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Rx and Specialty Providers hme news / August 2015 / www.hmenews.com 17 By Theresa FlaherTy, Managing editor W ITH All the hullabaloo these days surrounding ventilators, it's a good time to look at how far the technology has come in the past 25 years, says Dr. Roy Maynard, medical director for Roseville, Minn.-based Pediatric Home Service. Right alongside the advances in technol- ogy are advances in home care, he says. "First and foremost, people are willing to take the kids home because we have the technology," he said. "Children do well if they are nurtured at home." out of sync Initial infant ventilators were very simplis- tic, says Maynard. you set the respiratory rate on the vent, but it didn't synchronize with the baby. "The baby couldn't trigger a breath," he said. "you just had to hope that when a baby took a breath, the vent happened to Home care, vents advance in tandem be cycling at the same time. Imagine trying to take a breath and waiting for the vent to give you that breath." no Pressure Hospital-based vents run off high-pressure systems, which of course families don't have at home, says Maynard. That limited who could be sent home. "We had really specific limitations, depending on the oxygen requirements of the child," he said. "We wouldn't send kids home unless they were at 30% or less oxy- gen, because you couldn't provide enough oxygen." heAVy loAd Families also struggled with the old tanks, which weighed more than 100 pounds. Today's vents are portable, which has made a huge difference in the lives of patients, says Maynard. "These devices get smaller and smaller," he said. "They have little turbines inside these little boxes to generate the fow." Batteries are smaller and lighter, too, and the patient can get anywhere from four to 12 hours of use, says Maynard. QuAlity of life vents can be matched to a child's needs, and they have alarm systems in case of a problem. That gives kids the freedom to be, well, kids, says Maynard. "We have lots of kids who are depen- dent upon their mechanical ventilation," he said. "They are not out playing football, but they are watching the football games, they are going to school every day, and they are learning and out in the community." HME From the oldest (right) to the new- est (bottom), vents have come a long way for patients, say providers. "If you are dumbing down the codes, maybe you can use a lesser product for that patient, and it's really not meeting their needs," said Bill Hart, director of clinical ser- vices for Auburn Hills, Mich.-based Advent Home Medical. "Maybe there need to be more codes and, depending on the patient, maybe there needs to be a higher reimburse- ment for a particular diagnosis." CMS's proposal is driven by a spike in the use of non-invasive ventilation to treat sleep apnea—something that should rarely hap- pen, say providers. "We use non-invasive vents very specif- cally for neuromuscular and CoPD patients where, clearly, standard Bi-level is not work- ing," said Brian Simonds, director of Baystate Home Infusion & Respiratory Services in Springfeld, Mass. "We should have very low use of NIv for strictly sleep related issues." At the end of the day, CMS could solve a lot of problems if it provided clear guidelines on use of vents, say providers. "They need to develop, with industry input, an appropriate local coverage determi- nation and pay appropriately," said loPresti. "They are stuck on paying too much money rather than (solving the problem)." HME ASP model instead. However, even the oIg noted that it hadn't factored in the services, says NHIA. "If you (interrupt access), patients will be moved into skilled nursing facilities, which is more expensive," said van Pool. "By changing the drug rates and saying, 'oh, we're on pace to save all this money,' it's not a full picture of what's going on." Besides overlooking the cost of servic- es, the ASP model also doesn't allow for a differentiation of types of consumers, say stakeholders. "Hospitals pay far less than a home infu- sion provider," said David Franklin, presi- dent of Advanced Care Consulting Servic- es. "ASP generally is far less than acquisi- tion costs for a home infusion provider. They simply can't do it." NHIA is no stranger to educating law- makers on the value of home infusion. It has been working since 2006 to cre- ate a meaningful beneft for the therapy, most recently with "The Medicare Home Infusion Site of Care Act of 2015," intro- duced in both the House and Senate in February. "We're working with the Senate where there is a better understanding of these issues," said van Pool. "This is not a new issue for us and the Care Act can fx the problems the oIg pointed out, but do it the right way." HME LIBeRATOR C o n t i n U e d f r o M pa g e 1 veNTS C o n t i n U e d f r o M pa g e 1 6 INfuSION STAkeHOLDeRS PuSH BACk ON PROPOSAL C o n t i n U e d f r o M pa g e 1 6 arrangements with Coloplast. There are several charges outlined in the complaint, including: liberator received remuneration in the form of advertising expenses for certain Coloplast products; received free inventory in exchange for not using the products of competitors; and received a "back end" rebate of 30% for patient conversion growth. "generally speaking, rebates are prob- lematic under federal law," said Caesar. "With a rebate, you are rebating for results." A r r a n g e m e n t s i n which manufacturers provide incentives to promote their products are fairly common in the retail world and are called co-op marketing agreements, says provider Tom Wilson. "The key thing is manufacturers have to offer terms and conditions that put retail- ers on a level playing feld," said Wilson, president of The Caregiver Partnership and a former high-level Kimberly-Clark execu- tive. "If Walmart can justify that it costs 10% less to do business with them because of their scale, then the manufacturer might be able to give them a slightly better deal." The existence of such a complaint doesn't automatically mean liberator is doing anything wrong, caution attorneys. "There's no evidence at this point that this is even going to turn into a lawsuit, let alone that liberator is going to be found guilty," said Caesar. "It's possible that if the investigation continues we'll fnd that things are fne or that a whistleblower was overly infamed for who knows what reason." liberator Ceo Mark libratore said he couldn't comment on the investigation, but a 10-Q report stated that the company is cooperating fully. 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