Subscribe to E–SP RSS Feed


by: Theresa Flaherty - Monday, January 18, 2016

Now that you’ve fallen for my cheap, attention-grabbing ploy, let me clarify: after another year of white-knuckling it through “HR analyzes health coverage plans season,” a nightmare has come true.

It went something like this: I hit CVS to pick up my prescription for a three-month supply of Humalog, one of two insulins I must take.

Imagine my surprise to learn that the copay had jumped from $60 in October to $150—an increase of more than 100%.

I politely left without my insulin but filled with a faint cold fear that overshadowed the remainder of my weekend.

Turns out, although, ostensibly, my insurance coverage didn’t change (our HR, the capable Erika, thoroughly researches options every year), through some fancy footwork by the insurer, which shall remain nameless but rhymes with Barvard Milgrim, it did change things up some on the drug benefit.

That goes for my other insulin and apparently, everything else related to diabetes meds and supplies (even lancets for crying out loud). It looks like even their PREFERRED brand of test strips (which I had to switch to two years ago) will also be grouped in this third tier with the higher copay.

As I was moaning about this at the office, a coworker asked if there were other options for insulin (as in cheaper). However, all insulins are not created equal, except perhaps, in the eyes of the payer.

Even if I wanted to switch from a product I’ve used successfully since diagnosis, to one that works differently (and would greatly impact my quality of life)? Just, no.

And let me tell you, HME News coworkers, if you think I’m difficult to accommodate now when it comes to a communal work meal?

Plus, why is it that, in health care, we can be forced to change from an excellent product to one that is less excellent and have that be considered a reasonable option? If your cell phone plan for your iPhone6 is too rich for your budget, do you consider switching back to the iPhone4? Hell no!

All may not be lost: I think I can buy a cheaper syringe out-of-pocket at Walmart (I don’t shop at Walmart—ever—so this is an extra trip. And a moral outrage.)

It also looks like I can do the same with a CVS brand of strips and meter. The meter has a memory but I doubt it has download capabilities, which means the additional step of entering numbers into my Glucose Buddy app or old schooling it with paper logs. Really?

So, fingers crossed, it’ll all even out in the wash, but the impact is definitely a negative in this girl’s logbook.


by: Theresa Flaherty - Thursday, December 17, 2015

Yesterday, I gave a dollar to a homeless veteran. Sue me.

I’m hardly a bleeding heart myself but it always shocks me the vitriol some folks display toward those less fortunate. Ranting about freeloaders (yes, there are freeloaders) and welfare cheats (those, too!) and, here in Portland where there is a large immigrant community, what the misinformed refer to as ILLEGALS (ever notice people who rant, tend to do so in capital letters?).


And yes, there are better ways to give money then handing out the occasional buck. For example, the other day our office manager, the capable Erika, sent out her yearly email reminder for today’s annual silent auction which raises funds for the Good Shepard Food Bank. We do little bits of this year round, but today’s the last minute push to boost that total. I’ve got my bid in on a tequila set and I think I have a good chance around these lightweights.

As usual it’s been another year of reporting the ups and downs of the HME industry, but through it all, providers continue to amaze me with their resilience, their generosity and their belief in doing the right thing.

For your holiday reading enjoyment, below are links to two of my favorite stories from this year, as well as a handful I dug up from the archives.

Delivery driver saves man, daughter from river

Trickle down effect

Mission accomplished: Provider Tom Polston reunites with fellow veterans

What a trip: Providers help veterans fly

Provider makes big donation

Apria employee saves two

Provider medals in generosity


by: Theresa Flaherty - Tuesday, December 15, 2015

If you are in any way affiliated with the HME industry Tom Ryan won’t let you off the hook.

Especially when he’s got a new bill to push. I spoke to Tom last week about the introduction of the long-awaited House bill. These conversations with Tom often have him issuing the rallying cry for the industry to drum up support among their respective lawmakers. I think this alone is probably a full time job.

