CORAL SPRINGS, Fla. – Quest Health Solutions' new Tokyo-based investor provides a “substantial boost,” allowing the diabetes provider to scale its business and expand its market reach – possibly even into Asia, says CEO Adam Nadler. The company announced last week that received an investment from Sumitomo Corp. through its U.S. subsidiary Sumitomo Corporation of Americas based in New York. “This is laying the better financial groundwork for us as far as our objectives and bringing the resources (to) scale our business even further,” Nadler said. “They have experience doing that and it’s great that we can kind of plug into their network and take advantage of that.” Sumitomo has been active in health care globally for years, but the investment in Quest represents its first in the U.S. health care market. Overall, the company operates in 66 countries and regions in sectors ranging from energy to mineral resources to urban development. Nadler says there may be opportunities to add new product categories, but right now, Quest is focused on being an expert in continuous glucose monitoring – from the devices to patient management. In addition to its CGM business, the company has two sister companies, Quest Health Remote Care and Quest Health RPM Services. “It’s not just about wearing the device, it’s about educating the patient and making those behavioral changes,” he said. “What’s going to set us apart is the way we keep patients out of the hospital and prevent readmissions.” Longer term, Nadler also wants to enhance the Quest brand and bring it to Japan and Malaysia, where Sumitomo operates several managed care corporations. “The health care market over there is slightly behind the U.S. health care market,” he said. “Sumitomo (sees) what we can bring over to Asia and over to their businesses there. There’s a lot of opportunity in the future.” Here in the U.S., Quest operates in 48 states. Nadler founded the company in 2017, after exploring different diabetes supplies, including shoes, before turning to CGMs. “I realized there was an opportunity for us to get in on the ground floor of CGMs – it was so early we didn’t even know what the HCPCS codes or reimbursement were,” he said. “It’s been an exciting space that’s (now) appealing to people from outside the industry, as well.”**MORE**

NEW YORK – Parachute Health’s decision to embed prior authorization workflows into its platform is an example of how payers are increasingly driving the transition to e-prescribe, says David Gelbard. The company announced in June that it added the functionality through a partnership with Optum, which is owned by UnitedHealth Group, and Walgreens/CareCentrix. “There’s a favoring by payers to do business in a digital way vs. paper fax,” said Gelbard, CEO and founder of Parachute Health. “What will be important for DME providers is their continued progression to be digitized and to move toward e-prescribe, because it will be the baseline of competition going forward. No one wants the paper process to continue – definitely not payers.” Parachute Health’s news followed an announcement by Optum that it had launched DME Navigator, an end-to-end solution for benefits management that includes an EHR-integrated ordering platform, through a collaboration with Walgreens/CareCentrix. Gelbard says Optum reached out to Parachute Health to see if the company was willing and able to automate the prior authorization process in its e-prescribing platform. “As they were evaluating the DME benefit, it became obvious the way forward to drive efficiency and transparency was to leverage e-prescribe and embed and automate the authorization process,” he said. “That was the catalyst.” In what he calls a “win-win,” Gelbard says this new functionality also increases transparency and efficiency for providers. “The current process for managing authorizations is too burdensome,” he said. “It takes up too much administrative time; it results in delays in care.” Additionally, the new functionality gets ahead of a CMS rule that requires impacted payers to implement an Application Programming Interface (API) that enables electronic prior authorization requests by 2027. “That will be the next big altitude in e-prescribing and prior authorization,” he said. **MORE**

YARMOUTH, Maine – Weather events like hurricanes and tornadoes are happening more frequently and are stressing cash-strapped HME providers and an already fragile delivery system, say the majority of respondents to a recent HME Newspoll. About 76% of respondents report being in an area affected by weather events and of those about 64% report these events are happening more frequently. The biggest impact on their operations: Increases in costs like labor and gas. “Patients have unrealistic expectations (related to) power outages,” wrote Erin Dolan of Med-Essentials in New Hartford, Conn. “(They expect) to rely on backup (oxygen) tanks for days and that we will deliver replacements at excessive frequency. We try to educate them that they need to have a backup plan (generator, alternate location), but with each storm, we expect an onslaught of tank orders. We also spend a lot of time making calls to home-based patients to reexplain battery backup in hospital beds – how long patients can remain on an air mattress, etc.” AAHomecare recently asked providers to share how they go above and beyond to ensure their customers continue to receive vital equipment and services during weather events. Increased awareness of the role providers play in making sure patients remain safe and healthy during and after weather events could help to address lack of reimbursement and other support. All respondents – 100% - report that Medicare and other insurers aren’t doing enough in that area. “It would be nice to have a procedure code for ‘emergency call due to weather-related event,’” wrote one respondent. “This was never part of the ‘normal cost of doing business’ and, thus, was never factored into reimbursement.” Added another respondent: “There’s no additional reimbursement when we are delivering tanks after hours to rural patients who have lost power due to storms. (It) would be nice if it was billable.” Other impacts on providers from weather events include delays in product and service delivery (about 8%) and a reduction in employee availability (about 17%). “When we are hit by a hurricane, we are unable to get staff here and sometimes are limited by Internet access due to Internet provider line damage,” wrote one respondent. “Our staff cannot make it into work, and we have to prioritize our deliveries by emergency only.” Share stories of how you go above and beyond during weather events by emailing Ashley Plauché, AAHomecare’s senior director of brand marketing, atashleyp@aahomecare.org. **MORE**

