HME News

MAR 2017

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 22 WWW .hm E n EW s. CO m / m A r C h 2017 / hm E n EW s f ARMERS BRANCH, Texas – CCS Medical's dia- betes education program CCS Connects has been named a Diabetes Education Accredi- tation Program by the American Association of Diabetes Educators. CCS Connects uses health risk assessments and smart devices to collect real-time data, and also uses wire- less glucose technology and clinical monitor- ing. CDEs interact with members every three months to provide ongoing education and coaching focused on nutrition, product train- ing, behavioral changes and goal setting. "If we can increase high-risk member awareness to their condition, diagnosis and self-manage- ment principles, we can reduce diabetes-relat- ed ER visits and hospitalizations," said Kristine Erdman, vice president of clinical services for CCS Medical. CCS Medical is a mail-order provider of diabetes supplies, insulin pumps and continuous glucose monitors. hme CCS Medical diabetes program earns DEAP accreditation caused by the Cures bill," he said. Also last week, o ption Care, a leading home infusion provider, along with n HIA and other industry leaders, launched Keep My Infusion Care at Home, a coalition charged with sharing stories of the impact of the changes, all with the patient front and center. "These are patients that are late stage heart failure patients, or awaiting trans- plants or other procedures," said Paul Mastrapa, C eo of o ption Care. "The website for Keep My Infusion Care at Home makes it very easy for all involved to help make sure their representatives in Congress hear about this and address it as quickly as possible." There is already a "lot of noise" on the Hill about the payment gap, says Mastrapa. "Leadership in the House and Senate are on record as recognizing that this is a prob- lem and they are committed to fixing this issue," he said. hme o ption Care. "We are working with patients to get them referrals." The provider is still caring for its active patients, he said. As of Jan. 1, per a provision in the 21st Century Cures Act, Medicare pays for Part B infusion drugs under an average sales price model, a move that reduces payments so drastically that, essentially, they no longer cover services. Another provision in the act provides payments for these services, but not until 2021. In n ew York state, which has a heavy man- aged care penetration, the impact has been milder, but no less challenging. "We always do a case-by-case analysis," said Gregory LoPresti, senior vice president and C eo of Clinton, n .Y.- based Upstate HomeCare. "We try to work with the patient; we try to get them on cheaper drugs." L o P re s t i h a s b e e n expecting the change since at least last summer. "It's never a good thing to have a unilateral change where they cut the drugs and they know there's a technical component to this," he said. "It's irresponsible." The home infusion industry has made inroads in the past year or so in its years-long PATIENTS c o n t i n u e d f r o m pa g e 2 1 quest for better Medicare coverage, but really needs a long-term solution, says Mastrapa, "We have to clearly articulate and share what is the value of what we do," said Mas- trapa. "Any provider now matter how big or small, needs to take up arms to address this." hme IN fu SION GAP c o n t i n u e d f r o m pa g e 2 1 In the ruling, CMS set a one-time fee of $236-$277 for the device itself, plus a bun- dled monthly payment for related supplies. The question now is, how do providers bill Medicare for CGMs? Because existing HCPCS codes include all CGMs, Brummett thinks the Dexcom G5, the only CGM to currently meet CMS's definition as "thera- peutic," would need to be billed with a mis- cellaneous code—like e 1399—and would need to be documented somehow in the claim. e ven once all the details are worked out, providers say they will proceed with caution. "This is a complicated issue that I have not had the time to evaluate fully yet," said Lisa f eierstein, president of the Raleigh, n .C.- based Active Healthcare. "My major concern is that the cumulative revenue gained from handling CGMs may not be worth the poten- tial audit risk." All agree, however, that this is a step for- ward in diabetes treatment and, while the Dexcom is the only CGM to currently meet CMS's definition, the ruling will likely open the door for other devices. "I suspect that as other devices achieve the same label from the f DA, they would be able to qualify for the same benefit," said Bennet Dunlap, a patient advocate and founder of the Diabetes Patient Advocacy Coalition. "I think it will be major step toward acceptance of the technology." hme CGM S APPRO v E d c o n t i n u e d f r o m pa g e 1 Greg LoPresti medtrade booth 835

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