HME News

MAR 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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8 WWW.HMENEWS.COM / MARCH 2018 / HME NEWS Editorial PUBLISHER Rick Rector EDITOR Liz Beaulieu MANAGING EDITOR Theresa Flaherty tfl CONTRIBUTING EDITOR John Andrews EDITORIAL DIRECTOR Brook Taliaferro EDITORIAL & ADVERTISING OF FICE 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 REPRINTS For custom reprints or digital reuse, please contact our reprint partner, The YGS Group, by calling 717-505-9701, ext. 100, or ART CREDITS Steve Meyers: cartoon SUBSCRIPTION INFORMATION HME News PO Box 47860 Plymouth, MN 55447-0860 800-869-6882 Publishers of specialized busi ness 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 Seat elevation coverage: Where are we today? Reinvention and redemption BY SETH JOHNSON I T'S A new year that is full of opportunity on many fronts, including coverage and payment for seat elevation. A few years ago, providers, clinicians and manufacturers began challenging the notion that a power adjustable seat height (PASH) system was not "covered" or paid for by most third-party payers. Signifi cant progress has been made over the last couple years due to extensive outreach and education efforts with stakeholders—con- sumers, providers, clini- cians and payers—high- lighting the medical ben- efits provided through this enabling technology. So, where are we today? The good news is that extensive progress has been made on the Medicaid, Veterans Affairs and third-party payer front, includ- ing with commercial payers and Medicare HMOs, PPOs and Advantage Plans, which will consider PASH technology for cover- age and payment when reviewing the doc- umentation submitted for prior authoriza- tion. When we started tracking coverage and payment for this technology a few years ago ,most of what we heard from providers in nearly every state was "they won't pay for it." Fast forward to 2018 where we now have received hundreds of examples of payment from nearly every state that the technology has been paid for. A significant obstacle that was identi- fi ed early on was that many providers were simply not submitting a claim for payment because previous attempts to get paid were not successful or they did not believe the payer would cover it. As this issue was ana- lyzed in detail, it was determined that most payers will "consider" PASH technology for payment with a complex rehab power wheelchair when documentation is provided that specifi cally mentions what the benefi - ciary can do with the technology that they are unable to do independently without the technology. As we know, many end users can more fully participate in their mobility relat- ed activities of daily living with this technol- ogy, and independently "transfer" to a bed, chair, toilet, etc., and "reach" for dressing, grooming and meal preparation purposes. The coverage and funding battle has really come full circle where payers (aside from traditional Medicare) will consider it if the therapist's wheelchair evaluation includes documentation as to why the feature is need- ed and providers submit the information as a part of the prior authorization process. The technology available today is much improved over the standard power elevat- ing seat systems that were available fi ve to 10 years ago. Today's technology is highly functional, as it allows the individual to ele- vate/descend while driving their chair, the time it takes to move through the full range of elevation has been reduced by more than half and the chair can safely operate in the elevated position at a pace equal to or faster than average walking speed. These develop- ments were a result of consumer feedback. While traditional Medicare remains the biggest obstacle to overcome due to its posi- tion that power seat elevation (E2300) is not reasonable and necessary, and does not serve a "medical purpose," progress is being made in this area, too, due to consumer -led efforts to highligh the benefi ts and cost saving pro- vided through the use of this enabling tech- nology. Many consumers have stated that this technology doubles the functionality of the chair and allows them to more fully and independently access the three-dimensional world that we live in. They have stated that this reduces overall costs to the health care system by minimizing the risk for injury from a fall, burns, cuts, bruises, fractures and repetitive strain injuries. Savings can also be realized through a reduction or elimination of the cost of a caregiver. We have come a long way in the last few years in getting most third-party payers to consider and pay for this life changing tech- nology. There is certainly more work to be done to get Medicare to cover or consider it for payment, but the consumer efforts, cou- pled with clinical studies and other stake- holder efforts, are making real progress in this area. I remain hopeful that it will not be long before Medicare will join nearly all the other payers in recognizing the signifi cant medical benefi ts and cost savings of PASH technology. hme Seth Johnson is senior vice president of govern- ment affairs for Pride Mobility Products Corp. He can be reached at (800) 800-8586 or sjohnson@ Seth Johnson I EMAILED THERESA one recent morning to say I was taking a breather from this issue to work on the educational program for the HME New Business Summit. I start allowing thoughts of the Summit to enter my frontal lobe (that's the one respon- sible for "high-level mental functions," or so my Google search just told me) some time in January, and by Feb. 1, it's go-time. By April 1, the panic attacks start setting in (joking, not joking). So beware, in the next few months: This is when every story idea I get, every person I talk to, every article I read turns into a potential session for the Summit. Case in point: I was talking to Robert Wilkins, the CEO of SoClean, recently for a story about the company's investment from DW Healthcare Partners (see page 21). I had no idea of the company's origins. Wilkins was helping to run a company that made machines that cleaned DVDs and Blu-rays for Blockbuster when that industry started going downhill. "We saw that it wasn't long in the tooth," he said. But Wilkins, who has had a hand in run- ning 11 startups, mostly in the tech industry, felt the company was the perfect incubator— it had pick and pack, it had engineering, it had design, it had customer service. So he chal- lenged the company to come up with different business ideas, and they came up with 15. The one that stuck: a business making CPAP cleaning and sanitizing devices. Wilkins said he didn't even know what a CPAP device was at the time, but when he started looking into the market, it was eye-opening. "How big the market was, how pervasive of a problem cleaning the equip- ment is," he said. "I thought, 'There's a true need for this.'" As I was listening to Wilkins talk, I couldn't help but think, what a great story of reinvention and redemption. You know who needs stories about reinvention and redemption? HME providers. I also spoke with Katherine Royster, the executive vice president of business devel- opment for Classic SleepCare, recently. She said Classic SleepCare was ready to close its doors when a Hail Mary decision to offshore its back-offi ce operations to nurses in the Philippines not only saved the company but also spurred a new company, HealthScope Services Division, to offer the same services to other sleep providers. Did I mention they have private investment behind the idea? Good stuff, right? It just may be coming to a Summit near you…well, if you live in Georgia, because the Summit will be Sept. 16-18 in Savannah. If you don't live in Geor- gia, don't let that stop you from coming to the Summit. Come one, come all, and stay tuned. hme

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