Q. Where does the biggest opportunity exist for HME suppliers to support clinical continuity of wound care in the landscape of value-based care models?  A. HME suppliers must first understand their individual customer markets and the specific wound care needs that must be met. It is also critical to understand the mission of value-based care payment models: The patient needs to be at the center of everything we do, their good outcomes and satisfaction are paramount, and that means being more efficient and effective in the ways we use supplies and services.  When it comes to a busy outpatient wound care clinic, clinical staff have very little time to process the massive amount of case management that goes into any given day’s workload. HME providers must stay relevant and convenient in offering easy-to-use ordering processes to keep up. Using digital apps and easy-to-access online forms, integrating comprehensive product lists with multiple e-script platforms, and offering transitional support can all ensure continuity of care and reduce delays in supply acquisition. Doing these things also ensures patient satisfaction and outcomes are prioritized – two of the most important aspects of most value-based care reimbursement models.  Additional opportunities exist to bridge the gap in care and improve patient satisfaction and outcomes any time a patient transitions throughout the health care continuum: Patients leaving a hospital with several days between discharge and a wound specialist follow up visit; Medicare beneficiaries transitioning from day 100 to day 101 in a skilled nursing facility; Patients transitioning from traditional home health to maintenance therapy; Patients discharging from home health or hospice to the community with a chronic, non-healing wound. All these scenarios should incorporate HME supplier partners when patients need supplies or equipment. Kaitlyn Rios, PT, DPT, CWS, is vice president of clinical business development for DermaRite Industries. Reach her at KRios@dermarite.com.

Q. What is the future of hospital-at-home, beyond serving patients with acute illness, and how might that impact HME? A. The data is clear – we know hospital-at-home can improve patient outcomes, reduce unnecessary health care spending and lead to fewer readmissions. These successes will undoubtedly drive the demand to offer hospital-at-home services to patients in rural and underserved areas who may be far from a physical hospital facility. Telehealth, AI and remote monitoring technology will be crucial in making this possible, along with collaboration between critical stakeholders like health care providers, home medical equipment suppliers, pharmacies, commercial and government insurance providers, and more. Additionally, the chassis created for hospital-at-home can treat more than just acute illness. There are several factors that will influence this: reimbursement policies will need to evolve and expand, HMEs will have to be ready to meet the large and vast supply needs of a hospital-at-home patient, and health care providers will have to adapt their staffing methods to accommodate this new way of care.  HMEs can start preparing now for the geographic and clinical expansion of hospital-at-home. Start thinking about investing in technologies – like remote monitoring, AI or telehealth. Review your billing and invoicing practices – are you poised to switch to a value-based model to align incentives with the costs and outcomes of hospital-at-home programs or offer payment options that reflect the bundled payment reimbursement model? Review your warehouse and inventory strategy. Finally, think about who may deliver acute-level care in the home in the future – and how you’d work with those entities. Right now, the delivery of care is still largely driven by health systems. Once the home-based care infrastructure is more developed, expect non-health systems to jump in, too, including virtual care providers, primary care providers and, even, payers.  Alex Hoopes is senior director, Strategy and Execution – Cardinal Health Velocare. 

Q. Does my accreditation prohibit me from outsourcing some of my operational tasks?  A. The short answer is no, your accreditation does not prohibit you from outsourcing some of your operational tasks, but you’ll need to review your accreditor’s guidelines, as well as the tasks you are planning to outsource, to ensure that you are outsourcing the correct ones. There are several operational tasks that you should not consider outsourcing. The first is your sales staff. Your sales staff should be employees of your organization. CMS views the role of independent contractors to be one of a “person who is not under your supervision.” It is thought that an independent contractor might not be representing your business appropriately. Your sales staff does not have to be full-time employees – they can be part-time – but employees, nonetheless. Second is your order intake staff. Intake is the time when you are assessing whether the patient meets criteria for service, meeting payer requirements and more. It would be hard to leave that in someone else’s hands who might not have your best interest at heart. You are always responsible for every order you accept and fulfill. Be sure you do not outsource your compliance officer – they must be your employee. You can have a consultant perform a compliance audit, but an employee should be the one that your staff makes aware of compliance concerns and who reports to your board. You can always outsource after-hours call services if you need to have licensed staff available for problems and troubleshooting equipment outside of business hours, especially if you don’ t have enough staff to cover on-call and after-hours service. There are several other operational tasks that DME suppliers successfully outsource, such as billing, collections, call center staff, shipping and warehouse services. You should always refer to your DME attorney for further clarification. Mary Ellen Conway is a nurse-health care consultant and president of Capital Healthcare Group. She can be reached at maryellen@capitalhealthcaregroup.com. 

