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On the Editor's Desk

by: Liz Beaulieu - Thursday, October 13, 2016

Well, Theresa and Tracy, we had a good run.

Before now, we’ve been basking in the glow of having three recent HME Newspolls with more than 100 respondents.

In the August issue, our readers had plenty to say about whether or not they’ve stopped taking assignment on certain products this year (148 respondents); in the September issue, they had plenty to say about how Medicare pricing has impacted Medicaid and third-party payer pricing in their states (114 respondents); and in the October issue, they had even more to say about who will be their pick for president next month (303 respondents).

Before these polls, it’s been a struggle. Take our July issue, when we asked about the impact of a new overtime rule on providers’ businesses. That poll had 53 respondents. In the June issue, we asked about a new overpayments rule. That poll had 24 respondents.

I concede that polls about Medicare assignment, piggyback pricing and the presidential election are slightly more sexy than polls about new overtime and overpayments rules, but we’re shooting for some diversity over here.

For our November issue, which we’re kicking out the door this week, we thought it would be a good idea to have a special Medtrade-themed poll, with the rationale that we could use the responses to said poll for a story for the Show Dailies that we’ll be doing onsite at the show. Since the goal for Medtrade this year is “Collaborate, Cultivate and Innovate,” we settled on asking providers about how they have collaborated, cultivated or innovated in their businesses this year.

Can you hear that? That’s the sound of a pin dropping.

Twenty-four hours after we sent the poll out—which is when we get the bulk of our responses—we’ve heard from eight providers. Eight!

Dejected, I took to twitter yesterday afternoon to say: “Based on the # of respondents to our poll so far, there’s not much innovation going on in the HME industry.”

I thought I might rile some folks into action—nope.

I did hear back from Tyler Riddle, a provider in Georgia. He tweeted: “@hmeliz folks just hanging on.”

There is that. One of the eight respondents to the poll wrote in: “For the first time, four local businesses sat down together and commiserated about the state of the industry. That’s the closest we’ve gotten to collaboration.”

There’s no doubt that, as a recent guest blogger said, “Medicare is the worst I’ve seen it,” but I prefer to think that the dearth of responses means providers are too busy collaborating, cultivating and innovating to be pestered by me, Theresa and Tracy and our little poll.

by: Liz Beaulieu - Friday, September 30, 2016

I’m not going to lie. When I asked Rick Glass, who always presents the results of our Financial Benchmarking Survey at the HME News Business Summit, to put together a 10-year snapshot to recognize 10 years of the survey, I was a little worried about what’d I’d get back.

As any of you know, a lot has happened to the HME industry in 10 years—a lot of it not good.

And as any of you know, Rick is not one to sugarcoat reality. If it’s bad, he’s going to tell you it’s bad.

So I was pleasantly surprised when Rick came back to me with this slide.

Granted, these numbers represent a small slice of the HME industry. And I tend to think that the providers who complete the survey tend to be the providers who have healthier businesses.

But look.

The number of providers who report Medicare as a large part of their business is decreasing—from 44% in 2007 to 25% in 2016. This, to me, means you really are changing your business model, whether it’s more non-Medicare business or more cash sales.

The number of providers who report revenues grew year over year has remained relatively stable—65% in 2007 and 62% in 2016. This, to me, means cost cutting and strategic efficiencies are allowing you to do more with less.

The number of providers who reported profit dollars grew year over year actually increased—from 61% in 2007 to 66% in 2016. Blow me over with a feather.

This is as good a way as any to end the week. Happy Friday!

by: Liz Beaulieu - Friday, September 23, 2016

We'll have two stories in our HME Newswire on Monday about different sessions at this week's HME News Business Summit.

(Don't tell anyone, but here are the links to those stories now: and

But there was so much good stuff from the Summit (stuff—real technical term, I know), I've also strung together some quotables from other sessions here.

Available green space
Interoperability has its roots in paving the way for acute-care providers to “talk” more easily with ambulatory care providers, but leaders have realized that’s not good enough, said Jeff Gartland, who sits on the operating committee of the CommonWell Health Alliance, a not-for-profit trade association of health IT companies working to create universal access to health data nationwide.

“One of the profound findings that we’ve found since we’ve deployed (the network to thousands of sites) is that the diversity of the ecosystem that is important goes beyond ambulatory,” said Gartland, who participated in a panel titled “Interoperability: Why it’s not pie in the sky.” “It’s really critical, if we’re to follow the patient where they are, that there is a diversity of care settings (involved).”

