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by: Theresa Flaherty - Thursday, August 25, 2016

Things have been tough for the HME community for the past few years but this summer has taken it to a whole ‘nother level. Not only has the Medicare reimbursement for DME been decimated, other payers have begun to follow suit.

AAHomecare has tasked itself with gathering anecdotes about the impact on businesses as well as beneficiaries and I know I’ve heard my own share of horror stories. The best thing providers can do right now, say stakeholders, is amplify that message.

Meanwhile, over in the fantasyland that is Big Pharma, Mylan execs are backing down a little from plans to increase the price of the EpiPen once again—since 2007, the price has been jacked about 500% for no reason other than they can. To add insult to injury, its execs aren’t even owning their responsibility in this mess. The only person on this planet who defended Mylan? Martin Shkreli.

Don’t even get me started on how much those same execs increased their pay especially after speaking with provider Chris Smythe yesterday who told me: “You can’t pay me $26 for a commode that cost me $25. It just doesn’t work.”

Or check out this convoluted tale of Optum, the PBM for United Healthcare, overcharged customers for prescription medication (often, more than what the drug itself cost) and then clawed back the “overpayment” from the pharmacist.

I’d say nice work if you can get it, but frankly, I prefer to sleep at night.

And finally, a headline that strikes fear in my diabetic little heart: "Soaring insulin prices have diabetics feeling the pain."


by: Theresa Flaherty - Tuesday, August 2, 2016

I’m a bit famous for my excellent memory.

For example, favorite childhood memory: my parents put bootprints, sleigh tracks and a carrot top on the roof outside my window the Christmas I turned 4 so that I would know where Santa landed.

That memory has come in handy more than once lately, as I’ve had a few providers reach out looking for various articles that dated back 8 to 10 years. Found ‘em! When Mike Moran (you all remember Mike, right?) left several years, I think there was some fear on the part of Liz and I that we were losing his institutional memory. Fortunately, we muddled through just fine.

I will mark 11 years here at HME News this month and these days, I’m the institutional memory (well, Liz too). Like when competitive bidding got delayed after 14 days in Round 1 back in 2008. And contracts were sent by FedEx. I didn’t have to look any of that up.

Of course, it doesn’t hurt that I have been writing about much the same stuff since day 1 (competitive bidding, audits), just from the other side of the issue.

It helps to have a good memory when you are a writer: you can recall facts, quotes, etc., to flesh out the story. Or the blog (see above: Santa). Memory also aids in spelling words correctly (Liz hollers over the cube wall because frankly, it’s just faster to ask me most of the time).

Of course, neither memory nor superior spelling skills prevent plain old typos. Typos that totally change the meaning of a word or sentence are likely to send me into giggles (trust me, I’m not a giggler).

This week’s winner: I tweeted a link to a Q&A with Bob Soltis, but called him Bobo. While I am sure there are Bobos in the world, I doubt most of them are former ALJs who now author books on Medicare hearings. If there are, I doubt they are taken seriously.

Fortunately, we caught it and dropped the Bobo.

by: Theresa Flaherty - Wednesday, June 15, 2016

Did you know that if you hold a session called “Women & Wine” men automatically know it’s not meant for them?

It’s true, and it was kind of a nice change of pace. Beth Cox-Hollingsworth reminded us all to take a moment to find the calm in our lives, something that is especially true in the hectic HME industry.

I am happy to report I regularly make time for some quiet calm, often with glass of (white) wine in hand; I have to. With Type 1 diabetes, I am well aware that stress is the enemy of us all.

The event also served as the setting to announce the new VGM HME Woman of the Year Award. The award is the brainchild of none other than new-ish CEO Mike Mallaro, who recognizes that women are often under-recognized and under-rewarded. Mike made an appearance—in video—at the session to talk about the award and its importance.

Know someone you’d like to nominate? Yourself? Do it here.

The new award and the new session are just two ways in which the folks at VGM are keeping Heartland fresh. The event is in its 15th year and it’s still pulling in first time attendees. I spoke to a few at lunch today, including an RT (48-year career so far) who is newer to the industry and needed CEUs. Another is a 23-year manager of a medical supplier who has recently taken on the mantle of sales manager—something that hadn’t existed previously at her company. She was here to learn anything and everything she could about sales and marketing.