WASHINGTON – The Federal Trade Commission has published an interim report that underscores the impact pharmacy benefit managers have on accessibility and affordability of prescription drugs. The FTC’s report, which is part of an ongoing inquiry launched in 2022, details how increasing vertical integration and concentration has enabled the six largest PBMs to manage nearly 95% of all prescriptions filled in the United States. This market structure has allowed PBMs to profit at the expense of patients and independent pharmacists, according to the report. “The FTC’s interim report lays out how dominant pharmacy benefit managers can hike the cost of drugs—including overcharging patients for cancer drugs,” said FTC Chair Lina M. Khan. “The report also details how PBMs can squeeze independent pharmacies that many Americans—especially those in rural communities—depend on for essential care. The FTC will continue to use all our tools and authorities to scrutinize dominant players across health care markets and ensure that Americans can access affordable health care.”   The FTC launched an inquiry into the prescription drug middleman industry in 2022. The report highlights several key insights gathered from documents and data obtained from the FTC’s orders to Caremark Rx; Express Scripts; OptumRx; Humana Pharmacy Solutions; Prime Therapeutics; MedImpact Healthcare Systems, Zinc Health Services, Ascent Health Services and Emisar Pharma Services, as well as from publicly available information: Concentration and vertical integration: The market for PBMs has become highly concentrated, and the largest PBMs are now also vertically integrated with the nation’s largest health insurers and specialty and retail pharmacies. The top three PBMs processed nearly 80% of the approximately 6.6 billion prescriptions dispensed by U.S. pharmacies in 2023, while the top six PBMs processed more than 90%. Pharmacies affiliated with the three largest PBMs now account for nearly 70% of all specialty drug revenue. Significant power and influence: As a result of this high degree of consolidation and vertical integration, the leading PBMs now exercise significant power over Americans’ ability to access and afford their prescription drugs. The largest PBMs often exercise significant control over what drugs are available and at what price, and which pharmacies patients can use to access their prescribed medications. PBMs oversee these critical decisions about access to and affordability of life-saving medications, without transparency or accountability to the public. Self-preferencing: Vertically integrated PBMs appear to have the ability and incentive to prefer their own affiliated businesses, creating conflicts of interest that can disadvantage unaffiliated pharmacies and increase prescription drug costs. PBMs may be steering patients to their affiliated pharmacies and away from smaller, independent pharmacies. These practices have allowed pharmacies affiliated with the three largest PBMs to retain high levels of dispensing revenue in excess of their estimated drug acquisition costs, including nearly $1.6 billion in excess revenue on just two cancer drugs in under three years. Unfair contract terms: Evidence suggests that increased concentration gives the leading PBMs leverage to enter contractual relationships that disadvantage smaller, unaffiliated pharmacies. The rates in PBM contracts with independent pharmacies often do not clearly reflect the ultimate total payment amounts, making it difficult or impossible for pharmacists to ascertain how much they will be compensated. Efforts to limit access to low-cost competitors: PBMs and brand drug manufacturers negotiate prescription drug rebates some of which are expressly conditioned on limiting access to potentially lower-cost generic and biosimilar competitors. Evidence suggests that PBMs and brand pharmaceutical manufacturers sometimes enter agreements to exclude lower-cost competitor drugs from the PBM’s formulary in exchange for increased rebates from manufacturers. The report notes that several of the PBMs that were issued orders have not been forthcoming and timely in their responses, and they still have not completed their required submissions, which has hindered the FTC’s ability to perform its statutory mission. The commission's staff have demanded that the companies finalize their productions required by the 6(b) orders promptly. If, however, any of the companies fail to fully comply with the 6(b) orders or engage in further delay tactics, the FTC can take them to district court to compel compliance. The Commission voted 4-1 to allow staff to issue the interim report, with Commissioner Melissa Holyoak voting no. Chair Lina M. Khan issued a statement joined by Commissioners Rebecca Kelly Slaughter and Alvaro Bedoya. Commissioners Andrew N. Ferguson and Melissa Holyoak each issued separate statements.   

ALEXANDRIA, Va. – The National Community Pharmacists Association has released a new TV ad as part of its ongoing campaign to push lawmakers to enact pharmacy benefit manager reform. The ad, titled PBM Career Day, shows a PBM executive struggling to explain his job to curious children. The executive shares that he doesn’t make, prescribe or provide drugs, but he does decide what drugs patients receive and what he pays for them. "PBMs and the massive health insurance companies that they’re affiliated with extract billions in profits from patients and pharmacies worsening pharmacy deserts for consumers and snuffing out small businesses,” said NCPA CEO B. Douglas Hoey, pharmacist, MBA. “Our campaign is designed to shed light on these practices, mobilize the public to demand change, and push policymakers to finish the fight for PBM payment reforms. It is time for transparency and accountability in the health care system." The ad will run nationally on CNN. 