That opens the door for HME providers to become a bigger part of the process, said Nick Knowlton, an operating committee member and chairman of the membership committee at the Alliance. That process is far enough long to have momentum but not too far along to represent a missed opportunity.

“What the healthcare ecosystem needs is your leadership,” he said. “There’s a lot that still can be invented out there—there’s still a lot of green space.”

Irresistible demographics

M&A analysts believe private equity activity could perk up now that it’s possible that CMS has wreaked all the havoc it’s going to wreak with its competitive bidding program. This year, the agency applied bid pricing to non-bid areas.

“Once reimbursement is stabilized and it’s no longer a variable risk, the demographics are irresistible,” said Don Davis, president of Duckridge Advisors, who participated on a panel titled “M&A in a challenging market: What and where are the opportunities?”

Influencer of outcomes

When HME provider Dewey Roof thinks about what he prioritizes in his business, he thinks about what hospitals and health systems prioritize in theirs. That’s gone a long way toward making them see his company as “an influencer of outcomes” vs. a “widget provider.”

“All your data needs to be aligned to that goal and demonstrate that value to your referral source,” said Roof, president/CEO of LifeH2H, who participated on a panel titled “Connected health: Let’s get in the weeds.” “Whatever is important to them has to be important to you.”

by: Liz Beaulieu - Wednesday, September 7, 2016

I wrote a blog earlier this year about how competitive bidding has affected access to home medical equipment.

I used our HME Databank to look at two data points for walkers (E0143), a common product that has been included in the program:

  1. the number of Medicare beneficiaries who received the product in a given year
  2. the amount Medicare spent on that product in a given year

You’ll recall that I found a 9% decrease in the number of Medicare beneficiaries who received walkers from 2012 to 2013 and a 9.7% decrease from 2013 to 2014. From 2012 to 2014, pre- and post-Round 2 of competitive bidding, which saw reduced reimbursement spread to cities across the country, I found a 17.9% decrease.

I also found an 18% decrease in the amount Medicare spent on walkers from 2012 to 2013 and a 23% decrease from 2013 to 2014. From 2012 to 2014, it was a 37.4% decrease.

At the time, I was anxious to add 2015 data to the mix. Round 2 went into effect July 1, 2013, so 2015 data would give us a picture that spans more than two years.

Now I have 2015 data.

We’ll be updating our HME Databank with 2015 data on Oct. 1, but below is a sneak peek at what the two data points above look like for walkers:

2014: 705,831 Medicare bennies received the product

2015: 706,354 Medicare bennies received the product

2014: $38,313,467 in total reimbursement

2015: $38,673,505 in total reimbursement

So it turns out the number of Medicare beneficiaries who received walkers and the amount Medicare spent on these products remained relatively stable from 2014 to 2015.

We all know, though, that 2016 has been a watershed year for the HME industry. On Jan. 1 and July 1, CMS rolled out bid-related pricing to non-bid areas nationwide. And on July 1, it also implemented further reductions in Round 2 areas as part of a re-compete of the program.

What do you think the data for 2016 will hold?

Stay tuned.

by: Liz Beaulieu - Friday, August 26, 2016

As I look at the educational program for this year’s HME News Business Summit, I don't necessarily see sessions on how to overcome challenges.

What I do see are sessions on how to take advantage of opportunities.

The kinds of opportunities that present themselves when you become a player in the eyes of health systems because you’ve armed yourself with outcomes data.

The kinds of opportunities that present themselves when you educate yourself about new trends in healthcare delivery and health data exchange.

The kinds of opportunities that present themselves when you stop, even for just an hour, to think about why you’re resisting the flurry of change around you, and how that’s holding you back.

You spend enough time thinking about the challenges—at least eight hours a day, some days more.

At this year’s Summit, it’s our goal for you to spend a day and half thinking about opportunities.

The challenges will still be there when you return to the office. But with opportunities in your line of vision, they won’t seem as insurmountable.

We hope you'll consider joining us.

by: Liz Beaulieu - Friday, August 19, 2016

As I was writing up a story on our most recent HME Newspoll results (see Monday’s HME Newswire), I remembered some comments made by Inogen officials during the company’s recent conference call to discuss its second quarter financial results.

In our poll, we asked readers whether or not new Medicare pricing (new pricing went into effect in non-bid areas on Jan. 1 and July 1, and in Round 2 areas on July 1) has impacted third-party pricing in their state. An overwhelming majority—more than 80%—said yes.

