HME News

JAN 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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Page 17 of 24

Rx and Specialty Providers CVS-Aetna deal casts chilling shadow . . . . . . . . . . . . . . . . 1 Nine providers all that remain in diabetes market . . . . . . 17 Prosthetic policies need overhaul . . . . . . . . . . . . . . . . . . . 17 Vent bill reintroduced in Senate . . . . . . . . . . . . . . . . . . . . . 18 ■ Why is CMS reducing reimbursement as part of a proposed coding change, asks AOPA's Tom Fise. See story this page. Briefs Diabetes supplier dropped from lawsuit INDIANAPOLIS – J&B Medical Supply in Wixom, Mich., has been dismissed from a lawsuit alleging it had sold blood glucose test strips under the retail pharmacy ben- efit rather than the DME benefit. All charg- es were dismissed without prejudice and without costs, according to a court filing. The lawsuit, filed earlier this year by Roche Diagnostics and Roche Diabetes Care, claimed that they wrongfully paid millions of dollars in rebates and lost millions of dollars in legitimate sales to an alleged scheme by several pharmacies and medi- cal supply companies. J&B Medical at the time said it stopped purchasing test strips from Roche in 2009. Blue Mint Pharmacy hunts for HME HOUSTON – Blue Mint Pharmacy, a four- year-old online pharmacy, has added home medical equipment to its services to grow its customer base, it announced Nov. 29. It will not carry an inventory of HME but act as a "personal bargain hunter," taking inquiries for specific equipment and searching across the country for the lowest available price. The company already uses this strategy for pet medications. Blue Mint Pharmacy is a locally owned, full-service, independent pharmacy based in Hous- ton. It specializes in retail and customized, compounded medications, and accepts most major insurance prescription plans. BioScrip bolsters management team DENVER – BioScrip has added two new ex- ecs to its management team: Harriet Book- er as senior vice president and COO, and Danny Claycomb as senior vice president of revenue cycle management. Most recently, Booker was interim senior vice president of revenue cycle management for Option Care. She has also worked at Coram/CVS Specialty Infusion Services, Coram Special- ty Infusion and Apria Healthcare. Most re- cently, Claycomb was senior vice president of revenue cycle management at Envision Healthcare. He has also worked at Coram/ CVS Specialty Infusion Services, Coram Specialty Infusion and Medtronic. PharMerica sells to investment firm LOUISVILLE, Ky. – PharMerica, a specialty pharmacy services provider, has been ac- quired by global investment firm KKR and Walgreens Boots Alliance, it announced Dec. 7. PharMerica shareholders will re- ceive an amount in cash equal to $29.25 per share of PharMerica common stock, without interest, and its stock will cease trading on the NYSE, according to a press release. PharMerica operates 96 institu- tional pharmacies, 20 specialty home in- fusion pharmacies and 5 specialty oncol- ogy pharmacies in 45 states. In March, PharMerica acquired New Hyde Park, N.Y.-based CareMed Specialty Pharmacy. www. HME n E w S .co M / january 2018 / HME n E w S 17 By Theresa Flaher T y, Managing e ditor CORAL SPRINGS, Fla. – With Arriva Medical, the largest mail-order supplier of diabetes test- ing supplies, closing its doors at the end of the year, industry stakeholders predict chaos. Arriva serviced 450,000 Medicare benefi- ciaries in 2016, according to the latest infor- mation in the HME Databank. "This is a disaster," said Tom Milam, an industry consultant. "I think CMS has to find a way to react to this, but there's no other firm out there that has the infrastruc- ture or capacity to service but a small frac- tion of these beneficiaries." Earlier this year, Arriva Medical lost an appeal seeking to reinstate its Medicare bill- ing privileges. CMS revoked those privileges in 2016, alleging the provider submitted 211 claims for deceased patients between April 15, 2016, and April 25, 2016. Also closing, according to an article in the Sun Sentinel, is Boca Raton-based American By Theresa Flaher T y, Managing e ditor MADISON HEIGHTS, Mich. – InfuSystem has shifted its focus from expanding its fleet of infusion pumps to improving collections, and it's starting to pay off, says Gregg Lehman, executive chair- man of the board. The infusion provider reported net revenues of $17.6 million for the third quarter of 2017, a 2.1% increase com- pared to the same period in 2016. "We are making solid progress