HME News

DEC 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 18 WWW.HMENEWS.COM / DECEMBER 2018 / HME NEWS WASHINGTON – CMS has finalized a rule that includes a temporarily transitional payment for home infusion services, and implements a new home infusion therapy benefit. The rule, originally published in July, implements the transition payments effective Jan. 1, 2019, through Dec. 31, 2020, prior to permanent home infusion therapy services payments beginning Jan. 1, 2021. The tem- porary payments, required by the Bipartisan Budget Act of 2018, address a payment gap created by the 21st Century Cures Act. The final rule also establishes health and safety standard for home infusion provid- ers as part of a new home infusion therapy benefit, and establishes the approval and oversight process for accrediting organiza- tions of these providers, as required by the 21st Century Cures Act. CMS states, however, that is it seek- ing further comments on its interpretation of "infusion drug administration calendar day" and its potential effects on access to care. Industry stakeholders have expressed concerns about this interpretation, which they say doesn't take into consideration how infusion drugs are typically administered. Specifically, the agency wants to require a nurse to be present on the days when a drug is administered in the home to receive pay- Nurse provision sticks in final infusion rule ment, but it is not uncommon for infusion drugs to be administered without a nurse, they say. "At a time when private payers, Congress, and beneficiaries are seeking to modernize health care delivery, the final home infu- sion rule doubles down on the payment policy of yesteryear," said Bill Noyes, interim execu- tive vice president for the National Home Infusion Association. " U n f o rt u n a t e l y, t h e result will be more hos- pitalizations and nursing home visits for benefi- ciaries, and a higher bill for the taxpayer." In a press release, Bio- Scrip the largest independent provider of home infusion services, said it disagrees with the CMS's interpretation. "Based on CMS's final rule, we are eval- uating the future treatment of Medicare beneficiaries, while also considering next possible steps to ensure this new transi- tional benefit is implemented as Congress intended," said Dan Greenleaf, president and CEO. HME BRIEFS Vizient urges CMS to reconsider new home infusion benefit IRVING, Texas – Vizient, a member-driven health care performance improvement company, and its subsidiary Provista, a supply chain partner for non-acute healthcare delivery organizations, have urged CMS to reconsiders its "very nar- row interpretation of the new Medicare home infusion benefit. The benefit was *finalized in the recently released Home Health Prospective Payment System fi- nal rule for 2019. The rule will limit reim- bursement for home infusion services to only the day on which the services are furnished by skilled professionals in the individual's home. "Unfortunately, this decision will likely limit patient access to high-quality, low-cost home infusion ser- vices," the groups stated. Soleo taps COO, Shire taps Soleo MCKINNEY, Texas – Soleo Health has named Ron Lindahl as chief operating officer. Lin- dahl has more than three decades worth of experience in specialty pharmacy and home infusion, most recently as chief technology office at Axelacare Health Solution. Prior to that, he held positions at Accredo Health and Critical Care Sys- tems. "In my new position, the focus will be on the Company's continued commit- ment to providing an excellent clinical experience for our patients and ability to best leverage technology to improve pro- ductivity," said Lindahl in a press release. Soleo Health provides specialty home and alternate site infusion services through lo- cations in 19 states and holds pharmacy licensure in all 50 states…Soleo Health has been chosen by Shire as a provider of the specialty drug VONVENDI, the first and only recombinant von Willebrand fac- tor designed specifically for treating and managing adults with von Willebrand dis- ease. VWD is the most common bleeding disorder, affecting up to 1% of the world's population. Specialty Rx group names Jose Domingos to board of directors CARY, N.C. – The National Association of Specialty Pharmacy (NASP) has named Jose Domingos, president and CEO of the Accreditation Commission for Health Care (ACHC), to its board of directors. ACHC, which launched a Pharmacy Ac- creditation program in 1996, has more than 900 pharmacies accredited in the United States. "Jose joins a diverse group of experienced and accomplished healthcare veterans tasked with elevat- ing the practice of specialty pharmacy, promoting the education and certification of specialty pharmacists, and advocating for public policies that ensure patients have appropriate access to specialty medications and receive high quality, high touch patient care and support ser- vices," said Sheila Arquette, executive director of NASP. NASP, has more than 100 corporate members and 1,200 indi- vidual members. "The result will be more hospitalizations and nursing home visits for beneficiaries, and a higher bill for the taxpayer." Bill Noyes, NHIA utilization for an old code, E0464, that it says was the result of providers bill- ing for pressure support vents that also function and are used as PAP devices for the