CARLSBAD, Calif. – Advanced Diabetes Supply recently expanded its Part B services to retail pharmacies to include management of diabetes supplies.  The move made sense for ADS, which has already been partnering with pharmacies to offer continuous glucose monitors, says CEO Bill Mixon. “CGM is central to what we do, but we provide other diabetes testing supplies that these patients might need,” he said. “We can fulfill those through the DME benefit, which is difficult for the pharmacy to handle well.” To make it all work, ADS connects with the pharmacy’s workflow systems and contacts patients within 24 hours to “take over” management of CGMs and other diabetes supplies. The company educates and trains, communicates about refills, obtains prescriptions and necessary documentation, and collects reimbursement. With about 80% of CGM medical records and prior authorizations at least one component shy of meeting requirements, ADS’s expertise in Part B billing is key to pharmacies, says Mixon. “Pharmacies tend to be oriented around high-volume prescriptions,” he said. “We, as a CGM DME provider, have a much more hands-on approach, where we work with the patient to make sure they are using the technology to drive better health outcomes and allow the pharmacy to focus on other business.” Since initially partnering with pharmacies to offer CGMs in 2020, ADS has contracted with Medicare and more than 500 private insurers, serving more than 60,000 patients on behalf of about 12,500 national and regional pharmacies. A patient re-order rate of 96% points to how well the program works for pharmacies and patients, say Mixon. “The pharmacy’s patients have a great patient experience, and it leads to ongoing retention for the pharmacy,” he said. “We’re very focused on education and being a resource for the patient.” Bill Mixon made the leap from wheelchairs to diabetes supplies in 2023. **MORE**