CINCINNATI – Researchers at the University of Cincinnati are developing a PAP machine that uses vortex airflow technology, a mechanism commonly used in aerospace engineering applications, to eliminate the need for a tight seal. As a result, the VortexPAP is able to use a mask that is designed to barely touch the patient’s face, increasing comfort, researchers say. “Despite the clinical efficacy for CPAP in controlling OSA, patient compliance with the therapy remains a major cause of treatment failure,” said Liran Oren, PhD, research associate professor in the Department of Otolaryngology, Head and Neck Survey, at the UC College of Medicine. “The vast majority of complaints from patients in CPAP therapy revolve around improving the comfort of the mask. However, regardless of design, they all require a tight seal over the face, so that the airway can be pressurized. This design requirement for a tight seal is the main limitation for making CPAP therapy more comfortable.” The project is a collaboration between Oren; Roy Kulick, MD, UC entrepreneur-in-residence; Ephraim Gutmark, PhD, distinguished professor, Ohio Eminent Scholar in the UC Department of Aerospace Engineering; and Ann Romaker, MD, director of the UC Sleep Medicine Center and professor in the UC Department of Internal Medicine. The group's goal is to eventually commercialize the VortexPAP in the U.S., with strong support from the UC Venture Lab.  

WASHINGTON – AAHomecare has launched a nationwide survey on the impact of the expired 75/25 blended Medicare reimbursement rates in non-bid/non-rural areas on the HME industry and patient access to home medical equipment. The association encourages all providers serving patients in these areas to take the survey by July 19. “AAHomecare and other HME stakeholders continue to push for legislation to restore the 75/25 blended rates suppliers in non-bid, non-rural areas, and we want to strengthen our advocacy with state-specific data,” said Tom Ryan, the association’s president & CEO. “Your responses will help us share a clearer picture on how the Jan. 1 cuts are challenging HME suppliers and threatening access to care.” The 75/25 blended reimbursement rates expired on Jan. 1, 2024. AAHomecare says state-specific data on the impact of the expired reimbursement, which has been requested by Capitol Hill, will bolster efforts to include relief as part of a health care or omnibus legislative package later this year. The association says it will only share data in aggregate as state and national figures. It will keep company specific or identifiable information strictly confidential. What’s in play: The DMEPOS Relief Act of 2023(H.R. 5555 and S. 1294) would provide a 90/10 blended Medicare reimbursement rate for most home medical equipment products in competitive bidding areas for all of 2024 and extend the current 75/25 blended rate currently in effect in rural/non-CBA areas through 2024.    

LIVINGSTON, Tenn. – Home-based COPD management programs led by respiratory therapists using AI-driven software with plan of care goals can have a significant impact on admissions, quality of care metrics and overall cost of care, according to an abstract developed by Encore Healthcare and published by the American Thoracic Society.  HME providers using Encore’s Nexus software for patients using non-invasive ventilation produced the following results: Enrollees who reported at least one hospitalization in the 12-month prior to enrollment experienced 65% fewer admissions post-enrollment It total, patients experienced 34,029 fewer hospitalizations while enrolled in the program vs. the prior year Using a standard DRG-related reimbursement of $7,500 for a COPD-related hospital stay, the program has resulted in an estimated total U.S. health care cost savings of more than $225 million The results are based on 17,394 home-based COPD patients managed from January 2018 to October 2023. In another abstract, HME providers using Encore’s Nexus software for patients using home oxygen therapy produced the following results: Calculated as a per patient per month rate, enrolled patients experienced 94% fewer admissions vs. their 12-month prior history In total, patients experienced 1,156 fewer hospitalizations while enrolled in the program vs. the prior year Using a standard DRG-related reimbursement of $7,500 for a COPD-related hospital stay, the program has resulted in an estimated total U.S. Health care cost savings of more than $8.6 million These results are based on 30,950 COPD and chronic lung supplemental oxygen patients managed from May 2021 to October 2023. Read more about the abstracts here.

GOLETA, Calif. - Inogen has appointed Kevin P. Smith as general counsel and executive vice president of business development, effective July 22. He joins Inogen from Sirtex Medical, where he served as general counsel and executive vice president, business development, since 2018. “Kevin will be an invaluable addition to our leadership team at Inogen,” said Kevin Smith, president and CEO. “His extensive experience in the medical device and securities field will play an important role in strengthening our legal team and ensuring Inogen remains an organization based on integrity and compliance.” Prior to joining Sirtex, Smith served as vice president and associate general counsel at Flexion Therapeutics, focusing on securities requirements, business development and intellectual property. Previously, he was general counsel for the Danaher Life Sciences Platform. He has also held senior legal leadership positions within Novartis Pharmaceuticals. Before moving in-house, Smith worked for multinational law firms in New York, Silicon Valley and London. 

IRVING, Texas – Strive Medical, a portfolio company of NMS Capital, has acquired ProMed DME, a Stuart, Fla.-based provider specializing in diabetes, urology and wound care supplies. The deal allows Strive Medical, a provider of direct-to-patient urological, wound care and other disposable medical supplies, to expand into the CGM market. “This transaction is a crucial milestone in Strive Medical’s dedication to investing in growth markets and delivering our unique offerings to patients in rapidly expanding disease areas,” said Todd Philbrick, CEO of Strive. “We are excited to collaborate with the ProMed team, known for their patient-first approach, and to enhance our commercial reach. This next chapter for Strive broadens our presence in the health care ecosystem. Strive Medical plans to operate ProMed DME as a Diabetes Center of Excellence, continuing to support the patients who rely on us.” NMS is a private equity firm managing assets of more than $1.5 billion. “The combined scale and reach will further solidify Strive’s position as a leading independent, specialty distributor of medical supplies, which now includes CGM products,” said Luis Gonzalez, senior partner at NMS. 