treatment of OSA, rather than respi- ratory failure. VieMed and others vouch for the clini- cal efficacy of NIV and the study backs them up: KPMG found patients who receive high-touch NIV therapy fared bet- ter across the board, says Frazier. "In our data, COPD and CRF patients on NIV are less likely to return to the hospital over the next six months, total healthcare costs go down and they live longer," he said. "It's a win-win-win for patients, providers and payers." What VieMed would like to happen next: to hold meetings with CMS and other stakeholders, and to have them lowest overall costs and hospitalization rates, it found. Specifically, the study examined results of untreated patients who used no respi- ratory device at home, patients using a bi-level positive airway pressure device (BiPAP), and patients using an NIV device. Only 22% of COPD patients with chronic respiratory failure using NIV died, compared to 38% of untreated patients, the study found. Other findings: 4 Patients with no ventilation support cost CMS $41,000 110 sample claims Medicare paid in 2014 and 2015, only 24 complied with Medicare requirements. "These people haven't even been through the appeals process for anything the OIG has found," said Kim Brummett, vice presi- dent of regulatory affairs for AAHomecare. "The claims haven't even been recouped yet." Members of AAHomecare's Regulatory Council plan to hold a strategy call after Medtrade to determine next steps, Brum- mett said. "We will see if we can get to somebody at OIG after we regroup and say, this is pretty unrealistic and really sets suppliers up to fail," she said. "It's ludicrous." HME develop best practice metrics and clear guidance on who should qualify for NIV therapy—something that has been sorely lacking as utilization rates for the therapy increase. "We need to take the gray out," Fra- zier said. "We need to have consensus on what the qualifying rules are. We never have arguments about who qualifies for oxygen—we know those rules." VieMed recently launched a second study to analyze 2017 data, which, thanks to an increase in vent patients, will be a "much-enriched" data set, Fra- zier says. Allowed charges for the new code, E0466, were nearly $350 million in 2017, an increase of 25% from $281 million in 2016, according to the HME Databank. HME VIEMED MAKES CASE FOR NIV C O N T I N U E D F R O M PA G E 1 7 STUDY RESULTS C O N T I N U E D F R O M PA G E 1 7 program, there have been a lot of changes in the diabetes supply market, including new technology and the advent of subscription ser- vices. Thoughts? Aprigliano: I applaud the disruptors in the industry. Part of the reason why these sub- scription services have started is because the traditional models of insurance design are failing people with diabetes or chronic condi- tions in general. Even with co-insurance or copays, it can be less expensive to use these services. HME: You can't talk about diabetes these days without talking about the skyrocketing cost of insulin. Will we ever see relief there? Aprigliano: I firmly believe that it will require legislation on the federal level to ensure that every person who needs insulin has access to affordable insulin, and that's insulin analogs, not the human insulin you can purchase at Walmart. I do know that manufacturers aren't deaf. They hear the cries from the patient community and they are trying to provide safety net programs but we find them too restric- tive and almost Byzantine in trying to get access. HME DIABETES C O N T I N U E D F R O M PA G E 1 7 BYRAM HEALTH C O N T I N U E D F R O M PA G E 1 7 will continue to drive in that direction." In 2017, Byram was acquired by Owens & Minor, a global healthcare services com- pany, for about $380 million. The acquisition will enable Byram to take the next step in the healthcare continuum, says Bernocchi. "We've been in the healthcare industry a long time and it continues to evolve and change," he said. "Our relationship with the new parent company, Owens & Minor, will help Byram evolve. They are really focused on the acute and sub-acute space and Byram is a significant player in the homecare space. Together, we really complete the con- tinuum of care." The healthcare market also continues to push in a more data-driven direction and Byram, with its high-touch customer model, is right there with it, Bernocchi says. "We talk to the customer more than the doctor, more than the insurance company," he said. "We can help the healthcare provider with behavior, control spending and the cost at home, and we can provide data back to the insurer or provider. That's going to be the future of health care." HME CPAP AUDITS C O N T I N U E D F R O M PA G E 1 4 Patients using a BiPAP cost $39,000 4 Patients using NIV coupled with a high-touch care model cost $29,000 4 25% of untreated patients were admitted to a hospital 4 26% of patients using a BiPAP were admitted to a hospital 4 Less than 20% of patients using NIV and receiving high-touch care model were admitted to the hospital. "The KPMG study is one of the most important studies of this issue to date," said Dr. William Frazier, chief medical officer for VieMed, which commissioned the study. "It should help physicians and others make informed decisions about the best approach to treating patients suffering from COPD." HME

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