WASHINGTON – NCART has submitted a HCPCS coding application to formally appeal CMS’s decision to only increase the fee schedule for seat elevation systems by about $13 to $2,013.96. “While we appreciate CMS’s willingness to listen to our concerns and review the follow-up information we provided, they indicated it could not be considered, since it was not part of the public meeting process last year,” said Wayne Grau, executive director of NCART. “In addition, we will highlight the problems using Internet pricing, which does not reflect the additional significant costs to comply with Medicare requirements compared to that retail model.” Previously in March, CMS established a new code, E2298, for seat elevation systems and set reimbursement to about $2,000 effective April 1. On an interim basis prior to April 1, CMS was paying about $2,800, on average, for seat elevation systems. CMS adjusts requirements for replacements WASHINGTON – CMS will require prior authorization for all power mobility devices being replaced within the five–year useful lifetime effective June 2, NCART reports. Providers should submit prior authorizations as an expedited request and the agency will process them within two business days. For wheelchairs being replaced due to loss, theft or irreparable damage, the following should be included with the request: information and/or detailed reports that explain the reason leading to the need for replacement, such as policy report when the PMD is lost or stolen; and a physician’s written order prior to delivery (WOPD) for the new replacement items. If CMS affirmed the original prior authorization, the DME MACs will not review for medical necessity. Once the request is affirmed, providers should submit the claim with the RA modifier. For wheelchairs being replaced due to change in medical need or reasonable useful lifetime met, the following should be included with the request: a new face-to-face evaluation, WOPD and documentation from the medical record that supports the need for the item and documentation to support the change in condition, if applicable. REMSleep receives clearance, details marketing plan CLEARWATER, Fla. – REMSleep Holdings has been awarded 510(K) clearance from the U.S. Food and Drug Administration for its new Deltawave CPAP Pillows Interface mask.  With the clearance, the company has begun preparing the Deltawave for market by updating its website and ordering a large inventory. REMSleep has also announced a strategic marketing plan for Deltawave that includes identifying key distributors, providing comprehensive training to those distributors, expanding its reach, and launching marketing and awareness campaigns. "We are incredibly excited about the future of REMSleep  and the tremendous potential of Deltawave,” said CEO Tom Wood. “Our journey ahead is filled with immense opportunities, but we recognize that it will require both strength and patience to achieve our corporate goals. We are committed to identifying and collaborating with the best distributors to ensure that Deltawave reaches those who need it most. Our team is dedicated to advancing our technology, expanding our market presence, and ultimately improving the lives of countless individuals affected by sleep apnea.” Deltawave’s features include the ability to support normal breath rate and a reduction in the need (or no need) for humidification. AOPA announces award recipients ALEXANDRIA, Va. – The American Orthotic and Prosthetic Association (AOPA) has announced the recipients of the 2024 Howard R. Thranhardt Award are Andreas Kannenberg, MD (GER), PhD, Shane Wurdeman, PhD, CP, FAAOP (D), Tyler Klenow, MSPO, MBA, CPO, FAAOP, and Russell Lundstrom, MS. The award, established in 1996 through a gift from J.E. Hanger in memory of Howard R. Thranhardt, CP, has become one of the most distinguished honors in the orthotics and prosthetics profession, annually recognizing the strength in clinical research. “Their work will contribute to the profession’s clinical base, helping to improve and further the care provided to the individuals we are privileged to serve,” said Mitchell Dobson, CPO, FAAOP, president, AOPA.  “Their presentations are just two of the informative and exciting educational sessions you will experience at this year’s National Assembly. We look forward to congratulating and honoring them for these accomplishments.” The award and presentations will be given Sept. 14 in conjunction with the 2024 National Assembly in Charlotte, N.C. Kannenberg and Wurdeman will present “Assessing Outcomes with Microprocessor Knee Utilization in a K2 Population (ASCENT K2): Findings from a Clinical Trial of 107 Individuals with Above-knee Amputation.” Klenow and Lundstrom will present “Reduction in Falls and Fall-Risk with Increased Walking Speed Found Following 1 Year of C-Brace Use: Interim Results from the C-Brace Registry.”  AmeriCare Medical’s nurses recognized TROY, Mich. – AmeriCare Medical has received recognition from thestate of Michiganfor its exceptional work in home care. Leaders from thestate'sHouse of Representatives delivered a tribute that honored and commended AmeriCare Medical's team of registered nurses and their commitment to excellence in health care. "At AmeriCare Medical, our nurses are the heart and soul of our organization," saidGreg Jamian, president and CEO. "They embody the values of compassion, integrity and expertise, delivering personalized care that enhances the quality of life for our patients every day." For more than four decades, AmeriCare Medical has provided the gold standard in home care, employing a team of more than 250 health care professionals who serve across hospitals, government facilities and private residences statewide.  Soleo Health tapped to distribute IG drug FRISCO, Texas – Soleo Health has been named a limited distribution specialty pharmacy partner for GC Biopharma USA, Inc. to dispense ALYGLO (Immune Globulin Intravenous, Human-stwk) 10% Liquid for adults with primary humoral immunodeficiency (PI). "Our partnership with GC Biopharma underscores our shared commitment to enhancing patient care and showcases Soleo Health's unparalleled expertise in managing patients with complex conditions,” said Drew Walk, CEO. “We are honored to be chosen as a partner for ALYGLO, highlighting our ability to provide individualized patient services across various care settings.” Soleo Health has deep clinical knowledge and experience in the provision of immunoglobulin (IG) services and its ability to collect real-world evidence clinical outcomes through SoleMetrics, its proprietary clinical outcomes program.  HME News recently interviewed Walk and Craig Vollmer about Soleo Health’s map for the future. HME Home Health receives recognition for Dove Mattress RICHMOND, B.C. – HME Home Health has received the CAOT Seal of Recognition for its award-winning HME Signature Series Dove Mattress. “Since the 2023 launch, the HME Signature Series Dove Mattress has won multiple awards, including the BC Care Providers Safety Product Innovation Award, and now we are thrilled to have received the CAOT Seal of Recognition,” said Robert Boscacci, co-founder and CEO. “The HME Dove is now the leading low air-loss mattress in B.C. and is leading the market in safety and innovation.” HME Home Health offers a wide range of mobility and accessibility devices and medical equipment, including wheelchairs, walkers, hospital beds, lifts, ramps and other installed products. Read about why HME Home Health began making products in response to supply chain disruptions. 

WASHINGTON – NCART has submitted a HCPCS coding application to formally appeal CMS’s decision to only increase the fee schedule for seat elevation systems by about $13 to $2,013.96. “While we appreciate CMS’s willingness to listen to our concerns and review the follow-up information we provided, they indicated it could not be considered, since it was not part of the public meeting process last year,” said Wayne Grau, executive director of NCART. “In addition, we will highlight the problems using Internet pricing, which does not reflect the additional significant costs to comply with Medicare requirements compared to that retail model.” Previously in March, CMS established a new code, E2298, for seat elevation systems and set reimbursement to about $2,000 effective April 1. On an interim basis prior to April 1, CMS was paying about $2,800, on average, for seat elevation systems.

WASHINGTON – CMS will require prior authorization for all power mobility devices being replaced within the five-year useful lifetime effective June 2, NCART reports. Providers should submit prior authorizations as an expedited request and the agency will process them within two business days. For wheelchairs being replaced due to loss, theft or irreparable damage, the following should be included with the request: information and/or detailed reports that explain the reason leading to the need for replacement, such as policy report when the PMD is lost or stolen; and a physician’s written order prior to delivery (WOPD) for the new replacement items. If CMS affirmed the original prior authorization, the DME MACs will not review for medical necessity. Once the request is affirmed, providers should submit the claim with the RA modifier. For wheelchairs being replaced due to change in medical need or reasonable useful lifetime met, the following should be included with the request: a new face-to-face evaluation, WOPD and documentation from the medical record that supports the need for the item and documentation to support the change in condition, if applicable.