Inogen officials back up those results.

This, from Scott Wilkinson, president and COO:

“We have also seen some private insurance payers reduce their rates for oxygen services in the second quarter of 2016 in response to the lower Medicare reimbursement rates. We do expect these private payer rates to continue to decline in alignment with the new Medicare Round 2 re-compete competitive bidding pricing. Looking ahead, in spite of these significant reimbursement changes, we believe we are well positioned to continue our total revenue growth in the oxygen therapy market with best-in-class and patient-preferred products and services with the competitive total cost of ownership.”

Ali Bauerlein, CFO and co-founder, described the impact of this piggyback pricing on Inogen’s second quarter:

“Turning to rental revenue, direct-to-consumer rental revenue in the second quarter was $9 million, representing a decline of 22.8% from the same period in the prior year, primarily due to the anticipated Medicare rental reimbursement cuts that took effect in the first quarter of 2016 and reductions in private-payer rates as they followed the decrease in Medicare rates and higher rental revenue adjustments.”

She also described the impact on the company’s full-year guidance:
“We expect additional rental revenue headwinds, due to the additional private insurance rate reductions, higher provisions for rental revenue adjustments, and lower net patient additions as we focus on sales versus new rental. We currently expect total rental revenue to decline as a percent of total revenue and decrease approximately 25% in 2016, compared to 2015.”

by: Liz Beaulieu - Wednesday, August 3, 2016

There has been a rash of companies buying other companies, as well as public companies reporting their latest financial results, in the past week, and reacting to change is a recurring theme behind all of their activity.

When I was writing up an item on Cape Medical Supply buying New England Medical Homecare, this quote from Cape Medical President and CEO Gary Sheehan jumped out at me: “As we continue to explore our strategic options for succeeding in a changing and crowded healthcare market, bringing our industry-leading sleep therapy program to one of the most populous regions of Massachusetts made a lot of sense.”

Note my emphasis on “changing and crowded healthcare market.”

When I was writing up an item on Cardinal Health’s latest financial results, this line jumped out at me: “The Cardinal Health team is well-positioned to adapt, innovate and lead during a time of great change in the healthcare industry.”

Again, my emphasis.

From Mick Farrell, CEO of ResMed, during the company’s recent conference call to discuss its latest financial results: “Well, the whole sleep industry landscape has changed fundamentally, I would say in the last 18 months, approaching 24 months, since we launched Air Solutions. And the basis of competition in the space is now changed to not be only, do the devices have to be quieter, smaller and more comfortable, but they also have to be more connected. And we think that connectivity has really changed the space.”

This from a company who has not only connected CPAP devices, but also connected vents and soon-to-be connected POCs.

From Matt Monaghan, chairman, president and CEO of Invacare, during the company’s recent conference call to discuss its latest financial results: “With the North America/HME transformation underway, we have initiated the second phase of the change, which is the enhancement of our post-acute care business affecting principally the IPG segment. Over the past quarter, we’ve begun developing our specialized post-acute care sales force with investments in clinical sales training of certain customer call points and recruitment.”

This from a company that’s taking advantage of its position as a maker of devices for the growing post-acute care market.

Seth Godin says, “The cost of being wrong is less than the cost of doing nothing.”

So, what’s change got you doing?

by: Liz Beaulieu - Tuesday, July 19, 2016

The disappointment was palpable on Friday, when word began spreading that the Senate had failed to pass a bill delaying a second round of Medicare reimbursement cuts in non-bid areas before it began its long summer recess.

I received twitter messages with swear words.

I received emails with GIFs showing a man sweating and biting his nails.

I received phone calls from business owners that can’t believe they’re expected to continue serving Medicare beneficiaries when their payments have been essentially cut in half.

As the ever-poignant Pat Naeger told the Southeast Missourian about the new payment rate of $86 per month for home oxygen therapy: “My cable bill is higher than that.”

Senators actually hightailed it out of D.C. on Thursday night, but official word didn’t come (at least to us at HME News world HQ) until noon on Friday from The VGM Group, and until 2:50 from AAHomecare.

Since the cuts already went into effect July 1, a retroactive delay was already Plan B. (Side note: How the logistics of a retroactive delay would even work are beyond me, considering CMS’s bungling of a one-year delay to a bid-related reimbursement cut to accessories for power wheelchairs).