PITTSBURGH – sovaSage, a company specializing in AI-based software and services for the management of obstructive sleep apnea, has promoted Jamie Caputo to vice president of sales. Caputo has played a key role in driving the roll out of two products: an AI-based software platform designed to select and fit the best CPAP mask for patients; and TherapistAssist Jeanie, a virtual sleep coach and compliance management platform that’s augmented with live support sleep coaches and respiratory therapists. “Jamie’s extensive experience in PAP compliance management and resupply, his over 25 years in HME and his well-established relationships from previously leading the Philips PAMS and medSage programs have proven invaluable,” said William Kaigler, co-founder and CEO. “I am excited to have Jamie take on this new leadership role and help our customers continue to improve the lives of their patients.” In his new role, Caputo will be responsible for overseeing all sales activities across all products and markets. Previously, he served as the company’s vice president of strategic business development.  

YARMOUTH, Maine – There’s a lot of noise right now around improving the prior authorization process for Medicare Advantage plans and the HME industry needs to make sure it continues to add its voice to the conversation, say stakeholders. Most recently, in June, members of the House of Representatives and the Senate reintroduced bipartisan legislation to streamline and standardize the use of prior authorization for these plans. TheImproving Seniors’ Timely Access to Care Act has the support of the American Medical Association and more than 500 other national and state medical associations. “It isn’t specific to DME, but it does apply because it includes provisions to streamline the authorization process and really make it more transparent,” says David Chandler, vice president of payer relations for AAHomecare. “There’s not a lot of data sharing going on, so these managed care plans kind of hide behind their internal processes – right or wrong.” The bill would: Establish an electronic prior authorization process for MA plans including a standardization for transactions and clinical attachments. Increase transparency around MA prior authorization requirements and its use. Clarify CMS’s authority to establish timeframes for e-PA requests, including expedited determinations, real-time decisions for routinely approved items and services, and other PA requests. Expand beneficiary protections to improve enrollee experiences and outcomes. Require HHS and other agencies to report to Congress on program integrity efforts and other ways to further improve the e-PA process. Because there’s not a lot of data-sharing going on, that, in turn, allows the plans to deny coverage, even where Medicare guidelines, which the plans are required to follow, requires them to cover the items, say stakeholders, who are actively soliciting examples  of this behavior to share with CMS to illustrate how pervasive the problem is. “We have the attention of some folks within CMS,” says Craig Douglas, vice president of payer and member relations for VGM & Associates. “Really, the only way we have of (showing the problem) is with examples.” Two product categories with some of the most issues with denials are complex rehab technology and non-invasive ventilation. Eleven members of the House of Representatives recently asked CMS Administrator Chiquita Brooks-LaSure to take action to ensure that Medicare Advantage payers do not employ coverage criteria for non-invasive ventilators that is more restrictive than Medicare NCD guidelines. AAHomecare has developed an outreach letter for providers to share with patients and caregivers who are experiencing access issues. “If providers are going into the home, if a patient wants to share their story, film it on your iPhone,” Chandler said. “We have attention at every level of the issues – there’s no disagreement that there’s a challenge with managed care and prior authorizations but we’ve got to do our part in holding plans accountable. Congress needs to see this so they can provide better oversight.” Read AAHomecare’s recent recommendations to CMS for improving transparency. View the OIG’s recently posted video on managed care.

AMARILLO, Texas – The Department of Justice’s new task force on health care monopolies and collusion is “absolutely warranted,” says attorney Jeff Baird, chairman of the Health Care Group at Brown & Fortunato. The DOJ 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. Here’s what Baird had to say about how this type of activity is impacting the HME industry today and how, if left unchecked, could have a much bigger impact in the future. HME News: How big of a deal is it that the DOJ has created this task force?  Jeff Baird: The DOJ creates task forces when it determines that potential problems are on the horizon that the government needs to get its arms around before the problems become unmanageable. Many in health care have been concerned about the proliferation of vertical integration. The government has taken notice, and it appears to be considering responsive steps before the adverse effects of vertical integration become more pronounced.  HME: Why is this focus warranted? Baird: This focus is absolutely warranted. In the pharmacy space, the “Big 5” pharmacy benefit managers (PBMs) control much of the industry. All or most of the Big 5s own mail-order pharmacies (“MOPs”) that compete with independent MOPs. The PBMs limit the number of independent MOPs on the PBMs’ mail-order panels and steer patients to their own MOPs. DME suppliers do not have to deal with PBMs, but they have to deal with Medicare Advantage Plans and Medicaid Managed Care Plans. Also, if insurance companies (that own the plans) decide to move into the DME space (i.e., own DME operations), then independent DME suppliers will find themselves in the same predicament as independent pharmacies. Up to now, I have been talking about a small segment of the overall health care industry. Look at the bigger picture: If hospital systems own physician practices, infusion centers, SNFs, etc., then the systems control A to Z health care for their patients.  HME: The task force seems pretty action-oriented. Part of its goal is civil and criminal enforcement. Will the task force have teeth? Baird: Criminal cases will be brought only in extreme circumstances. I do see a proliferation of civil cases. The task force will have “teeth” to the extent that it will provide a road map to the DOJ and FTC to scrutinize mergers/acquisitions and, if the facts so warrant, bring enforcement actions against the transactions. HME: What does this potentially mean for HME providers? Baird: On the one hand, it is hard for me to see monopolization issues arising out of acquisitions in the DME space. Sure, national DME suppliers will purchase independents; however, I do not think that any national supplier will have the market share to adversely affect service and reimbursement. And in any event, reimbursement is controlled by Medicare, Medicaid and insurers. In the same vein, although there is a lot of private equity activity in the DME space, I don’t see such activity approaching monopolization levels. Where vertical integration will affect DME suppliers is when the large insurers purchase DME suppliers or form their own DME businesses. If this happens, independent DME suppliers will find themselves in the same predicament as independent pharmacies that have to deal with PBMs.