CLEARWATER, Fla. – REMSleep Holdings has been awarded 510(K) clearance from the U.S. Food and Drug Administration for its new Deltawave CPAP Pillows Interface mask. With the clearance, the company has begun preparing the Deltawave for market by updating its website and ordering a large inventory. REMSleep has also announced a strategic marketing plan for Deltawave that includes identifying key distributors, providing comprehensive training to those distributors, expanding its reach, and launching marketing and awareness campaigns. "We are incredibly excited about the future of REMSleep  and the tremendous potential of Deltawave,” said CEO Tom Wood. “Our journey ahead is filled with immense opportunities, but we recognize that it will require both strength and patience to achieve our corporate goals. We are committed to identifying and collaborating with the best distributors to ensure that Deltawave reaches those who need it most. Our team is dedicated to advancing our technology, expanding our market presence, and ultimately improving the lives of countless individuals affected by sleep apnea.” Deltawave’s features include the ability to support normal breath rate and a reduction in the need (or no need) for humidification. 

ALEXANDRIA, Va. – The American Orthotic and Prosthetic Association (AOPA) has announced the recipients of the 2024 Howard R. Thranhardt Award are Andreas Kannenberg, MD (GER), PhD, Shane Wurdeman, PhD, CP, FAAOP (D), Tyler Klenow, MSPO, MBA, CPO, FAAOP, and Russell Lundstrom, MS. The award, established in 1996 through a gift from J.E. Hanger in memory of Howard R. Thranhardt, CP, has become one of the most distinguished honors in the orthotics and prosthetics profession, annually recognizing the strength in clinical research. “Their work will contribute to the profession’s clinical base, helping to improve and further the care provided to the individuals we are privileged to serve,” said Mitchell Dobson, CPO, FAAOP, president, AOPA.  “Their presentations are just two of the informative and exciting educational sessions you will experience at this year’s National Assembly. We look forward to congratulating and honoring them for these accomplishments.” The award and presentations will be given Sept. 14 in conjunction with the 2024 National Assembly in Charlotte, N.C. Kannenberg and Wurdeman will present “Assessing Outcomes with Microprocessor Knee Utilization in a K2 Population (ASCENT K2): Findings from a Clinical Trial of 107 Individuals with Above-knee Amputation.” Klenow and Lundstrom will present “Reduction in Falls and Fall-Risk with Increased Walking Speed Found Following 1 Year of C-Brace Use: Interim Results from the C-Brace Registry.”

TROY, Mich. – AmeriCare Medical has received recognition from thestate of Michiganfor its exceptional work in home care. Leaders from thestate'sHouse of Representatives delivered a tribute that honored and commended AmeriCare Medical's team of registered nurses and their commitment to excellence in health care. "At AmeriCare Medical, our nurses are the heart and soul of our organization," saidGreg Jamian, president and CEO. "They embody the values of compassion, integrity and expertise, delivering personalized care that enhances the quality of life for our patients every day." For more than four decades, AmeriCare Medical has provided the gold standard in home care, employing a team of more than 250 health care professionals who serve across hospitals, government facilities and private residences statewide.

FRISCO, Texas – Soleo Health has been named a limited distribution specialty pharmacy partner for GC Biopharma USA, Inc. to dispense ALYGLO (Immune Globulin Intravenous, Human-stwk) 10% Liquid for adults with primary humoral immunodeficiency (PI). "Our partnership with GC Biopharma underscores our shared commitment to enhancing patient care and showcases Soleo Health's unparalleled expertise in managing patients with complex conditions,” said Drew Walk, CEO. “We are honored to be chosen as a partner for ALYGLO, highlighting our ability to provide individualized patient services across various care settings.” Soleo Health has deep clinical knowledge and experience in the provision of immunoglobulin (IG) services and its ability to collect real-world evidence clinical outcomes through SoleMetrics, its proprietary clinical outcomes program.  HME News recently interviewed Walk and Craig Vollmer about Soleo Health’s map for the future. 

RICHMOND, B.C. – HME Home Health has received the CAOT Seal of Recognition for its award-winning HME Signature Series Dove Mattress. “Since the 2023 launch, the HME Signature Series Dove Mattress has won multiple awards, including the BC Care Providers Safety Product Innovation Award, and now we are thrilled to have received the CAOT Seal of Recognition,” said Robert Boscacci, co-founder and CEO. “The HME Dove is now the leading low air-loss mattress in B.C. and is leading the market in safety and innovation.” HME Home Health offers a wide range of mobility and accessibility devices and medical equipment, including wheelchairs, walkers, hospital beds, lifts, ramps and other installed products. Read about why HME Home Health began making products in response to supply chain disruptions.

