HME News

FEB 2019

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 By Tracy Orzel, c ontributing Writer SAN DIEGO – San Diego State University (SDSU) has become the first college in California to offer an adaptive sports program, thanks in large part to Seeds of Hope. Inspired by the Rio 2016 Paralympic Games, Exton, Pa.-based ABC Medical, a provider of urological, ostomy and incon- tinence supplies, started the Seeds of Hope Initiative in 2016 to develop competitive adaptive sports programs at universities across the country. Out of more than 1,000 colleges with athletic programs, only 21 schools offer adaptive sports programs and/or intramural clubs. "There are about 30,000 kids doing adaptive athletics in high school and then another 30,000 kids below high school age," said Keith Jones, chairman of ABC Medical's board of directors, who spear- headed the project. "Unless you're a top athlete, there's just not a lot of options for you." Michelle Cross, SDSU's first official stu- dent-athlete in adaptive track and field, says she chose to attend SDSU mainly for its adaptive sports program. "I love it. It's definitely a challenge for me," said Cross, who has cerebral palsy. "I'm in the weight room three times a week and my coach is making me do exer- cises to build up my right arm." ■ Pediatric Home Service is ready to bring its model to new states, says CEO Mark Hamman. See story page 1. NHIA conference unblurs the lines . . . . . . . . . . . . . . . . . . 16 Seeds of Hope takes root in California . . . . . . . . . . . . . . . 16 Q&A: Jim Hewlett, Jim Newberry Award recipient . . . . . . 16 Moneyline: Highmark, InfuCare Rx, Soleo Health . . . . . . 17 16 hme news / febuary 2019 / www.hmenews.com By Theresa Flaher T y, Managing e ditor A S SO often happens, 2018 was a year that saw forward progress, even as CMS seemed poised to take at least one giant step backward, as reflected in our Top 5 most read specialty pro- vider stories. Even as it put the competi- tive bidding program on hold for retooling in November, CMS couldn't resist trying to sweep more products into the program—ventilators made the shortlist—which caused alarm for providers in our No. 1 most-read specialty story, "CMS doubles down on vents." Not only were industry stakeholders caught complete- ly off-guard by the proposal— after all, CMS had tried to do so once before with non-invasive vents then backed off—but the By T. Flaher T y, Managing e ditor ORLANDO, Fla. – The lines between home infusion and specialty pharmacy are blurring and this year's National Home Infusion Association Conference aims to bring some clarity to the trend, organizers say. "A lot of specialty pharmacies are trying to get into home infu- sion and home infusion pharmacies are getting into specialty By Theresa Flaher T y, Managing e ditor J IM H E wl ETT worked in marketing and merchan- dising before he decided to pursue a career in orthot- ics, first working directly with patients and later, develop- ing accreditation standards and testing and inspection protocols. "It's important for people to educate themselves on all the changes and Medicare changes everything on a daily basis," said Hewlett, recipient of the 2018 Jim Newberry Award for Extraordinary Service. "To keep up, you need to keep your finger on the pulse of the profession." A l t h o u g h H e w l e t t i s re t i re d n o w, he still keeps h i s h a n d i n as an author, educator and consultant. He spoke with HME News recent- ly about the importance of accreditation and working for goose bumps. HME N E ws: How does it feel to receive this award? Jim Hewlett: It's very humbling and I never dreamt I would get it. Many wonderful friends— including Jim Newberry— were very generous with their time and knowledge, and I remain grateful for their mentorship. HME: You've done a lot of work developing accreditation standards for BOC and sur- veying facilities . Do you think accreditation has had a posi- tive impact? Hewlett: If you compare the H M E i n d u s t r y n o w w i t h when accreditation began in 2009, it has come a long way. Accreditation has made pro- viders much more efficient. I think people are doing more things right and proper today than they ever have, and that's most read Vents dominated headlines in 2018 agency wants to include inva- sive and new multi-function vents, as well, a dangerous precedent, say providers who care for these fragile patients. l ess surprising was the news that Performant Recovery, the national recovery contractor for HME, was targeting both invasive and non-invasive vents for widespread complex reviews in our No. 2 most read specialty story, "Vents: RACs join the party." Maybe when there's more hard data on the effective- ness of non-invasive vents in treating patients CMS will be convinced of their value? At least that's the hope behind a new study in our No 5 most read specialty provider story, "Viemed works to elevate NIV." Viemed, which cares for NHIA conference unblurs the lines Seeds of Hope takes root in California ABC Medical was inspired by the 2016 Paralympic games Jim Hewlett works for 'goose bumps' T H is y E ar's Na T io N al Ho ME iN fusio N Co N f E r ENCE once again offers hands-on training in sterile procedures and nursing essentials for attendees . N h I A c o n f e r e n c e s e e n e x t pa g e v E N t S d o m i n at e s e e n e x t pa g e A D A p t I v E s p o r t s s e e n e x t pa g e h E w L E t t s e e n e x t pa g e Jim Hewlett Keith Jones Briefs nh I a pushes for clarifications w AS h ING t ON – The National Home Infusion Association has submitted comments to CMS asking the agency to issue sub-reg- ulatory guidance that clarifies that home in- fusion services are reimbursed on any day a patient receives a professional service. The NHIA also asks the agency to estab- lish a billing mechanism that distinguishes between professional services provided in the home by a nurse, and remote pharmacy services. The NHIA submitted comments in response to a final rule that CMS published in November detailing its plans to create a new home infusion therapy benefit and cre- ate a transitional payment for services. Pacific m edical target of audit for braces t RACY, Calif. – Pacific Medical did not always comply with Medicare requirements when billing for selected orthotic braces, accord- ing to an audit by the Office of Inspector General. For 89 of the 100 sampled claims, the company complied with requirements, but for the remaining 11 claims, it did not. Specifically, Pacific Medical billed for orthot- ic braces that were not medically necessary for nine claims and could not provide medi- cal records for two claims, the OIG says. On the basis of sample results, the OIG esti- mates that Pacific Medical received at least $247,483 in unallowable payments. The agency recommends, among other things, that Pacific Medical refund the DME MACs $247,493; and exercise reasonable diligence to identify and return any additional similar overpayments outside of the audit period, in accordance with the 60-day rule, and iden- tify any returned overpayments as having been made in accordance with this recom- mendation. s olera h ealth adds Gem c are to network ph OENIX – Solera Health has added Ohio- based GemCare Wellness to its national network of diabetes providers. Solera's net- work is comprised of providers recognized by the Centers for Disease Control and Prevention as diabetes prevention program (DPP) providers. GemCare offers a personal- ized program focused on diet adjustments, increased physical activity and stress man- agement. Since starting its program, most participants lost weight and 30% were no longer considered to have pre-diabetes at its conclusion, according to a press release. Infu s ystem's board gets new leader MADISON h EIG ht S, Mich. – InfuSystem Hold- ings has selected Scott Shuda as chair- man of its board of directors. Shuda has been a member of the board since Sep- tember 2015. He succeeds Gregg Lehm- an, PhD., who served as chairman since May 2015 and who will continue to serve on the board as vice chairman. Shuda, 53, is managing director of Meridian OHC Partners, a private equity firm.

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