Although VGM is a big deal in Waterloo, and the Heartland Conference is a big deal in the industry, shockingly my cab driver was in the dark.

“What are you in town for?” asked he.

“Heartland,” answered I, using the industry shorthand.

“Is that a church?” asked he.

Anyhow, today was our final day here at the conference and one thing we couldn’t find? Postcards! Anywhere!

by: Liz Beaulieu - Tuesday, June 14, 2016

Imagine if you never forgot a person’s name ever again? How much easier could that make your life? That was the talk at today’s opening session at Heartland 2016.The session was called “Welcome to Your Brain” and it was about training your memory. A trained memory, according to keynote speaker Bob Gray, can enhance your business and your relationships and your business relationships.

“You can remember anything as long as it’s associated to something else in your life,” he told attendees. “I have yet to come across a business that cannot work better and more effectively through better recall.”

(I’m gonna inject here and just say, training or not, Mr. Gray has some sort of out-of-this-world-genius-robot memory, as demonstrated by a few fun exercises that had us riveted.)

Just to use our own myopic HME industry view of the world, we could all use memory association to sort out which round of competitive bidding included what categories, in which areas and started when. Am I right?

“Find your 12,365,” says Gray. “It has to be ridiculous.”

I also sat in on sessions on Google and AutoPay, both of which point the way to new ways of thinking, of doing business, of staying not only afloat but relevant and profitable.

But that’s why you’re all here, right?

I also attended the Washington Legislative update. While we were teased with breaking news (thanks, Jay Witter, you know how to get a reporter to stick around til the bitter end), there wasn’t anything specific per se that came out of today’s session, but judging by all the messages Witter seemed to be getting (from THE HILL!) point to something big happening, immediately if not sooner (as my dad used to say).

Reading between the lines, I’d say we’re looking for movement on the two bid bills, which by the way are at 32 cosponsors for the Senate bill and 103 for its House companion.

Well, something big needs to happen and it needs to happen fast, because Congress breaks for the summer on June 24. That’s ten days, people.

And that 12,365? It’s not only the number of months and days in the year, it’s the same height as Mt. Fuji. That’s merely one example of memory association.

by: Theresa Flaherty - Monday, June 13, 2016

Waterloo, Iowa, is 1,366.9 miles from Portland, Maine, if you’re driving. I’m not sure how far it is as the crow (or in this case, Delta) flies, but two 2-hour plane flights, and an hour’s drive in a rental car with Siri’s help (she pronounces it water-LOO) and we made it to our hotel tired and hungry but relatively unscathed.

Then we got lost on the tiny drive to the Heartland hog roast. I’d like to blame Siri, but who knows how we wound up meandering through the local neighborhoods looking for something, anything, that looked like the downtown or the riverfront.

At the kwik mart where we stopped for directions:

Clerk: “It’s near the “Waterloo Library. Do you know where that is?” No.

Helpful customer: “Isn’t it near the library?” So we’ve heard.

The good news is, we now know where the apparently ever-popular Waterloo library is.

This year is the 15th year of the annual VGM Heartland Conference and Van Miller’s absence appears keenly felt. His dog, Daisy—soon to be a working dog with veterans, children with autism, and, ahem, people with diabetes—made the rounds tonight, as did several other pups.

They’ll be around all week and if you can, check out this important cause, Retrieving Freedom, which trains the dogs and matches them with families.

Another theme I’ve already noticed at this year’s event: wine.

There’s been a couple of networking events centered on wine, including the women and wine event (or wine, women and song, as Jo-Ellen insists on calling it) that’s on my calendar for Wednesday afternoon. Shocking, I know!

While I didn’t see any wine at the hog roast tonight, there was a special beer on tap: It’s called Thumbs Up and it was brewed specially in honor of Van.

I also got a hot tip for a special announcement happening on Wednesday. I’m sworn to secrecy, but I can tell you, I approve!