NEW YORK & CORAL SPRINGS, Fla. – Sumitomo Corp. has made an investment in Vast Medical Holdings, the parent company of Quest Health Solutions, a provider of continuous glucose monitors and other diabetes supplies. Quest Health, through its sister companies Quest Health Remote Care and Quest Health RPM Services, integrates CGM data with clinical support such as patient education, meal planning and exercise guidance to improve health outcomes. “The confidence shown by Sumitomo, and its alignment with our vision for the industry, adds tremendous momentum to our growth plans,” said Adam Nadler, CEO and co-founder of Quest. “Finding a partner who believes in our model was critical to our priorities and our quest for continued improvement in patient care. The transaction marks Sumitomo’s entry into the U.S. health care market and expands its network of health insurers and medical institutions. “We have found an ideal partner to mark our entry into the U.S. health care market,” said Jeremy Yap, general manager of the Healthcare Group and Business Development Group at Sumitomo. “The scope of Quest Health Solutions operations aligns well with our business strategy and supports our focus on improving health outcomes and providing greater access to health care resources.” Adam Nadler is also co-founder and CEO of CompliantRx, an AI/ML-powered platform that automates medical record review for HME providers by identifying the necessary coverage criteria and highlighting any missing information.

MODESTO, Calif. – Home Oxygen Company’s recent acquisition of the DME division of a local hospice provider will boost its patient census in California’s Central Valley and position it to grow into 2025, says CEO Andrea Ewert. Home Oxygen Company in June announced it had finalized a deal to acquire the DME business from Modesto, Calif.-based Community Hospice & Health Services, a company that it already had a good working relationship with, says Ewert. “We supported Community Hospice & Health Services with patient equipment outside of their normal service area,” she said. “We also worked with them during times of equipment or staffing shortages.” Home Oxygen Company started in 2007 as a home oxygen provider, before expanding into sleep apnea therapy equipment and supplies, and nebulizers. As part of the deal, it now provides Homefill systems, POCs, Group 1 pressure relieving mattresses and a “robust educational support system” to patients of Community Hospice & Health Services, says Ewert. The company has also moved its warehouse to a larger, 10,000-square-foot facility to accommodate the purchase and serve as a regional distribution enter for its warehouses in Sacramento and the San Francisco Bay area, she says. “Our new warehouse allowed our acquisition of Community Hospice & Health Services distribution center products and personnel, which also allows Home Oxygen Company to support our distribution centers in the San Francisco Bay Area & Sacramento,” she said. “We also use this space for storing and shipping soft goods as we handle resupply shipping in-house.”  

