Friday, December 2, 2016

Glimmer of Hope for HME- CURES Bill Passes and Rep. Price Named HHS Secretary

This week the House of Representatives passed the 21st Century Cures Act, by a vote of 392 to 26. The bill is expected to move to the Senate next week and the Obama Administration has already weighed in expressing support for the legislation.

The legislation sets the stage for possible future regulatory relief for rural providers, as it requires HHS to reissue payment regulations for items and services furnished on or after January 1, 2019, with adjustments to the non-bid fee schedule in some areas based on stakeholder input, costs, volumes, and numbers of suppliers serving those areas.

Specifically, the legislation will provide six months’ worth of retroactive relief for the second phase of bidding-derived cuts for rural and non-bid area providers; delays the application of bidding-derived pricing reductions for complex rehab technology accessories used with Group 3 power wheelchairs for an additional six months; accelerates the application of plans to limit state Medicaid reimbursement amounts for HME to the Medicare fee-for-service payment rates, including applicable competitive bidding rates, by one year, to Jan. 1, 2018; and also instructs HHS to conduct a study on the impact of the bidding program on the overall number of HME providers and availability of HME products over the course of 2016.

While AAHomecare and other HME stakeholders advocated for a longer delay for the second phase of bidding derived cuts, this legislation marks an important step in efforts to scale back the effects of the bidding program.  Both chambers of Congress, along with party and committee leadership, have recognized that the home medical equipment community in rural areas needs relief and that the bidding program requires more scrutiny.

These measures set the stage for working with the new Administration to move towards more sustainable Medicare reimbursement policies for all HME providers, as well as again taking up these issues in the 115th Congress.

Also this week, President-elect Donald Trump announced he will appoint Congressman Tom Price (R-Ga.) to serve as Secretary of Health and Human Services in his Administration.  Price, who has represented Georgia’s 6th Congressional District since 2004, has been a consistent advocate for better public policy in the healthcare arena and has championed legislation to make sure that patients who rely on home medical equipment have access to those products and related services.

Seema Verma, founder and president of health policy consulting firm SVC Inc., was selected to serve as Administrator of the Centers for Medicare and Medicaid Services.

Thursday, November 10, 2016

Medicare Open Enrollment Tips for HME Providers

The Medicare open enrollment period began on October 15, 2016 and runs through December 7, 2016.  It’s important to know how these plan changes will impact your patients and your company.  Even though the enrollment period runs through December 7, it may take longer for many plans to update their systems.

Determining Plans Available in your Service Area

Many insurance plans may add products or eliminate products they previously offered.  There may even be new insurance plans created and offered in your areas.

This is the website that beneficiaries can use to investigate plan choices.

Providers can enter the zip code for their service area to determine which plans are available to their patients and answer the following questions.

1.     How do you get your Medicare coverage?
        -- Select “Original Medicare”

2.    Do you get help from Medicare or your state to pay your Medicare prescription drug costs?
       -- Select “I don’t know”

3.    Select "I don’t want to add drugs now"

You can then Select “All” and “Continue to Plan Results” to obtain listing of all the plans in your service areas.  This will also give you deductible and copays for durable medical equipment for each plan. 

Next Steps After you have the Plans Available

Review these plans and determine your risk as a company in plans that you are not in network with.  Determine if these plans offer out of network benefits.

Develop a plan to ensure you have current insurance information on all new and existing rental patients.  Develop transition plan for those patients electing a payer you are not in network with if they do not offer out of network benefits.

You can elect to send letters to all your existing rental patients informing them of open enrollment and steps they should take in informing you of insurance changes.  You can suggest in this letter the plans that you are in network with as plans they may want to choose.

Evaluate if there are any big budget changes based on plans available.

Plan changes could have an impact on your revenue stream.  Preparing for these can help eliminate denials and rework in your companies.

Friday, October 28, 2016

Louisiana Home Medical Equipment Providers Hold Out a Lifeline to Flooded Communities

(3rd Installment: Home Medical Equipment Providers Overcome Major Storms to Help Patients)

Home medical equipment (HME) suppliers have a long track record of making sure their patients get the products and services they need during natural disasters.  August’s catastrophic floods in much of Louisiana provides the latest examples of the extraordinary efforts undertaken by companies to serve their communities in extremely challenging conditions.

Apria Healthcare’s employees in Louisiana have been working around the clock to ensure continuity of care for approximately 700 patients with lost or flood-damaged equipment, many of whom have had to evacuate their homes.

While Apria’s branches in Baton Rouge, Lafayette and Alexandria have been on the front lines making sure their patients are cared for, their locations in New Orleans, Shreveport, and Beaumont, TX also provided inventory.  In addition, Apria is sending tractor trailers loaded with respiratory equipment to Baton Rouge to replace damaged, lost equipment and to ensure there are enough portable cylinders to accommodate ambulatory needs of their patients.

Apria’s ability to respond quickly in these situations is the result of extensive preparation and advance planning for emergency situations.  Every branch at Apria has a pre-planned emergency preparedness plan, which includes identifying and contacting high acuity patients and all respiratory patients who need oxygen, and making sure they are triaged accordingly.  Apria staffers also coordinate with local authorities and public safety personnel to set up staging areas to meet patients if they are displaced to receive services.