As I was wrapping things up and saying goodbye Tom interrupted me.

“Theresa, have you reached out to your lawmakers yet?”

That caught me slightly off-guard (hey, I’m the one asking the questions here).

But truthfully, as I told Tom, I haven’t, mainly because reporters need to stay out of the picture, so to speak.

This is not always easy. After a couple of years crisscrossing the Hill with Karyn Estrella, I often felt an urge to speak up with enthusiasm about what providers do, or explain exactly what is wrong with competitive bidding. But I don’t. It’s not my place (especially that time I was booted from Sen. Kerry’s office simply for being a reporter—and the senator wasn’t even there!).

Eh. It’s all material.

I am happy to report that both of Maine’s senators are original cosponsors of S. 2312.

I am not happy to report that, at last check, none of Maine’s representatives are currently signed on to H.R. 4185. Unfortunately, we just learned that neither bill, nor bills aimed at CRT accessories will be included in the omnibus bill. While both bills will remain live, I give you permission to take a Holiday break from lobbying (sorry, Tom).

by: Theresa Flaherty - Friday, December 4, 2015

I can still remember the glazed looks of my parents when I brought my first issue of HME News to Thanksgiving so they could see what, exactly, I was writing about. Now they only read my blogs.

I mean, HME News readers might find the latest coding issues or marketing trends fascinating, but the rest of America? Not. So. Much.

And, although I am often (slightly) in the know about what’s happening in the greater scheme of things (reporters of any stripe tend to pay attention), it’s not often that what I write about daily directly applies to my life when I leave the office.

Until this week’s rather mobile editorial meeting, during which we discussed fodder for our January NewsPoll and cartoon.

First, the cartoon. I won’t reveal the substance of it here, but it’s a play on the old game Twister. After work last night, I caught a very old episode of Friends on cable. They were playing Twister. I am confident when I say that in 10 years of Friends, that’s the only episode they ever play Twister. Or any other Milton Bradley game.

Coincidences like this make me think the universe is a wonderfully cosmic place.

Second, the newspoll. We asked how providers are finding the transition to ICD-10, Hint: So far, better than expected. A few months ago, we asked whether they expected the transition to disrupt cash flow. They did.

Fast forward to last night. After Friends ended, I headed to my friend Sallie’s house to hang out. She’s a self-employed massage therapist who doesn’t love billing. She’s experiencing disrupted cash flow because at least one giant insurer has some sort of weird transition issue and she hasn’t been paid for six weeks, when turnaround time is supposed to be three.

To paraphrase Oscar Wilde, sometimes life imitates work.


by: Theresa Flaherty - Tuesday, November 17, 2015

I was eating celery with cream cheese yesterday as an afternoon snack (really, I was eating cream cheese, the celery a mere vehicle) and thinking it was lucky editor Liz was out. I know she finds the crunch annoying.

As I munched, I was reading a summary from the sales team about their West Coast sales trip and learned that Mick Farrell of ResMed fame is trying to be more engaged with social media and if the good folks at HME News could follow him on Twitter (@ResMedMick) that’d be great. I hadn’t even known he was on there, but I follow him now.

I always appreciate it when people let me know things like this, it’s so easy to get lost in the clutter online. Although there are more providers and others in the HME industry turning to social media, it seems like it’s been a slow migration.

Myself, I find Twitter at times variously amusing/annoying/informative/misleading but I focus on the amusing and informative.

For example, without Twitter, I would never have known it was Healthy Lunch Day. Alas, my lunch was only semi healthy, although my afternoon snack today was a salad—better than the bag o’ fake cheesy puffs associate editor Tracy has been rattling around with this week.

I also learned (gasp!) that Liz eats and feeds “the kid” Pirate's Booty. To understand my shock, please know that Liz thinks it’s worthwhile to press her own coffee beans and make her own granola, despite having a one-year-old.