PHILADELPHIA – Dynamic Healthcare Services and Hometown Oxygen Pittsburgh on July 15 filed a lawsuit against Philips Respironics, DeLage Landen Financial Services and Philips Medical Capital for cutting off access to financing and leasing programs that the providers say are necessary for them to compete. According to the lawsuit, filed in the U.S. District Court for the Eastern District of Pennsylvania: Prior to the Philips recall, DHS purchased thousands of respiratory devices from Respironics, financing those purchases through PMC. After the recall, however, the company was unable to monetize its inventory of recalled devices and, therefore, unable to make payments to PMC. In August of 2022, PMC declared DHS in default. Respironics and PMC then shared this confidential, commercial information with DLL, which informed ResMed and HOP that it would no longer do business with HOP until DHS paid PMC for the recalled devices DHS had purchased from Respironics. "Defendants are engaged in an ongoing conspiracy, in violation of Section 1 of the Sherman Act, to cut off access to financing and leasing programs necessary for respiratory device suppliers in the U.S. to compete,” the lawsuit states. “DLL and PMC used their affiliation, market power and exclusivity agreements with respiratory device manufacturers to offer 0% interest financing. Defendants then shared commercially sensitive information about their customers as part of an anticompetitive scheme to foreclose competition from other lenders and respiratory device manufacturers and raise prices for patients in the U.S.” DLL is the leading financier of respiratory devices in the U.S., holding about 30% market share, according to the lawsuit, and PMC is a joint venture between DLL and Philips North America and is the exclusive financier of devices manufactured by Respironics. DHS and HOP seek to recover all damages and obtain injunctive relief available under federal antitrust law. Access Infusion buys Big Sky I.V. Care CHICAGO – Access Infusion Care, a portfolio company of Chicago-based New Harbor Capital, has completed its acquisition of Big Sky I.V. Care, a provider of home and specialty infusion services in Kalispell, Mont. This marks Access Infusion Care’s first add-on deal as part of New Harbor and is a key part of its broader strategy to partner with high-quality infusion providers in underserved areas with diversified therapy offerings and delivery settings, and outsized growth potential. “We are excited to add another high-quality infusion business to the Access family,” said Bo Mlnarik, principal at New Harbor Capital. “The combined resources, culture and experience of the teams, as well as the added scale, diversification and growth avenues make this a great fit for our infusion strategy.” Big Sky offers a wide range of infusion therapies, including specialty medications, antibiotics and total parental nutrition for chronically ill patients in their homes and at infusion sites. Founded in 2005 in Kalispell, Mont., by Julie Lyon, BSN, and Dave Grady, BA, Big Sky I.V. Care operates a 503A compounding pharmacy and a state-of-the-art ambulatory infusion center facility with a dedicated team of more than 15 professionals, including pharmacists, technicians and nurses. It is accredited by ACHC for home infusion therapy and features USP and USP compliant clean rooms for sterile compounding.  “We are thrilled to announce our new partnership with the Big Sky I.V. Care team,” said Bruce Kutinsky, CEO of Access Infusion Care. “Julie and Dave have built an impressive and innovative business with a diverse array of service offerings and world-class facilities. This acquisition is a significant step forward in fulfilling our vision of bridging the access gap in healthcare. By improving access to specialized infusion therapies in underserved markets, we are making a tangible difference in the lives of patients who need these services the most.  We are excited about the future and the potential to transform the infusion care landscape through this strategic partnership with Big Sky I.V. Care.” Access Infusion Care was formed in January 2024 through the acquisition of AIC North and JLS Infusion Nurse Staffing Services. New survey: Denials tops list of challenges CHARLOTTE – The No. 1 billing and revenue cycle management challenge for HME providers is preventing or reducing denials and appeals, according to the results of a new survey sponsored by Prochant and conducted by in90. The No. 2 challenge: Hiring, training and retaining qualified intake, billing and collections staff. “In response to these challenges, 60% of respondents have outsourced at least one RCM function in the past year, with over 70% attributing this decision to resource limitations and cost concerns,” Prochant stated in a press release. “The difficulty in managing RCM effectively, coupled with the high cost and scarcity of local talent, drives many to seek external expertise. For those that have chosen to outsource, about 50% of respondents reported that they were likely to outsource payment posting, claims scrubbing and denials and appeals. For those choosing an outsourcing partner, respondents value revenue capture and real-time performance tracking/visibility.” To conduct the survey, in90, an independent third-party consulting firm, interviewed 100 HME executives directly involved in RCM. Forty percent were CEOs or owners. The survey also found that more than 80% of respondents reported dissatisfaction with their current RCM approach, citing accounts receivable over 90 days overdue and excessive write-offs due to billing errors and complexities. Check out the full report here. MediWound raises $25M YAVNE, Israel – MediWound has entered into a definitive purchase agreement with several new and existing investors, including Mölnlycke Health Care, a medtech company specializing in solutions for wound care and surgical procedures. MediWound plans to use the $25 million in gross proceeds from the private investment in public equity (PIPE) to advance EscharEx pre-commercial activities and support general corporate purposes. “We are proud to have the strong support of Mölnlycke, and of our new and existing investors in this financing,” said Ofer Gonen, CEO of MediWound. “This significant investment will enable us to further strengthen our strategic plans for EscharEx, creating substantial long-term value for our stakeholders and help improve the standard of care for patients.” Concurrently with the PIPE offering, Mölnlycke will be granted specific rights, including a representative to attend meetings of the company's R&D Committee, and will be able to participate in potential strategic partnership discussions and M&A processes under certain circumstances. Mölnlycke's ownership, however, will be limited to no more than 9.99% of the company's issued and outstanding ordinary shares. MediWound says it has developed a strong R&D pipeline, including the company’s lead drug under development, EscharEx, a Phase III-ready biologic for the debridement of chronic wounds that offers significant potential advantages and an opportunity to expand the market. New bill expands coverage for monitors, supplies in Illinois SPRINGFIELD, Ill. - A bill sponsored by Democratic State Sen. Julie Morrison to expand insurance coverage for medically necessary glucose monitors and related supplies was signed into law on July 1. “High costs that come with managing diabetes can put an unnecessary economic burden on families,” said Morrison, Majority Caucus Whip. “This law will ensure people with any type of diabetes receive crucial medical care.” Senate Bill 3414 requires insurance companies to cover glucose monitors, related supplies and training for individuals diagnosed with any form of diabetes. Previous law required coverage for individuals with Type 1 and Type 2 diabetes. Additionally, individuals who obtain a prior authorization for a CGM prescription will have cost-sharing waived on a one-month's supply of CGMs and a transmitter, if needed. VGM names Dan Bunting as senior advisor WATERLOO, Iowa – VGM Group has announced that Dan Bunting, who was most recently COO and strategic advisor to the CEO of AdaptHealth, has joined its team as a senior advisor. In this role, Bunting will help VGM develop long-term strategies to promote and support its customers and the HME industry. “I don’t think there’s anyone in the United States who knows more about our industry than Dan,” said VGM Group CEO Jeremy Stolz. “The health care industry, and HME in particular, is constantly evolving. And I am thrilled to have Dan’s experience and expertise with us as we continue to shape the future of VGM and the industries we serve.” In all, Bunting’s career spans 40 years, with experience in nearly every aspect of HME, including product development and manufacturing. Born and raised in Manchester, Iowa, less than an hour east of VGM’s headquarters, Bunting has been close to VGM throughout his life and career. He first met Van Miller, VGM’s founder, while attending the University of Iowa. At that time, Miller had an HME business where Bunting worked for two years while getting his degree. Later, when Bunting set out to start his own HME business in Iowa City, Miller and a few of his friends helped finance it. Bunting’s HME business, which sold to Rotech in 1996, was one of VGM’s earliest members. “I have dedicated my entire career to helping advance the HME industry, and I’m honored to continue that work with VGM,” Bunting said. “VGM, in many ways, feels like a return home for me. I am excited to do my part to help VGM in its mission to make a difference—both in the industry and in the communities it calls home.” DME Service Solutions partners with NAHC WASHINGTON – DME Service Solutions, a provider of B2B outsourcing solutions specializing in health care, has partnered with the National Association for Home Care & Hospice to connect with a network of professionals focused on effective home care solutions. "We are honored to collaborate with NAHC, whose dedication to providing affordable care aligns with our mission at DME Service Solutions,” said Ryan Holbrook, president of DME Service Solutions. “We look forward to working alongside NAHC and its members to make a meaningful difference in the lives of those we serve." DME Service Solutions offers HIPAA-compliant workforce solutions, including document management, revenue cycle management, multichannel customer engagement and tech support. The NAHC represents the interests of more than 35,000 home care and hospice organizations, their 2 million nurses, aides and therapists, and the 14 million patients they serve annually. CMS announces flexibilities in Texas WASHINGTON – CMS on July 12 announced that additional resources and flexibilities are available in response to Hurricane Beryl in Texas. President Biden on July 12 determined an emergency in the state beginning on July 5, and HHS Secretary Xavier Becerra on July 12 determined a public health emergency in the state beginning July 5. The agency says it will permit Medicare beneficiaries who have lost or realized damage to their DMEPOS as a result of the hurricane to receive replacements for such items and services to ensure beneficiaries can continue to access what they need. “CMS stands ready to assist with resources and waivers to ensure hospitals and other facilities can continue to operate and provide access to care to those impacted by consequences of the hurricane,” the agency stated. CMS will also provide waivers, make available special enrollment periods for the Federal Health Insurance Exchange, activate the Kidney Community Emergency Response program and take other measures. FMI, go here. 

