having large amounts of data provided by and for us, we can now drive the research agenda," said Kathy Page, who has sleep apnea and is a member of MyApnea.org's Patient Engagement Panel. MyApnea.org is the public face of the Sleep Apnea Pa- tient Centered Outcomes Network. tricare implements new breast pump policy fALLS CHuRCH, va. – Service members and their spouses will be able to receive free breastfeeding supplies, lactation services, and any manual, electric or hospital grade breast pump under a new policy. Those who purchased a breast pump or other supplies covered by the policy on or after Dec. 19, 2014, can also seek reimbursement. The policy was implemented July 1, 2015. negative pressure wound therapy poised for growth LONDON – The global market for negative pressure wound therapy will expand from $700 million in 2014 to about $1.07 bil- lion by 2021, representing a compound annual growth rate of 6.2%, according to new research from consulting frm Global- Data. The increase will be driven primarily by increasing physician awareness of the technique and its various applications, ac- cording to the frm. nst taps new VP CONCORD, N.H. – National Sleep Therapy has named Kelly Bacon as vice president of operations and resupply. Bacon will oversee NST's customer service and re- supply teams in Maine, Massachusetts, New Hampshire and Vermont, according to a press release. She has worked in the DME feld for most of her life, but has also worked in the fnance and mortgage indus- tries. "I'm excited to be an integral part of such a dynamic, pioneering and visionary company," said Bacon. NST made Inc. Magazine's 5000 list of one of the fastest growing private U.S. companies.