HME News

AUG 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 18 www. H menew S . CO m / au G u S t 2017 / H me new S p ORT ST. LUCIE, Fla. – Mail-order supplier Lib- erty Medical in late June was expected to close on a deal in July to sell the majority of its assets. If the deal closes, the company will lay off 263 employees Aug. 27, according to a local news report. Among the affected posi- tions: president, chief financial officer and director of human resources. Liberty has undergone much turmoil over the past few years. In December 2012, a group of Liberty executives bought the company from its parent company, Express Scripts. Two months later, in February 2013, it filed for Chapter 11 bankruptcy. It cited a dispute with Express Scripts over tax liabilities and a significant recoupment by Medicare among its liabilities. Liberty settled with Medicare in Octo- ber 2014, paying $32 million. That same month, a bankruptcy judge approved a stalking horse bid for Liberty's assets. It was acquired for $68.5 million by Palm Beach Capitol. t welveSt O ne D raw S $3.5 m I n fun DI n G m URFREESBORO, Tenn. – TwelveStone Health Partners, a provider of pharmacy, infusion and enteral, respiratory and DME services, has secured $3.35 million in funding from Nashville, Tenn.-based private-equity firm Claritas Capital. "We have been wanting to accelerate our expansion plans for some time, and Clari- tas Capital offers the smart money, speed to market and accountability we had been looking for," said Shane r eeves, CEO of TwelveStone. TwelveStone plans to use the funds to expand from its primary base in middle Tennessee into Chattanooga, where it plans to open a pharmacy and infusion center. The company also plans to add an infusion center to its company headquarters here. Additionally, TwelveStone plans to take its MEDIpack packaged medication offering nationwide and to invest in an end-to-end tech platform to support post-acute chron- ic care management. "TwelveStone under- stands the post-acute care market like no other, and it's where the growth of health- care is heading," says John Chadwick, a partner and founder at Claritas, which represents more than 50 companies and oversees $6 billion in aggregate financing. TwelveStone was formed in 2016 when r eeves-Sain retail pharmacy and Entrust, its specialty pharmacy, were purchased for $66 million by Fred's, a rural retail phar- macy organization. TwelveStone emerged from the remainder of the r eeves-Sain busi- nesses. HME Liberty Medical shops for buyer real-life experiences. "We're trying to make a presence nationally, but people already know Laura," Yen said. "She's got a national fan base. She talks about things a nurse wouldn't necessarily be able to commu- nicate. We hope through our initiative, our brand will get out there more." Cox was hired four years ago after Shield Healthcare CEO Jim Snell saw an interview with her on the Comedy Central show "Tosh.0" with Daniel Tosh. The video, which takes place in a bathroom, shows Cox breezily chat- ting about using the bathroom, dating issues and misconceptions about hav- ing an ostomy. The company also provides breast pump and wound care supplies and last fall, it hired Aaron Baker as a spinal cord injury lifestyle specialist. "Our CEO has a heart for helping patients and end users," Cox said. "He saw a need there, and took a chance on me. I think it speaks a lot about how Shield values our customers, not just as a customer but as people." Shield's focus on expanding its expertise in ostomy and lifestyle care is the result of addressing a need in the market, Yen said. "There are Medicare patients that are dissatisfied by the level of service and someone. HME: What are the challenges that new ostomy patients have? Cox: It's a lot of lifestyle stuff. One is how do I shower, how do I swim? How do I keep my pouch from leak- ing? Some of it is related to intimacy, or how do I tell my friend? How do I build the confidence to go outside of my house? How do I make my life full with this new thing? They want to know they aren't alone. It's a wonder- ful additive to the clinical information that patients get. HME: Why is this platform so important to you? Cox: I feel really lucky to do what I do for Shield Healthcare. They discovered me when I was advocating for myself and we've been able to bring that to so many people. This is my life's passion—to help people. It's the reward of having some- one say, 'This helped me so much' or 'I went on an airplane for the first time in 10 years because I read this blog.' HME SHIELD RENEWS OSTO my p USH c o n t i n u e d f r o m pa g e 1 7 the limited product selection in a chal- lenging reimbursement environment," he added. "We are hoping to fill that gap." HME L AURA COX c o n t i n u e d f r o m pa g e 1 7 Many private insurers already pay for wigs, says Aframe, who said a high-quality syn- thetic wig costs around $350. While it's exciting that a bill as been introduced, there is a long road ahead to getting it passed, says Jensen. "We need to gain momentum with the House bill and then be able to get a Senate companion introduced, as well," she said. "We need to get the word out." Essentially Women will launch a grassroots campaign using email and social media to reach its members to raise awareness and gain support for H. r . 