Thursday, January 19, 2017

What's Next? - A Message From AAHomecare's President

As we start the New Year, with a new Congress just getting settled in and a new Presidential Administration beginning in just a couple days, AAHomecare has hit the ground running to ensure we can build on last year’s legislative and regulatory successes and capitalize on potential opportunities for even better public policy outcomes for HME in 2017.  I’d like to give you a quick rundown on what we’ve been focusing on at the start of the year to make that happen.

Rural O2 Payment Policy – As we've recently reported, AAHomecare has asked CMS to reconsider their changes to the 2017 fee schedule for stationary oxygen, resulting from the misguided combination of a 2006 offset balancing rates for portable and stationary oxygen with bidding-derived pricing for rural providers.  While we’ve continued to attempt to engage CMS on this issue, we are now reaching out to Capitol Hill to alert them to this issue and ask them to get involved and are also planning media/PR outreach on the issue if it not quickly resolved.

Competitive Bidding Program – Last year’s success in getting a measure of relief for rural providers for July through December of 2016 will certainly be welcomed by providers when CMS finally announces a refund process (more on that in a moment), but a longer-lasting solution is critically needed.  While our champions on Capitol Hill have expressed their willingness to take up the fight for fairer rural relief policy in the 115th Congress, we’re all too aware of how slowly that process can move.  To that end, we brought in a sub-group of AAHomecare’s Regulatory Council to explore and develop regulatory actions the new administration could take to provide relief for rural providers, especially given that the recent CURES legislation will require HHS to reissue payment regulations to take effect by the start of 2019.  

Reimbursements from Other Payers – We believe that other payers who base their rates on the Medicare fee schedule should provide commensurate retroactive relief for the July 1-Dec. 31 period, where applicable.  We are currently working on our messaging to make this case to TRICARE and Medicare Advantage plans.

Where’s the Refund? –  As I noted above, HME providers in rural and non-bid areas are anxiously awaiting word on the procedures and timing for the relief mandated in the CURES Act – it’s certainly a question that the AAHomecare staff has heard repeatedly from our members and other HME stakeholders.  We’ve pressed CMS to provide guidance as soon as they can, and you can be sure we’ll share that news with you as quickly as we get it.

We’re Just Getting Started – While AAHomecare helped deliver important gains for the HME community in 2016, we recognize that the HME industry still faces a reimbursement and regulatory environment that is causing many well-established companies to change their business models or shutter their operations – leaving patients and communities with less access to essential home medical equipment.  Be assured that the current AAHomecare team enters 2017 with a renewed commitment to improving the business environment for HME through continued advocacy work on Capitol Hill and at CMS, by building relationships with non-Medicare payers, and by exploring new approaches to reimbursement models for value-based approaches and emerging technologies.  I truly believe this will be our most productive and effective year yet, and I look forward to working with the AAHomecare membership and other HME stakeholders to make it happen. 

To learn more about the work of the American Association for Homecare, or to join us, please visit or contact Michael Nicol at  

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.