TWINSBURG, Ohio – Edgepark’s new online storefront for ostomy products will “elevate and modernize” the ordering experience for prescribers and clinicians, says Yelena Brusilovsky, vice president of sales. Edgepark launched the national storefront in June, leveraging Parachute Health’s e-prescribing platform. “We are essentially unlocking the capability for health care providers to prescribe ostomy products through an e-prescribe (platform),” said Brusilovsky. “Historically, that transmission map of prescriptions was through fax or other more traditional methods.” Through the Parachute platform, clinicians can set up a free account, browse the Edgepark catalog of ostomy products, create a prescription for supplies, utilize e-signature capabilities and provide the necessary clinical documentation.  A track-my-order feature allows clinicians to “opt in” patients to check order status, eliminating the need to call the office. “It goes back to modernizing this experience for the patient,” said Brusilovsky. “When patients embark on their journey as a new ostomate, it can feel very dauting. They are going through a lot of changes and at Edgepark, we recognize the privilege and responsibility we have to support a patient throughout the journey.” For Edgepark, which also offers diabetes and breast pump storefronts through Parachute Health, extending those capabilities to another category was an “exciting” next step, says Brusilovsky. “We’re seeing tremendous adoption in the home health and DME space for e-prescribe technologies,” she said. “We’re really excited to continue supporting the growth of this adoption. The ostomy storefront is a great example of bringing more product categories into our Parachute storefronts and allowing more patients (this opportunity).”

LOVELAND, Colo. – Mobility and More’s commitment to staying independent and openness to evolving has helped the company stay in business for 20 years, says Tab Black, business manager. When Black’s parents opened the company in 2004, it was one of more than a dozen HME companies serving its primary service area – the northeastern quadrant of Colorado. Today, it’s the only wholly locally owned and operated company in that area, Black says. “We were approached multiple times about joining (another company) or selling,” said Black, who uses a wheelchair and who previously worked for Quickie Wheelchair. “We’ve stuck to our guns. Our business plan has changed 15 times over the years, but here we still are.” Today, Mobility and More primarily serves Longmont, Greeley, Fort Collins and Loveland, Colo., as well as Cheyenne, Wyo., and all points in between. The company has had to evolve over the years, responding to market pressures like Medicare’s national competitive bidding program. The program was a big reason behind its decision to narrow its focus, particularly on complex power wheelchairs, which are exempt. “(Competitive bidding) was a train crash,” Black said. “We’re north of Denver, which isn’t considered rural, so we had to comply with non-rural reimbursement, but everyone here knows it is rural.” Then there’s the fact that Colorado was one of the first states to pass a right-to-repair bill. “That hasn’t been successful – I understand that three people have called manufacturers over the last year for parts to do repairs themselves,” Black said. “Everything we sell, we repair, but we also know what the reimbursement is. We try to bundle service trips, which can take longer, or we tell them if they can come to us, we’ll take care of them now.” Mobility and More has also evolved to rely less on Medicare and Medicaid – Black estimates that side of the business has gone down at least 20% over the years – and more on Veterans Affairs, particularly in Cheyenne, and cash pay. “Our VA work includes repairs, setups, deliveries and installs,” he said. But Mobility and More has stayed the same in one other way: It’s still a family-run business. Kyleen Black, Tab Black’s mom, who was the company’s president since the start, passed away in 2019, but Tom Black, his dad, still comes in on Tuesdays and Thursdays. “At one point, it was only family (running the company), but now we’re family-plus,” Black said.