2925. Providers are encouraged to message their members of Congress. HME "The Value of r ehabilitation and Habili- tation Services and Devices" held by Sen. Tammy Duckworth, D-Ill., who sharply criticized the Senate healthcare reform bill unveiled June 22. "All of the problems with this bill are especially true for Americans with a dis- ability," said Duckworth on the call. "Over- all this bill would force working families to pay more money to receive significantly worse care." The three priority issues for amputees mirror those of other populations: no cuts to Medicaid that would curb access to treat- ment and devices; no waivers to services that are covered as an essential health ben- efit; and no changes to authorize higher premiums for pre-existing conditions, in this case, amputation. "We want to ensure that amputees will not be excluded from any insurance plans," said Michael Oros, president of AOPA, on the call. "It has been demonstrated that access to prompt and proper care can save lives and money." There are more than 2 million amputees in the u nited States, with 500 people join- ing those ranks each day due to vascular disease, cancer and trauma. Providing limbs ensures amputees will lead more productive lives, said Adrianne Haslet, a Boston marathon bombing survi- vor and world class ballroom dancer, who has become an amputee rights advocate. "In the past four and a half years, I have run a marathon on a blade, dove with sharks and danced again," she said during the call. HME The ability to provide products and ser- vices end-to-end also allows ASP Global to ensure product continuity, something that's becoming increasingly important as hospitals try to prevent readmissions, says Tritt. "Especially in the wound care space, hos- pitals lose control of the patient once they leave," he said. "They want to make sure the patient gets the same product, but that's dif- ficult if all the are doing is passing them on to anoth- er third party." The deal is part of a larg- er trend of manufacturers dipping their toes into the provider side of the mar- ket, with Coloplast buy- ing Comfort Medical and Domtar buying Home Delivery Incontinence Services, both in December 2016. "There's a lot of home care, and you com- bine it with the Internet in terms of more and more people buying online," said Tritt. "I think it will continue to pick up steam, which is why players are starting to get more into this." Professional Healing Solution's model of quality care—one built by two nurses—was a big draw for ASP Global, says Tritt. "We are seeing that patients don't need someone just to order supplies, they need someone to be more consultative and take a clinical approach to care," he said. "They are actually onsite at the hospital or the wound care center and are able to see what the patient really needs and provide better treatment." HME and we don't want to, either, but we need a code. The industry shared its concerns and, lo and behold, they were able to program the code." The adjustments are mandated by the 20th Century Cures Act. A provision in the act delays a second round of reimbursement cuts in non-bid areas from July 1, 2016, to Jan. 1, 2017, allowing providers to recoup a portion of six months worth of payments. The remark code—N689—will not only give providers a way to parse out Cures adjustments from other reprocessed claims, but also, theoretically, give software vendors a data point for creating customized reports. "That way providers know how many claims have been adjusted, how much money they've collected, and, just in gen- eral, how things are moving through," said Andrea Stark, a reimbursement consultant for MiraVista, who hosted a webcast recently on how providers should be preparing for the adjustments. Stakeholders breathed a sigh of relief when providers started receiving adjustments in May, but it turned out the MACs were just running two test batches. The MACs, which are still processing their normal load of claims, wanted to see how much additional work processing the adjustments will be. "They watched to see how many of them suspended for manual customer service inter- vention and will require people power," Stark said. "They did notice some issues, includ- ing recoupments that were requested after an overpayment had already been paid, and recoupments that were initiated for skilled nursing facility visits where the data may have changed after the fact." But by early July, VGM reported that Noridian had processed 6.1% of adjusted claims, and CGS had processed 11.4%. While stakeholders have argued the adjust- ments are taking too long, they acknowl- edge it's a huge undertaking, with the MACs expected to process 140,000 claims per day across the four jurisdictions once they're run- ning full bore in July. "I think it's been a big issue for suppliers and the MACs, because of the volume and how it needs to be handled," said r onda Buhrmester, a reimbursement specialist for the VGM Group. "We're hoping once they work out some of the kinks it will go quicker." HME BILL SEE k S COVERAGE FOR WIGS c o n t i n u e d f r o m pa g e 1 7 AS p GLOBAL c o n t i n u e d f r o m pa g e 1 A mp UTEES c o n t i n u e d f r o m pa g e 1 7 CURES p A ym ENT c o n t i n u e d f r o m pa g e 1 Lorne Tritt

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