HME stakeholders have been fighting Medicare Advantage for some time, particularly when it comes to these plans not following Medicare policy and coverage for complex rehab technology and non-invasive ventilators, two product categories for patients with the greatest needs. At the Heartland Conference in June, there was even a panel discussion titled “Dealing with Medicare DISadvantage Plans - Are You Ready, Martha?”Stakeholders continue to take it up a notch. AAHomecare announced in July, for example, that it has engaged Dobson Davanzo & Associates to conduct a study quantifying the differences in outcomes and overall treatment costs for patients with significant respiratory challenges who receive NIV therapy vs. those who don’t. Their rationale, I’m guessing: If they can show that NIV improves outcomes and reduces costs, it’ll be another two nails in the coffin of MA plans that deny claims for this therapy without good reason – some to the tune of 86 out of every 100 times. As is often the case for the HME industry, which represents less than 2% of overall Medicare spending, it’s a David vs. Goliath situation, with the companies behind most of these MA plans the biggest names in health care. UnitedHealthcare and Humana, which had the most Medicare Advantage enrollees in 2023, have large footprints across the country, offering plans in most counties, according to the Kaiser Family Foundation. UnitedHealthcare is offering plans in 87% of counties and Humana is offering plans in 90% of counties in 2024, roughly the same as in 2023, KFF reports. But week by week, it seems, the HME industry, as well as the National Community Pharmacists Association, is getting more company in trying to keep these Goliaths in check. The Federal Trade Commission published an interim report in July that details how increasing vertical integration and concentration has enabled the six largest pharmacy benefit managers (PBMs) – Humana among them – to manage nearly 95% of all prescriptions filled in the United States. The NCPA called the report “scathing.” The Department of Justice announced in May that it had formed a Task Force on Health Care Monopolies and Collusion (HCMC) within its Antitrust Division to guide its enforcement strategy and policy approach, including by facilitating advocacy, investigations and, where warranted, civil and criminal enforcement in health care markets.Health care attorney Jeff Baird says the task force has the potential to rein in the PBMs that are having a significant negative impact on independent pharmacies and could help prevent a similar scenario cropping up in the HME industry (See story page 2). Additionally, at press time in July, the Wall Street Journal published an investigation of MA claims that showed big insurers have pocketed $50 billion from Medicare for diseases that no doctor treated. Call me anxious, but that’s the kind of attention that I think would make even UnitedHealthcare and Humana  nervous.

