HME News

NOV 2018

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 ■ AOPA hosted its national assembly in September in Vancouver, British Columbia. See photos next page. NHIA to CMS: Don't 'shortchange' home infusion . . . . . . 16 Custom breast forms legislation drops. . . . . . . . . . . . . . . 16 Roche, pharmacies clash over rebates. . . . . . . . . . . . . . . 16 Aeratech Medical: 2018 HME Excellence Winner. . . . . . . 16 16 HME NEWS / NOVEMBER 2018 / WWW.HMENEWS.COM BY JOHN ANDREWS, Contributing Editor MEDINA, Ohio – HME Excellence Award winner Aeratech Medical truly backs up its tag line "We are Respiratory" by putting its money where it mat- ters—in respiratory therapy. CEO Roy Neely is an RT. Direc- tor of clinical services Erin Fowler is an RT. So is Terry McAtee, medical compliance officer. In all, there are 18 RTs on staff. "We are a company made up of therapists—90% of our staff are ther- apists," Neely says proudly. It isn't just Aeratech's commit- ment to clinical quality that vault- ed the company to the pinnacle of HME Excellence, however; the HME News judging panel cited Aeratech's "healthy" financials as the key to its prominent place on the awards podium. Neely is quick to point out that there is no magic formula to profit- ability for the company—it's just a matter of explanation. "We have tight control over every- thing," he said. "Our RTs are on the front line working with our patients and they know the cost of good care. BY THERESA FLAHERTY, Managing Editor WASHINGTON – With a final rule not expected until November, industry stakeholders continue to press CMS for changes to provisions related to home infusion. Board members of the National Home Infusion Association and others met with Demitrios Kou- zoukas, principal deputy administrator of CMS and director of the Center for Medicare, on Sept. 17 to urge the agency to strike a provision that would require that a nurse be present in the home the day an infusion drug is administered. "To the extent that CMS is trying to save money by shortchanging home infusion, that would be penny wise and pound foolish," said Sharon Pearce, vice president of government affairs for NHIA. "Without access to home infusion (in the home), these patients would wind up in costlier WASHINGTON – A bipartisan bill that would require Medicare to cover custom breast pros- theses was introduced in the House of Representatives in September. The Breast Cancer Patient Equity Act, H.R. 6980, is co-sponsored by Rep. Rob Blum, R-Iowa, and Judy Chu, D-Calif. " I a m p ro u d t o introduce this bipar- tisan bill w i t h m y colleague, Democrat Rep. Chu, t o p r o - vide women with coverage of more options following a mastectomy," said Blum in a press release. "As breast can- cer rates continue to rise and we work toward finding a cure, it is important to help the women who are fighting this battle and ensure they have options following this life-changing procedure." Medicare already has a code and an allowable for custom breast forms, but local coverage determinations (LCDs) down code them as "not medically necessary." That means custom forms get reimbursed the same as BY THERESA FLAHERTY, Managing Editor INDIANAPOLIS – A judge has sided with Roche Diagnostics and issued a court order pre- venting a pharmacy network from dispensing Accu-Chek Test Strips, according to court documents. The order, issued by the U.S. District Court for the Northern District of Alabama on Sept. NHIA to CMS: Don't 'shortchange' infusion Custom breast forms bill drops 'We are respiratory' says it all at Aeratech Roche, pharmacies clash over 'unwarranted' rebates HME EXCELLENCE AWARDS: FIRST PLACE H O M E I N F U S I O N S E E N E X T PA G E R O C H E S E E N E X T PA G E A E R AT E C H S E E N E X T PA G E C U S T O M F O R M S S E E N E X T PA G E 17, is in response to a lawsuit filed by Roche against Priority Healthcare Corp., a network of pharmacies in Alabama, Mis- sissippi and Arkansas. In the lawsuit, filed Sept. 11, Roche says it paid $37.5 mil- lion of "unwarranted" rebates to insurance companies and their pharmacy benefit man- agers for claims submitted by PHC between Jan. 1, 2013, and the end of the first quarter of 2018. Furthermore, Roche says PHC is controlled by an indi- vidual who was convicted of criminal insurance fraud in 2010 and banned by the feder- al government from providing mail-order diabetes supplies to Medicare beneficiaries in 2016. His wife is listed as the owner of PHC, to hide her hus- band's involvement, accord- ing to the lawsuit. Both are among the individuals listed as defendants. "Over the past several years, defendants, operating through a shifting collection of corpo- rate entities that they constant- ly shuffle in order to avoid Lawsuit says Priority Healthcare wrongly submitted thousands of claims for retail test strips AERATECH MEDICAL boasts a staff of 18 respiratory therapists. "Without access to home infusion (in the home), these patients would wind up in costlier settings, like hospitals." Nikki Jensen Sharon Pearce settings like hospitals and nursing homes." Stakeholders also urged CMS to adopt an expanded definition of home infusion profes- sional services, said Pearce. "It's hard to know if we are getting though," she said. "Mr. Kouzoukas seemed sympathetic, but he might be hamstrung by budgetary restraints." To also apply congressional pressure on CMS, BRIEFS Essentially Women releases schedule WATERLOO, Iowa – Essentially Women has released the schedule for its annual edu- cational conference for HME and mastec- tomy service providers. FOCUS: The EW Conference will feature nearly 20 sessions covering topics like billing and reimburse- ment, succession planning, compliance and cyber security, compression therapy, mastectomy fitting and marketing, among others. "FOCUS is all about providing our members with education tailored to help them improve their business," said Nikki Jensen, vice president of Essentially Wom- en, a division of The VGM Group. The con- ference will take place Feb. 2-4 in St. Pete Beach, Fla. 180 Medical honored OKLAHOMA CITY – 180 Medical, a provider of urological and ostomy supplies, has been recognized for the 9th year as one of the Best Places to Work in Oklahoma by the Best Companies Group, which surveys near- ly 6,000 companies every year. "We are just so proud and pleased to be ranked as one of the best employers in Oklahoma," says Angie Christopher, HR director. "We're dedi- cated to making 180 Medical a fun and fulfill- ing place to work for our employees, where they can feel like they're making a difference in our customers' lives, while also being val- ued and rewarded for their productivity." NCPA's Jim Spoon named pharmacist of the year Boston – Jim Spoon, PharmD, owner of Spoon Drug in Sand Springs, Okla., has been named the National Community Pharma- cists Association 2018 Willard B. Simmons Independent Pharmacist of the year. Spoon received the award, sponsored by Upsher- Smith Laboratories, at NCPA's recent annual convention in Boston. The award recognizes an independent pharmacist for exemplary leadership and commitment to independent pharmacy and their community. It is named in honor of Simmons, a former executive secretary of NCPA and a long-time trustee of the NCPA Foundation. AOPA names new executive director ALEXANDRIA, Va. – The American Orthotic and Prosthetic Association has named Eve Humphreys as executive director effective Nov. 19. Humphreys, currently the execu- tive director for the Society for Healthcare Epidemiology of America, has more than two decades of experience navigating legislative and regulatory advocacy, working with vol- unteer and society leaders to create policy and position statements, practice guidelines, and continuing medical education content to advance organizations and industries, according to a press release. "It is an excit- ing time in the orthotic and prosthetic field," Humphreys said in the release. "AOPA is well positioned to continue on its trajectory of success by expanding its influence and leadership in all areas."

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