PLYMOUTH MEETING, Pa. – Josh Barnes will step down as president of AdaptHealth on Aug. 31 and from the board of directors on Dec. 31, the company has announced. “Founding Adapt and helping it become the leading provider of HME is a source of immense pride,” said Parnes. “With Suzanne (Foster) as CEO, I am confident the company is in excellent hands and will continue to innovate, grow and deliver patient-focused best-in class care.” AdaptHealth also appointed Dale Wolf as chairman of the board effective July 1. Wolf has served on the company’s board since November 2019 and will assume the role from outgoing Chairman Richard Barasch.  "I am thrilled to assume the role and look forward to working alongside Suzanne and her team to leverage the momentum in our business as we continue to improve the lives of millions of people who rely on us,” said Wolf. Additionally, Foster, who became CEO on May 20, has joined the board effective July 1. FDA, Philips address potential vent malfunction WASHINGTON – The U.S. Food and Drug Administration on June 27 highlighted updated use instructions from Philips Respironics for its BiPAP V30, BiPAP A30 and BiPAP A40 ventilators due to potential interruptions and/or loss of therapy. Philips has updated the use instructions for the vents due to a potential failure in the ventilator inoperative alarm, which can cause therapy interruption or loss. New instructions If interruptions of therapy can be tolerated and the ventilator inoperative (vent inop) alarm occurs, the patient/caregiver will have instructions to remove the patient from the device and to place them on an alternative device. If interruptions of therapy cannot be tolerated, the patients and caregivers are instructed to provide alternate ventilation AND contact the equipment supplier for immediate device alternative. The potential issue The vents may reboot intermittently for five to 10 seconds then restart with the same patient settings; reboot intermittently then restart with factory default settings; and enter a ventilator inoperative state after three reboots within 24 hours, or without a preceding reboot. These issues can result in therapy interruptions or loss, potentially leading to hypoventilation, hypoxemia, hypercarbia, respiratory failure or death in vulnerable patients, the FDA says. The impact There are a total of 911 reports reportedly associated with the recall issue (ventilator inoperative): 894 are malfunctions, 10 injuries, and 7 deaths.Philips statement Philips noted that, while there have been reports of potential patient harm, investigation of these reports could not conclusively determine the cause. The company also noted that customers may continue to use their system in accordance with instructions for use and the field safety notice. The company says it is currently investigating the issue and will implement appropriate actions. CMS seeks to exclude cath codes from program WASHINGTON – CMS has published a proposed rule to address significant, anomalous and highly suspect (SAHS) billing activity within the Medicare Shared Savings Program in response to an observed increase in DMEPOS billing for selected intermittent urinary catheter supplies in calendar year 2023. The agency says SAHS billing activity for codes A4352 and A4353, if not addressed, could adversely impact the accuracy, fairness and integrity of the program’s financial calculations. In the proposed rule, CMS proposes to exclude payment amounts for the two codes on DMEPOS claims submitted by any supplier from expenditure and revenue calculations used for: assessing performance year (PY) 2023 financial performance of Shared Savings Program ACOs establishing benchmarks for ACOs starting agreement periods in 2024, 2025 and 2026, and calculating factors used to determine revenue status and repayment mechanism amounts in the application and change request cycles for ACOs applying to enter a new agreement period beginning on Jan. 1, 2025, or continue their participation in the program in PY 2025, respectively.  CMS will accept comments on the proposed rule, “Medicare Program: Mitigating the Impact of Significant, Anomalous and Highly Suspect Billing Activity on Medicare Shared Savings Program Financial Calculations in Calendar Year 2023,” until July 29, 2024. Comments can be submitted at: https://www.regulations.gov/. Refer to file code CMS-1799-P). Aeroflow Health launches telehealth nutrition counseling service ASHEVILLE, N.C. – Aeroflow Health has launched Aeroflow Nutrition Services, a telehealth service for personalized and group-based sessions with qualified dieticians. Aimed at patients with Type 2 diabetes, the services will help to simplify and support nutrition counseling and use the power of food to manage diabetes and reduce the risk of complications, the company says. “Food should always be a part of the discussion for patient treatment plans,” said Sophie Lauver, registered dietitian for Aeroflow Health. “What we eat is directly tied to our health outcomes. There is a lack of understanding about what foods are detrimental to our health, and this is where Aeroflow’s Nutrition Services will make a significant impact with education for patients, especially those looking to effectively manage type 2 diabetes. Nutrition education is paramount for patients managing any type of chronic disease. With individualized sessions and personalized treatment plans, patients can quickly make changes that will positively impact their health.” Aeroflow Health will offer the services virtually so patients can participate from the comfort of their homes. The company says the services will be available as a preventative care benefit, with little to no cost for most patients through insurance.  BOC honors Chris Casteel OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) has named Chris Casteel, BOCO, BOCP, co-owner of Anew Life Prosthetics and Orthotics in Detroit, as the recipient of this year’s Certificant of the Year Award. After overcoming his own obstacles following limb loss at the age of 24, Casteel has made it his mission over the past two decades to "pay it forward" by empowering others to live fulfilling lives with the help of O&P devices. "I am deeply honored to receive BOC’s Certificant of the Year Award,” said Casteel. “This recognition is a testament to the incredible support I have received from my colleagues, patients and community. My journey through limb loss and rehabilitation has been profoundly personal, and it has driven my passion to help others regain their mobility and independence. This recognition encourages me to continue advocating for O&P advancements and to remain dedicated to providing the best care possible for my patients and community.” In addition to his experience as a practitioner, Casteel has been a peer counselor for many years and hosts a monthly amputee support group that he initiated at the University of Michigan – a model that has now spread to other local hospitals. In 2010, he also volunteered in Haiti, where he donated his time, energy and knowledge of O&P to assist children and adults with disabilities who needed help following the region’s catastrophic earthquakes. The nomination period for BOC’s next