It’s hard not to feel sorry for our HME industry.

What other industry succeeds in getting bills passed in both the House of Representatives and the Senate, but because they are different bills and because of “personality and politics,” a final bill never made it to the president’s desk to become law.

If I were a betting woman (which I’m not), I would have said a final bill was a given. The Senate even agreed to run with the House bill, which had a three-month vs. one-year delay and a non-Medicaid related pay-for.

I have a friend whose husband will get laid off from his job next week. She is stressed, but she also knows the situation is out of her control. What can you do, she says, but look forward and ask, where do we go from here?

So where do we go from here, HME industry? I’m in the process of trying to find out, amidst fielding tweets, emails and calls from justifiably angry providers.

What I know so far: a retroactive delay is still a possibility when lawmakers return to D.C. in September. Another option: a go-forward delay (a pause, if you will).

Industry stakeholders maintain that the lawmakers that passed two bills and the senators who initiated a “hotline process” for a final bill last week are in shock themselves about what happened.

“They are emboldened even more to get something substantive done in September,” said Cara Bachenheimer, senior vice president of government relations for Invacare. “The momentum was so strong, and the disappointment so great. There were a lot of lawmakers thinking, are you kidding me?”

by: Liz Beaulieu - Wednesday, July 6, 2016

If you follow me on twitter (@hmeliz), you know I gleefully announced yesterday that Associate Editor Tracy Orzel is back from her leave of absence, during which she walked the Camino de Santiago, a weeks-long walking pilgrimage across Spain.

Not only is Tracy back, she’s clear headed, she’s tan, she’s fit. Not that she wasn’t any of these things before—she knows what I mean.

During our 10:55 this morning (go here for more on that), she shared an interesting story from her trip.

One day, an older gentleman named Tim recounted the story of how, when he asked a woman for a second date, she told him he needed to answer a question first: You’re walking along and you come across a wall; what do you do?

Each of the members of her Camino crew answered the question. Their answers varied from, I’d walk around the wall, to I’d climb over the wall, to I’d blow up the wall. One member, a Brit with military experience, said he’d crouch down, brace his back against the wall and create a foothold with his hands so his mates could climb over.

The point of the question is not only to determine a person’s approach to problem solving, but also to get insight into how they view the world.

The woman who said she’d blow up the wall—Tracy characterizes her as a firecracker. The Brit with military experience—Tracy says he’s used to doing everything as part of a team.

Me, I envisioned the wall as insurmountable and had a panic attack (this may or may not have something to do with the wear and tear of having an almost two-year-old).

I thought this was a good question for HME providers to ask themselves, with the wall, of course, representing competitive bidding.

In light of yesterday’s news that the House of Representatives has passed a bill that would delay a second round of Medicare reimbursement cuts in non-bid areas, maybe you envision the wall having a hole big enough for you to walk through.

Or maybe, because there are still some devils in the details (like getting the House and Senate to agree on the length of the delay and the pay-for—all in two weeks), you envision the wall as crumbling and you’re preparing to deliver the final blow that will open it right up.

Think about it (it’s a good exercise in self exploration if anything), and while you’re at it, join me in welcoming back Tracy, who I hope is not too upset that I stole a really good blog idea.

by: Liz Beaulieu - Tuesday, June 21, 2016

I blogged last week about the significant drop in the number of allowed beneficiaries for some of the most popular DMEPOS products starting in January of 2016.

I speculated that the nosedive was due to CMS’s roll out of competitive bidding to non-bid areas and its implementation of the first of two reimbursement cuts that each amount to about 25%.

Quite a bit of conversation on twitter ensued.

A number of providers (and Managing Editor Theresa Flaherty) speculated that the nosedive also had to do with deductibles.

Per provider Chris Rice’s suggestion, I dug back in to see if the same drop that we’re seeing from December 2015 to January 2016 happened from December 2014 to January 2015. And sure enough, it did.

But not quite as much.

Using oxygen concentrators as an example, I found that the drop in the number of allowed bennies was 17.5% from December 2014 to January 2015. From December 2015 to January 2016, it was 24%.

So I definitely think this is a toxic mix of competitive bidding and deductibles sending utilization spiraling downward.

The number of allowed bennies for oxygen concentrators from January 2015 to February 2015 did bounce back a bit, from 210,735 to 223, 357, but it fell well short of December 2014, when it was 247,618.

What happened in February 2016? Stay tuned.