on our collection efforts," said Lehman on a recent earnings call. "For the foresee- able future, our task is to focus on our existing business and managing it as well as possible." InfuSystem reported a net loss of $0.1 million for the quarter this year compared to a net income of $0.1 mil- lion for the same quarter last year. Breaking down revenues, rentals increased 4.7% to $15.3 million and sales decreased 12.4% to $2.3 million. The provider reduced debt by $2.9 By Theresa Flaher T y, Managing e ditor WASHINGTON – A proposal to "explode" the code for custom therapeutic inserts has raised eyebrows among stakeholders who say it's unnecessary. In a Special Open Door Forum Nov. 28, CMS officials outlined plans to revise the DMEPOS Quality Standards for custom fabricated inserts to account for advances in technology that allow them to be direct milled using com- puter assisted software. How- ever, because the technology is so different, the inserts must be billed under a new code, rather than under the existing A5513, the agency says. "We were surprised they created a new code," said Kim Brummett, vice presi- By Theresa Flaher T y, Managing e ditor BOSTON – A growing gap between technology advancements and what Medicare and other payers will cover creates safety issues for amputees, says a new study. The Rand Corporation, in a study released in October, says microprocessor-controlled knees (MPKs) prevent falls bet- ter than older artificial lower limbs. Twenty-six percent of patients with MPK limbs fall per year, compared to 82% of patients with non-MPK limbs. "As a clinician, I have experi- enced with my patients that they are at a greater risk of falling when they do not have access to MPK technology," said Dr. Michael Oros, CPO and presi- dent of the American Orthotic and Prosthetic Association dur- ing a press conference. "Stability Diabetes market on precipice of disaster mail-order Medical Supplies, which serviced 33,000 beneficiaries in 2016, according to the HME Databank. Both companies are owned by Alere, which was recently acquired by Abbott Laboratories. That leaves just nine mail-order compa- nies to serve all Medicare beneficiaries, say stakeholders. "There were a lot of concerns in that sec- tor to begin with," said Tom Ryan, president and CEO of AAHomecare. "The infrastructure of the traditional DMEPOS sup- pliers is crumbling before us and all these closures put a strain on the infra- structure. It all comes back to access, access, access." Fueling those access problems: low reimburse- ment rates, which have been reduced 71% to a low of $8.32 for a box of test strips since the mail-order program first kicked off in 2011. "I have spoken to some of the skeletons of providers who have been excluded from the program and they have said at the cur- rent reimbursement there's no way they'd do it," said Milam. hme As Arriva Medical prepares to close, stakeholders expect increased pressure on an already shaky infrastructure InfuSystem reports progress Proposed changes to insert guidelines draw criticism dent of regulator y affairs for AAHomecare. "Typically, they just redefine the current code." The kicker: The reimburse- ment under the new code will be $38.67 per unit—a 14% decrease. "The Medicare reimburse- ment manual says that when you explode codes, both codes will have the same value," said Tom Fise, executive director of the American Orthotic and Prosthetic Association. "How does CMS get to magically say they are going to reduce the payment by 14% because you are creating the same product but you are not using the same manufacturing process?" AAHomecare is seeking clar- ification on how CMS arrived at the new reimbursement rate, says Brummett. hme Stakeholders call on CMS to overhaul prosthetic policies and safety mean everything to amputees." MPK devices do cost more than non-MPK devices: $15,083 per year vs. $13,382 per year. But they are associated with a reduction of $3,676 per year in direct health costs and $909 in indirect costs such as lost wages, according to the study. "Are the extra costs in line with other things that we fund?" said Dr. Soeren Mattke, manag- ing partner, Health Care Prac- tice, for the Rand Corporation. "Amputees have a much lower probability of falls with MPK and that translates to follow-on costs and quality of life impli- cations." Despite advances in tech- nology, Medicare total pay- ments for prosthetics declined 15% between 2010 and 2014. I N F U S y S T E M s e e pa g e 1 8 P R O S T H E T I C S s e e pa g e 1 8 Tom Milam

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