Pirate Booty! 

by: Theresa Flaherty - Tuesday, October 27, 2015

Today, while hanging at the HME News booth (1755), I had the pleasure of meeting someone who reads my blogs.

“Hi Theresa, you’re the Type 1 of the group, aren’t you?”

I almost said, “No, that’s Liz” before I realized he meant Type 1 as in diabetes, not Type A as in, uh, personality.

Turns out his daughter has Type 1, so he can relate.

When I told Liz this story, she immediately had the same confusion.

“What! That’s not you!”

Great minds think alike, even when they think wrong.

Anyhow, it was a good first day on the show floor. In a rare change of pace, both Liz and I got to hang out at the HME News booth (did I mention it’s number 1755?) for about an hour in the middle of the day.

That’s because, like the unsuspecting fly that hovers too close to the hungry frog, we were both trying to snag unsuspecting providers for a quote, and in Liz’s case, photos for question of the day.

There are several types of providers who attend Medtrade. Newbies, old timers, the positive and the occasional pessimist, to name a few. I talked to two first timers to the show, and I know Liz talked to a brand new provider. It always amazes me the optimism folks display about this industry.

I also spoke to a provider who flew in from Anchorage, Alaska. All together, her journey took about 16 hours, she told me. She said it’s been worth the trip.

For those of you that are old hat to Medtrade, you’ll know we will be putting out Show Dailies—I just shipped tomorrow’s edition to the printer. Look for it when you arrive at the exhibit hall Wednesday morning.

We’ll be heading to the AAHomecare Stand Up Reception shortly (I am not looking forward to the schlep across the Georgia World Congress), but it will make my dietician to know I am forced to walk thousands of steps every day. I am already at 7,330 for today.

See you tonight? Or maybe at the booth tomorrow or Thursday. And yes, I’ll be looking for more quotes. Don’t forget, it’s booth 1755.


by: Theresa Flaherty - Friday, October 23, 2015

Wouldn’t you just know? With a hectic next week expected, what with Medtrade and all, one hoped this week would slide gently into the weekend.

Not a chance. As I write this, associate editor Tracy is putting the finishing touches on our top Newswire story: the introduction late yesterday of a Senate bill on the CRT accessories issue. She came in early this morning to get a jump on it.

Speaking of early mornings, I know Editor Liz loves her early morning earnings calls. This week: Invacare and ResMed both reported in.

I caught up with AAHomecare’s Kim Brummett to get the deets on the tweaks OMHA has made to its appeals settlement process (hint: not a lot of changes).

I also have put the finishing prelim touches on the show dailies for next week and our editorial team has a plan in place for covering the show. We’re eyeing the Brightree Summit, updates on ICD-10 and complex rehab, the always popular AAHomecare reception, and a possible sheep.

Fun fact: I awoke in the wee hours this morning thinking "Oh, it's Saturday, no need to get up early," immediately followed by 'Oh no! Did I forget to drop my computer off at FedEx?!' With relief, I realized it was only Friday.

All of this pales, however, in comparison to the sad start of the week, when we learned that VGM’s Van G. Miller died on Sunday. Our condolences.

See you in Atlanta!

by: Theresa Flaherty - Monday, October 19, 2015

Here in Maine we’ve been spoiled by warmer fall weather. Until yesterday. The temp never got above 50 degrees and it dipped into the 20s overnight.

I reluctantly turned on the heat. (We usually wait until Halloween).

This morning, a thick layer of frost on my car windshield awaited me.

I arrived at HME News world headquarters only to find we had no heat. (It’s also not unheard of for the AC to conk out when it’s hot. We are, after all, located in an old fish cannery. It’s a tricky building).

While one of my wingmates had her husband bring us in some heaters from just up the road, it’s pretty chilly in here today.

What does this all mean? I am avoiding checking my blood sugar unless absolutely necessary. They say you can’t get blood from a stone. Well, it’s just as hard to get it from an icy digit.