“These unique situations require an extraordinary effort to replace damaged or lost equipment and help keep patients intact and avoid costly hospital visits,” said Bill Guidetti, Executive Vice President, East for Apria.  “From Hurricanes Katrina and Sandy to fires in the West, and now the flooding in Baton Rouge and Lafayette, Apria is on call for our patients.”

“Home medical equipment providers take great pride in helping to keep people out of hospitals and other clinical settings all year long,” added Guidetti.  “This role becomes even more important during times like these when healthcare and emergency services personnel are under extra pressure.”

Many HME company personnel have been helping others while trying to deal with significant challenges themselves, as evidenced by efforts by two Respiratory Therapists (RT) with Lafayette-based respiratory services provider Viemed.

Adam North, an RT in Baton Rouge, started out the week with three-and-a-half feet of water in his home and his company delivery vehicle.  Fortunately, he had bought a 20-year-old pickup truck from one of his patients the previous month.   Adam worked all week driving his “new” truck, responding to calls from patients whose non-invasive ventilator equipment was damaged or left behind in the haste to escape the quickly rising floodwaters.  

In many cases, he had to seek them out at a relative's house or in an emergency housing shelter.

Matt Bourg, an RT in nearby Denham Springs, had similar experiences, but fortunately did not suffer water coming into his house.  Matt’s efforts included meeting up with a patient discharging from the hospital evacuating to his daughter's house.   That patient had left his ventilator at home, which was under eight feet of water; Viemed replaced that equipment, and has done so in several other instances.

“We’ve replaced a lot of equipment in the last week, even though we’re not obligated to do so and it’s not clear if or how we’ll get compensated for that,” said Max Hoyt, president & CEO of Viemed. “It’s times like these that remind us that just doing the right thing is the best business practice.”

Thursday, October 27, 2016

“No matter how much you prepare for an event like this you cannot completely predict the obstacles your team will face” – Family Medical Supply Tells Their Story

(2nd Installment: Home Medical Equipment Providers Overcome Major Storms to Help Patients)

Family Medical Supply is headquartered in Dunn, NC with 18 locations in the state. 

While the sun rose to a clearing sky on Sunday morning, October 10, the havoc wreaked by Hurricane Matthew just a few hours before was only beginning to be realized.

"Roads were washed out in some places and completely gone in others," states Joey Tart who, along with his brother Billy, owns Family Medical Supply and its 18 North Carolina locations.

By the time emergency crews were assessing the storm's damage the Family Medical team was already at work, delivering over 300 oxygen tanks that first day to patients over thousands of square miles.

"No matter how much you prepare for an event like this you cannot completely predict the obstacles your team will face," adds Billy.  "We have a very committed group who worked days on end to look after oxygen and ventilator patients.  We worked with emergency services and even the National Guard in an area we couldn't access due to flooding.”

"That first day's obstacles were only the beginning of one of the longest weeks in recent memory for DME companies across the southeast.  By Monday, the orders for oxygen had almost doubled and the downstream communities were suddenly coming to terms with flooding that would take out highways, interstates, and most importantly, direct access to patients.  The Tart brothers had drivers that were taking three and four different routes to try to find a way to serve patients in dire need.

"It's two weeks out and we are still trying to assess the amount of lost and damaged equipment," reflects the Tart brothers report.  "We have heard from the Department of Health and Human Services and from BlueCross/Blue Shield concerning how to proceed with looking after these patients.  So far the only thing we've gotten from Medicare is more audits."

"We are paying hundreds of hours of overtime, working with emergency services to access patients and going the extra mile for patients that Medicare does not want to pay us for because the doctor signed or dated the orders in the wrong place.  The patient visits have run into the thousands, but at this point we do not know of a single patient that had to go to the hospital because we could not get to them."

That last sentence is what is missed in the modern understanding of a DME business.  An industry that is having a definite impact on hospital costs through its commitment to service is only seen as a boxed goods provider by policy makers.  The most undervalued aspect of any industry is the bill that is not yet due.  What would a couple of thousand extra hospital admissions cost Medicare last week?  Let's hope we do not have to find out after the next hurricane.  Call your congressman and ask him to roll back the ruinous cuts for HME providers serving rural communities.

Wednesday, October 26, 2016

Home Medical Equipment Providers Overcome Major Storms to Help Patients

Home medical equipment suppliers have a long track record of making sure their patients get the products and services they need during natural disasters.  The recent catastrophic floods stemming from October’s Hurricane Matthew hitting the Carolinas, along with stories from the August severe flooding in Louisiana, provide compelling examples of the extraordinary efforts undertaken by companies to serve their communities in extremely challenging conditions.

This remarkable effort outlined below is the first installment of examples of home medical equipment companies providing personal and committed care to individuals with significant healthcare needs – including seniors, and people with disabilities or chronic conditions.  While HME companies devote extra resources to making sure their patients are cared for in disaster situations, they do not receive extra compensation from Medicare for providing emergency services.