Certificant of the Year award will open in the fall of 2024. Those eligible for the award include BOC-certified durable medical equipment specialists, mastectomy fitters, orthotic fitters, orthotists, pedorthists and prosthetists who have made outstanding contributions to their profession, including commitments to service, research and outreach. CMS to implement small increase for seat elevation systems  WASHINGTON – CMS has agreed to increase reimbursement for seat elevation systems for power wheelchairs by $13.62 to $2,013.96, according to NCART. The agency will implement the change and provide instructions on submitting previously submitted claims for adjustment as part of its July DMEPOS fee schedule update, the organization says. Reimbursement of $2,000 for the new code E2298 went into effect April 1, 2024. On an interim basis prior to April 1, providers were being paid about $2,800, on average, for seat elevation systems. Stakeholders had recommended a rate of $3,450, on average. The change follows a meeting between CMS and stakeholders. Click here for CMS’s letter to Wayne Grau, executive director of NCART, about the change. Dynarex opens flagship warehouse MONTVALE, N.J. – Dynarex Corp. has opened an expansive new warehouse in the Town of Wallkill (Middletown), N.Y.  With easy access to New York State Route 17 and Interstate Highway 84 and just 14 miles from Stewart International Airport, the facility will serve as the company’s distribution center for the Northeast region. "This new warehouse is a shining example of our commitment to excellence and growth," said Dynarex CEOZalman Tenenbaum. "TheTown of Wallkillfacility is more than just an addition to our network — it's our flagship warehouse and our e-commerce hub that will significantly boost our fulfillment capabilities across the Northeast region." The 450,000-square-foot facility, which features 36-foot ceilings and 22 high-level bay doors with full van access, is nearly quadruple the size of the company’s previous facility. It also features an advanced automated conveyor system to assist in receiving, selecting and shipping and to increase worker safety. Dynarex held a formal ribbon-cutting ceremony at the facility on June 24 that was attended by local dignitaries. Honest Medical incorporates ADA standards in updated website OCEANSIDE, Calif. – Honest Medical has updated its e-commerce website with thousands of health care products to make it more accessible for people with disabilities. The company made the updates in accordance with new Americans with Disabilities Act accessibility standards. “At Honest Medical, we believe everyone deserves equal access to the medical supplies they need to live healthy lives,” said CEO Mike Greenan. “That’s why we’re thrilled to announce these significant enhancements that ensure our website is fully compliant with ADA accessibility standards.” Features of the website include tagging elements with button functionality to aid assistive technology like text-to-speech screen readers; adding alt text to images and fields that describe meaning and context so those with visual impairments can enable assistive technology; improving menus and dropdowns to coordinate assistive technology; and scaling font sizes and increasing letter spacing to aid those with learning disabilities like dyslexia. The ADA standards outline best practices for making web content more accessible, including ensuring users can navigate a website using the keyboard rather than a mouse; having heading structure that enables users with accessibility tools to easily navigate a site; and making sure all images have captions. State update: Carelon transition delayed WASHINGTON – Carelon Medical Benefits Management will not review Medicaid prior authorization requests for DMEPOS in Maryland (Wellpoint), Missouri (Healthy Blue) and Wisconsin (Anthem) on July 1 as planned, AAHomecare reports. The transition has been postponed until further notice, according to the association. “Suppliers in Maryland, Missouri and Wisconsin should continue to follow the current process when requesting authorizations for DMEPOS services under Medicaid,” AAHomecare stated in a bulletin. The transition was originally announced on April 1. For state-specific announcements, please go to: Maryland Missouri Wisconsin Trella Health enhances CRM platform ATLANTA – Trella Health, a provider of market intelligence and CRM solutions to the post-acute care industry, has launched several new features in its Marketscape platform to streamline workflows, improve goal tracking and minimize administrative tasks. The company says this enables sales reps to maximize their field time, strengthen referral relationships and drive significant growth for their organizations. “We’re thrilled to unveil these new enhancements in our CRM; through continuous improvement and consistent innovations, we are dedicated to delivering solutions that boost efficiency, save valuable time and drive cost reductions,” said Kathy Ford, chief product officer at Trella Health. “Our mission is clear: to empower our customers and their go-to-market teams with the tools they need to strategically grow and achieve unparalleled success.” The enhancements include goal creation to track objectives more effectively; event templates to align strategy; enhanced calendar functionality to optimize workflow and market and sales spotlight to improve accessibility. Trella Health says the new meeting and event scheduling feature, for example, has resulted in a 41% decrease in time spent creating events and a 27% increase in saving events. Chiropractor admits to $14.9M Medicare scam NEWARK, N.J. - A Georgia chiropractor who owned or operated multiple DME companies and a cancer genetic testing (CGx) company has admitted her role in a health care fraud and illegal kickback conspiracy. Tefylon Cameron, 57, of Powder Springs, Ga., pleaded guilty on June 20, 2024, before U.S. District Judge Michael E. Farbiarz in Newark federal court to an information charging her with conspiracy to commit health care fraud and conspiracy to violate the Federal Anti-Kickback statute. According to documents filed in the case and statements made in court: Cameron and her conspirators owned, operated and had a financial interest in DME companies through which they obtained doctors’ orders for durable medical equipment, namely orthotic braces, for Medicare beneficiaries without regard to medical necessity. Cameron and her conspirators obtained DME orders using marketing call centers and telemedicine companies (including multiple Florida-based companies), caused the submission of false and fraudulent claims to Medicare and paid illegal kickbacks.   Cameron and her conspirators also owned, operated and had a financial interest in a CGx company through which she agreed to provide a clinical laboratory with leads of beneficiaries who were qualified to receive federal health care benefits for cancer genetic tests. Cameron submitted invoices to the clinical laboratory seeking payment on a per-lead basis but entered into a sham agreement to disguise kickback and bribe payments. In total, Cameron and her conspirators caused a loss to Medicare of more than $14.9 million.