With all the damage Medicare has done to the diabetes market, I haven’t written as much as usual about what’s happening in this space. So, I plan to call around and see what’s up. 

Our most recent update to the HME Databank showed some changes to the Top 10 diabetes providers for Medicare. To no one’s surprise, Arriva is at the top of the heap, billing for nearly 600k patients in 2014. Its next nearest competitor, All American Medical Supplies, billed less than half that, submitting claims for just over 162K beneficiaries. I may give them a call and see who they are.

I also can't help but wonder how the market shakes out with the next round of bidding for the national mail order program (Is it Round 2 rebid? Round 1 2017 national mail order? deja vu?).

If you’ve got something diabetes related you think I should be hearing about, or anything else for that matter, you know I always want to hear about it. Give me a call, shoot me an email or drop by the HME News Booth at Medtrade on Thursday, where I’ll be loitering.


by: Theresa Flaherty - Monday, September 21, 2015

Over the past year, whenever I’ve gone to the doctor (luckily, not often), I am tempted to ask: “Are you ready for ICD-10?”

Now that it’s upon us, I wish I had. After all, everything is fodder when you are a writer. HME providers by and large say physicians are not prepared. I am inclined to believe them.

On the bright side, it does sound as though most HME providers are as ready as they can be, which is good. I did have one provider post a comment on my recent story on the ICD-10 transition, in which he questioned whether there is a grace period for HME providers. There is not, but there is one for physicians, which will be of some benefit.

Let me explain it as I understand it:

The auditors have apparently been instructed NOT to deny a DME claim based solely on the specificity of the ICD-10 code. As long as the physician uses a valid code in the same family, you should be safe.

So, for example, if the physician uses one of the old codes for diabetes (you knew that’s the example I was going to use) instead of one of the new, more specific codes, you’re covered. If you forget to include one of the 57,000 other things required on the claim, you’re not. If the code applies to COPD on a claim for diabetes, you're also not.

I'd like to take a moment here to apologize for taking a week to see the comment, JGiles, but we don't have a dedicated person to do this. That's not to say that work ain't nothing but a party. (sorry, couldn't resist).

Speaking of which, when I first learned about this change, I was fascinated (and a little horrified on behalf of the entire medical community).

I actually tried looking up and comparing ICD-9 vs ICD-10 codes for diabetes. This proved impossible for a layperson like myself.

But I will definitely be curious to see how my code changes at my next visit. 

by: Theresa Flaherty - Thursday, September 3, 2015

My friend Danielle, a long-avowed animal lover, has been taking horseback riding lessons for the past year or so. In August, she finally realized her dream of owning her very own horse, a rehabbed mustang named Ladybug (she didn’t pick the name).

Sadly, Danielle’s first time riding her very own horse two weeks ago was not to be. She fell off (I’m oversimplifying here, but neither rider nor horse was at fault).

She broke her fibia and tibula (or is it fibula and tibia?) and dislocated her ankle. Fortunately, she was saved from further injury by her helmet and her soft landing (yes, you know what she landed in).

Last week, after several days of solitary confinement in her parents’ living room, our circle of four sprung her from the family home. (She can’t get into her own second floor apartment and also needed help with everything from showering to sliding on a flip-flop so it was mom to the rescue. Isn’t it always?).

Don’t even ask me the logistics of getting her and her crutches to Margaritas. I was struck by how helpless she is. Which reminded me of the whole brouhaha going on around Medicare prosthetic policies.

Over quacamole, I shared some of the more egregious proposed changes with my friends who were as appalled as anyone in the amputee community. 

While I am sure she’s doing much better this week, Danielle was very limited last week and very shaky her first time out of the house. But, it’s a temporary state of being and she will get better, and more mobile each week. After all, she didn’t lose a limb.

The idea that a prosthetic device, especially the most appropriate device, could be deemed not medically necessary should be a concern for all of us.