HME News

NOV 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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8 / november 2017 / hme news e ditorial Publisher Rick Rector e ditor Liz Beaulieu managing e ditor Theresa Flaherty contributing editor John Andrews e ditorial d irector Brook Taliaferro e ditorial & a dvertising o ffice 106 Lafayette Street PO Box 998 Yarmouth, ME 04096 207-846-0600 (fax) 207-846-0657 advertising account manager Jo-Ellen Reed advertising coordinator Christina Dubois Production director Lise Dubois re P rints For custom reprints or digital reuse, please contact our reprint partner, The YGS Group, by calling 717-505-9701, ext. 100, or a rt c redits Steve Meyers: cartoon s ubscri P tion i nformation HME News PO Box 47860 Plymouth, MN 55447-0860 800-869-6882 Publishers of specialized business newspapers including HME News and Security Systems News. Producers of the HME News Business Summit and the Home Health Technology Summit. President & ceo J.G. Taliaferro, Jr. vice President Rick Rector By Tom Ryan T here's no getting around the fact that the h M e sector remains under pressure thanks to significant cuts to Medicare reimbursement over the last few years. The effects of bidding program pric- ing, as well as the use of bidding-derived rates in rural and other non-bid areas, have hit almost every segment of this business hard. It's a fact I know first-hand as the former head of a n ew York-based oxygen provider. If you are an AA h omecare member, or you've been following our efforts in the trade press, you know that our top priority has been working to improve the reimbursement environment for h M e suppliers. To this end, we continue to advocate for long-term improvements to the competitive bidding program, relief for non-bid area providers, and better audit policies, as well as working with state Medicaid agencies and other pay- ers such as managed care groups, to secure sustainable rates. Making headway in these areas can be a slow and often frustrating process. Fun- damental reform of the bidding program, including increasing transparency of the program and implementing fairer methods of calculating bidding results, remains a high priority. We will continue to engage CM s and Capitol h ill with the aim of improving the program for the next bidding round, originally slated to go into effect in 2019. cures relief welcome news for many balance sheets While we continue to work for these long- term fixes to the bidding program, last year's CU res bill provided a measure of relief for many suppliers in non-bid areas. As the funds are finally making their way into h M e suppliers' accounts, I've heard from companies who have shared news of significant reimbursements: $2 million in one case, along with reports of $400,000, $500,000, and $1.7 million from others. In addi- tion, related T r ICA re retroac- tive reimbursements for the second half of 2016 are now being processed. While we're proud that our advocacy efforts have brought about tangible gains for h M e suppliers, we won't be satisfied until we can secure more long-lasting relief for non-bid area suppliers, as well as for other suppliers who service T r ICA re beneficia- ries or patients of other payers who are influ- enced by these rates. As of this writing, an Interim Final r ule (IF r ) that would appear to address this issue is under review at the o ffice of Management and Budget ( o MB). While we have had very strong engagements with CM s and hhs to move this effort forward, and have seen more than 200 members of the s enate and h ouse asking for long-term relief, we are unsure whether the stunning departure of hhs s ec- retary Tom Price will impact the final release of the promising IF r . crt accessories relief and P ayer relations make a difference AA h omecare and other stake- holders in the mobility arena also successfully lobbied to delay—and ultimately, per- manently stop—the applica- tion of bidding-derived pric- ing for complex rehab technol- ogy accessories for Group 3 wheelchairs, and are working to build support for legislation that would also exempt manual C r T accessories from those cuts. Turning back those cuts for C r T will result in meaningful gains for mobility suppliers over the long term and allow them to keep serving individuals with profound disabilities who depend on these products. AA h omecare's increased investment in payer relations work has also paid dividends in several states. We've supported state and regional association leaders to stop or delay proposed Medicaid cuts in n ew York, Maine, and the District of Columbia, and we're cur- rently working on the issue in several other Making headway on HME reimbursement Annu A l A ddress: AAHomec A re W e W en T live with 2016 data for our h M e Databank on o ct. 1. I've been playing around with the data ever since, and let me tell you, it ain't pretty. Take e 1390, stationary oxy- gen concentrators. Total Medi- care spend on this code in 2016 was $620,708,743, according to data obtained via a Freedom of Information Act request from CM s . In 2015: $903,973,456. Before we move on to declines in spend- ing in other DM e , let me say that obtaining the data this year was more difficult than in past years. o ur request for county-level data for total Medicare spend had to be forwarded from the Pricing, Data Analysis and Coding Contractor, which usually fulfills our requests easily and timely, to CM s 's F o IA office and then to the agency's "central office." It took months. But I'm glad to say that once it hit said "central office," the data was released promptly. Thank you! h ow about e 0601, CPAP devices? Total Medicare spend was $115,903,964 in 2016 vs. $150,060,612 in 2015. For e 0260, hospital beds, semi-electric with mattress: $48,239,698 in 2016 vs. $65,522,841 in 2015. A4235, blood glucose strips: $179,812,476 in 2016 vs. $222,324,155 in 2015. K0823, standard power wheelchair: $32,579,043 in 2016 vs. $43,227,808 in 2015. It goes on and on and on. Another aside: The line above reminds me of the kid's favorite book at the moment: "The Circus s hip" by Chris Van Dusen. Long story short, a circus ship crashes off the coast of Maine and the 15 animals aboard make their way to an island, where they surprise, and initially horrify, its human inhabitants. There's a tiger in the tulips, there's a lion on the lawn, there's a python in the pantry, it went on and on and on. I highly recommend it. s peaking of horrifying, when you combine this data with other data, such as the aging population (the number of Americans ages 65 and older is projected to more than double from 46 million today to more than 98 mil- lion by 2060), the increasing awareness and diagnosis of os A (it's estimated 75% of severe sleep disordered breathing remains undiag- nosed), etc., it's hard to make sense of any kind of declines at all. What is going on here? That's more of a rhetorical question, of course, because we all know what's going on here. And something's gotta give. hme Data, central office, The Circus Ship liz beaulieu a a h o n e c a r e s e e n e x t pa g e Tom ryan

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