PHILADELPHIA – Dynamic Healthcare Services and Hometown Oxygen Pittsburgh on July 15 filed a lawsuit against Philips Respironics, DeLage Landen Financial Services and Philips Medical Capital for cutting off access to financing and leasing programs that the providers say are necessary for them to compete. According to the lawsuit, filed in the U.S. District Court for the Eastern District of Pennsylvania: Prior to the Philips recall, DHS purchased thousands of respiratory devices from Respironics, financing those purchases through PMC. After the recall, however, the company was unable to monetize its inventory of recalled devices and, therefore, unable to make payments to PMC. In August of 2022, PMC declared DHS in default. Respironics and PMC then shared this confidential, commercial information with DLL, which informed ResMed and HOP that it would no longer do business with HOP until DHS paid PMC for the recalled devices DHS had purchased from Respironics. "Defendants are engaged in an ongoing conspiracy, in violation of Section 1 of the Sherman Act, to cut off access to financing and leasing programs necessary for respiratory device suppliers in the U.S. to compete,” the lawsuit states. “DLL and PMC used their affiliation, market power and exclusivity agreements with respiratory device manufacturers to offer 0% interest financing. Defendants then shared commercially sensitive information about their customers as part of an anticompetitive scheme to foreclose competition from other lenders and respiratory device manufacturers and raise prices for patients in the U.S.” DLL is the leading financier of respiratory devices in the U.S., holding about 30% market share, according to the lawsuit, and PMC is a joint venture between DLL and Philips North America and is the exclusive financier of devices manufactured by Respironics. DHS and HOP seek to recover all damages and obtain injunctive relief available under federal antitrust law. 

CHARLOTTE – The No. 1 billing and revenue cycle management challenge for HME providers is preventing or reducing denials and appeals, according to the results of a new survey sponsored by Prochant and conducted by in90. The No. 2 challenge: Hiring, training and retaining qualified intake, billing and collections staff. “In response to these challenges, 60% of respondents have outsourced at least one RCM function in the past year, with over 70% attributing this decision to resource limitations and cost concerns,” Prochant stated in a press release. “The difficulty in managing RCM effectively, coupled with the high cost and scarcity of local talent, drives many to seek external expertise. For those that have chosen to outsource, about 50% of respondents reported that they were likely to outsource payment posting, claims scrubbing and denials and appeals. For those choosing an outsourcing partner, respondents value revenue capture and real-time performance tracking/visibility.” To conduct the survey, in90, an independent third-party consulting firm, interviewed 100 HME executives directly involved in RCM. Forty percent were CEOs or owners. The survey also found that more than 80% of respondents reported dissatisfaction with their current RCM approach, citing accounts receivable over 90 days overdue and excessive write-offs due to billing errors and complexities. Check out the full report here. 

YAVNE, Israel – MediWound has entered into a definitive purchase agreement with several new and existing investors, including Mölnlycke Health Care, a medtech company specializing in solutions for wound care and surgical procedures. MediWound plans to use the $25 million in gross proceeds from the private investment in public equity (PIPE) to advance EscharEx pre-commercial activities and support general corporate purposes. “We are proud to have the strong support of Mölnlycke, and of our new and existing investors in this financing,” said Ofer Gonen, CEO of MediWound. “This significant investment will enable us to further strengthen our strategic plans for EscharEx, creating substantial long-term value for our stakeholders and help improve the standard of care for patients.” Concurrently with the PIPE offering, Mölnlycke will be granted specific rights, including a representative to attend meetings of the company's R&D Committee, and will be able to participate in potential strategic partnership discussions and M&A processes under certain circumstances. Mölnlycke's ownership, however, will be limited to no more than 9.99% of the company's issued and outstanding ordinary shares. MediWound says it has developed a strong R&D pipeline, including the company’s lead drug under development, EscharEx, a Phase III-ready biologic for the debridement of chronic wounds that offers significant potential advantages and an opportunity to expand the market. 

SPRINGFIELD, Ill. - A bill sponsored by Democratic State Sen. Julie Morrison to expand insurance coverage for medically necessary glucose monitors and related supplies was signed into law on July 1. “High costs that come with managing diabetes can put an unnecessary economic burden on families,” said Morrison, Majority Caucus Whip. “This law will ensure people with any type of diabetes receive crucial medical care.” Senate Bill 3414 requires insurance companies to cover glucose monitors, related supplies and training for individuals diagnosed with any form of diabetes. Previous law required coverage for individuals with Type 1 and Type 2 diabetes. Additionally, individuals who obtain a prior authorization for a CGM prescription will have cost-sharing waived on a one-month's supply of CGMs and a transmitter, if needed.