ASHEVILLE, N.C. – Aeroflow Health has launched Aeroflow Nutrition Services, a telehealth service for personalized and group-based sessions with qualified dietitians. Aimed at patients with Type 2 diabetes, the services will help to simplify and support nutrition counseling and use the power of food to manage diabetes and reduce the risk of complications, the company says. “Food should always be a part of the discussion for patient treatment plans,” said Sophie Lauver, registered dietitian for Aeroflow Health. “What we eat is directly tied to our health outcomes. There is a lack of understanding about what foods are detrimental to our health, and this is where Aeroflow’s Nutrition Services will make a significant impact with education for patients, especially those looking to effectively manage type 2 diabetes. Nutrition education is paramount for patients managing any type of chronic disease. With individualized sessions and personalized treatment plans, patients can quickly make changes that will positively impact their health.” Aeroflow Health will offer the services virtually so patients can participate from the comfort of their homes. The company says the services will be available as a preventative care benefit, with little to no cost for most patients through insurance.

DALLAS – The deadline to submit proposals for the 2025 Medtrade Conference is this Friday, July 5. The Medtrade educational program covers a wide range of topics and includes tracks for audits & compliance; operations & innovations; complex rehab technology (CRT) & mobility; legislative, regulatory, legal; managed care; product categories; and sales & marketing. Within each track are four specially curated session topics created by the Medtrade Educational Advisory Board to be used as both a guide and direction for submissions. Medtrade invites proposals on the topics outlined within each track, as well as any other subjects relevant and valuable to the the show’s audience. More about the 2025 conference tracks and topics can be found here. Medtrade takes place Feb. 18-20 at the Kay Bailey Hutchison Convention Center in Dallas.

PLYMOUTH MEETING, Pa. – Josh Barnes will step down as president of AdaptHealth on Aug. 31 and from the board of directors on Dec. 31, the company has announced. “Founding Adapt and helping it become the leading provider of HME is a source of immense pride,” said Parnes. “With Suzanne (Foster) as CEO, I am confident the company is in excellent hands and will continue to innovate, grow and deliver patient-focused best-in class care.” AdaptHealth also appointed Dale Wolf as chairman of the board effective July 1. Wolf has served on the company’s board since November 2019 and will assume the role from outgoing Chairman Richard Barasch.  "I am thrilled to assume the role and look forward to working alongside Suzanne and her team to leverage the momentum in our business as we continue to improve the lives of millions of people who rely on us,” said Wolf. Additionally, Foster, who became CEO on May 20, has joined the board effective July 1.

OWINGS MILLS, Md. – The Board of Certification/Accreditation (BOC) has named Chris Casteel, BOCO, BOCP, co-owner of Anew Life Prosthetics and Orthotics in Detroit, as the recipient of this year’s Certificant of the Year Award.After overcoming his own obstacles following limb loss at the age of 24, Casteel has made it his mission over the past two decades to "pay it forward" by empowering others to live fulfilling lives with the help of O&P devices."I am deeply honored to receive BOC’s Certificant of the Year Award,” said Casteel. “This recognition is a testament to the incredible support I have received from my colleagues, patients and community. My journey through limb loss and rehabilitation has been profoundly personal, and it has driven my passion to help others regain their mobility and independence. This recognition encourages me to continue advocating for O&P advancements and to remain dedicated to providing the best care possible for my patients and community.”In addition to his experience as a practitioner, Casteel has been a peer counselor for many years and hosts a monthly amputee support group that he initiated at the University of Michigan – a model that has now spread to other local hospitals. In 2010, he also volunteered in Haiti, where he donated his time, energy and knowledge of O&P to assist children and adults with disabilities who needed help following the region’s catastrophic earthquakes.The nomination period for BOC’s next Certificant of the Year award will open in the fall of 2024. Those eligible for the award include BOC-certified durable medical equipment specialists, mastectomy fitters, orthotic fitters, orthotists, pedorthists and prosthetists who have made outstanding contributions to their profession, including commitments to service, research and outreach.