Liberty Medical Overcomes Loss of Power and Phones, as well as Severe Travel Challenges to Serve Patients

Liberty Medical is headquartered in Whiteville, NC, with nine other locations in North and South Carolina.

Beginning October 3rd we began calling patients to assure they had proper back up for the equipment they had with us. For oxygen patients if they had used their back up tanks to any degree, we switched them out to assure in most cases at least two days. We also called other patients to remind them to charge any equipment they may have had that had battery backup. This included calling several hundred patients in the coastal areas as that was the areas that we had been receiving the warnings about at that time.  That process took us several days to complete and many man hours and the expense of additional equipment.

On Thursday, October 6th, as the storm was approaching our coast, we felt like we were prepared. At that time weather services were saying that we would get some rain and winds up to 60 MPH and that it would be downgraded by the time it reached the North Carolina coast. Our patients are throughout North and South Carolina and each area along the coastal regions would be impacted to some degree. The South Carolina direct coastal areas at that time were under a mandatory evacuation and we had patients calling to let us know they were leaving their homes; we advised them to take what they needed with them. North Carolina was not under any evacuation orders at that time. We began taking inventories of oxygen that we had in stock and ordered more from our supplier as we were running low as a result of stocking up the patients in the areas we felt were going to be impacted.
We began to get calls into our offices farther inland from patients of ours, as well as from patients of other companies seeking to get equipment that they left behind or trying to get more portable tanks while in hotels or with relatives.

On Friday, October 7th the storm began to get into our service areas with winds in some places over 60 MPH and rain. We had several offices that were in the evacuation areas to close at that time. All preparations for the storm had been completed. We felt like we were ready for what we had been told would be a category 1 or 2 storm.

We continued to monitor the storm and in most of our offices we continued to service our customers on a normal basis. The storms impact at this point was mostly high wind and heavy rain in the coastal areas.

As of Saturday the 8th the winds were picking up and the rain was continuing. It rained from Friday night until sometime Sunday afternoon. Many areas of North Carolina had received a considerable amount of rain several weeks prior to the storm which resulted in lakes, streams, swamps and creeks already being full of water.  The winds took down trees and the water started rising, power started going down, and roads began to become dangerous to travel by Sunday afternoon.  The inland counties by that time had received at least 16 inches of rain and the impact was just beginning. The coastal areas did not receive as much of an impact except where there was storm surge directly on the beaches.  As of Sunday afternoon, our phone system went down as well as the local 911 system as a result of flooding. We also lost our ability to get into our main software system as well because of a loss of power in another section of our building. We were running on generator power at that time. We later learned that the main substation for Duke Power that powered the entire town was underwater. We had our phone carrier to override our phone system and forward all calls to a single cell phone for calls.

By Monday morning the rivers and creeks started rising and several main roads were washed out from running water. Many of our employees could not get to work as detours were not posted and traffic began to back up on several of the main highways. As some employees began to get to work as best they could, we began to evaluate our work based on having no ability to make calls using our system but only with cell phones which were working only sporadically.  We could not at that time access any patient information using our software.

We put two customer service reps at our front entrance and provided them with our main incoming line cell phone and other cell phones to call patients back on without tying up that main line. We began contacting our branches to get a feel of what their circumstances were and who was open. All branches were open and had access to phones and systems. We at the home offices then got several lap-tops up and running and we were in business.

Then the calls started coming in from patients that were in shelters and needed oxygen as they left their equipment in their homes. We could get to them and provided them with oxygen. We also had several patients that came to the office as they had no phone service to get what they needed. We also had patients that at that time had been without power for two days contacting us for more backup.
Our problems had only started as more roads were being closed as a result of flooding.  By the end of the day on Monday we were not sure how our drivers could get to the inner part of the state as we were closed off by major highways on all sides of us. We could only go toward the coast at that time. All gas stations were closed, all stores were closed, and there was no UPS or mail service. I-95 was shut down for 30 miles, I-40 was detoured, and we had patients that needed help. Our drivers had to leave our warehouse not knowing if they could get where they were going or not. They seemed to always find a way to get where they needed to be and never complained – they just got the job done.
By Tuesday there were entire towns under water and residents being evacuated.  Some were our patients that we attempted to follow. We continued to provide services to our patients that we could get to.  Many times we would have to go East to eventually get to the West to go around closed roads and detours.

Our information system was completely functional on Wednesday the 12th, and we got full phone service restored the next day.

We are not aware of any of our patients having to get service from another source during this hurricane as a result of many hours of hard work and the dedication of our staff.  As of Tuesday the 18th we continued to have patients in shelters and we have employees that have lost their homes.
As a result of what we have learned in this process and what we know about the future of companies serving rural communities, we feel this type of service may not be available for the next event when it comes.  For the sake of the patients who depend on home medical equipment in good times and bad, we hope that doesn't come to pass.  Congress needs to take note of the high level of service that HME companies provide and finish the job on legislation to give some relief from deep cuts for suppliers in rural communities.

Visit the blog tomorrow to view a new story of an HME company devoting extra resources to make sure all of their patients are taken care of during Hurricane Matthew.