I’ve got my new Heartland app downloaded and am ready to get started tomorrow.

Cheers from the Heartland!

by: Theresa Flaherty - Monday, May 2, 2016

Well, it looks like I posted last week’s blog not a moment too soon. CMS released its highly anticipated list (and list upon list upon list) of the Round 2 re-compete contract suppliers.

I am sure you are all out there, busily poring over the list for you area of interest, both products and geography-wise.

And I know poor Kim Brummett and others like her will be poring over all of them.

So, in the interest of sanity, allow me to share initial thoughts on my area of interest: the diabetes category. Conveniently, it's also the only one that's a one-pager.

Last time around, CMS offered approximately 20 mail order contracts (I say approximately, because the number shifted a few times.)

This time around they offered only nine.

A quick comparison of this year’s list with the previous list, reveals that only three of the nine contract suppliers are repeaters. The new list also reveals that of the nine, four were among the top 10 providers in the category in the HME Databank in 2014.

So, first question, what kind of impact will reducing the number of mail-order suppliers by half have on a. beneficiary access and b. the suppliers themselves?

The second question is how these companies, will make any money off the new super low pricing?

It remains to be seen.

On a side note, scanning the websites of the new suppliers whose names I didn’t recognize, I stumbled across something I hadn’t seen before: a medical ID bracelet with a QR code. This way, emergency workers can scan the code and pull up what I would assume is a medical profile that’s a bit more comprehensive then a few engrave words can ever provide.

For all I know, this has been around since about the time I let my subscription to Diabetes Forecast expire (I renewed in February and got my first issue last week, it’s good to be back!).

by: Theresa Flaherty - Monday, April 25, 2016

“Hey, Theresa, any idea who won contracts?” asked more than a few providers in recent emails.

That, my friends, is the question of the day.

And the answer so far is no, for the most part. Two notable exceptions: Aeroflow Healthcare, which has received 645 contract offers for 108 CBAs; and Rotech Healthcare, which has received contract offers for general HME and standard mobility for all 117 CBAs and respiratory equipment in 116 CBAs.

Oh, and Inogen also made a big sweep—it got respiratory in 93 CBAs.

Rumor has it that CMS is having to extend additional contract offers because providers are rejecting them, and reaching out to nudge offer-ees to get those contracts signed and returned.

As in previous rounds of the bid program, it will be interesting to see who’s on the list. And, as the industry continues to scratch its collective head over the latest reduction—an average of 7%—that list of contract suppliers will be closely scrutinized because who the heck keeps lowering the limbo bar with lower bids?

And, once we see the names, we will have a clearer idea on how well various licensure laws, aimed at preventing things like someone in Florida bidding in Hawaii, have worked.

So much for a reporter to follow up on, and yet, I’m in limbo without that list.

Stay tuned.

by: Theresa Flaherty - Monday, April 18, 2016

Editor Liz and our marketing guru Heather (she’s very busy lately trying to drum up messaging to entice you to submit an HME Excellence application) both have very young children and therefore, like to compare notes on different stages of development, etc. Not coincidentally, they also use the same daycare so they also gossip about that.

I know all of this because Liz’s cube is on the other side of mine and I can’t help but hear. The convo is often fascinating to me.

Today’s topic was sleep. Apparently, even babies don’t always get enough. I also have a friend with a four-year-old struggling with sleep.

I suppose parents have always been concerned with how well their offspring are sleeping, but I’ve been thinking a lot lately about how the national conversation around sleep has grown. Especially since I sent an assignment to our contributing editor John Andrews today that featured—sleep.

Then I came across this article about the impact of sleep deprivation on employer’s wallets, to the tune of $63 billion a year in the U.S.

$63 billion! The tired mind boggles.

I have never been a good sleeper (sorry, Heather and Liz, that can happen), although I was an easy baby (unlike a certain brother of mine). I suspect this is because I’m a night owl by nature in a 9 to 5 world.

I'm also a light sleeper, which means precious sleep gets interrupted (why, oh why, is my roommate smashing around the kitchen at 6 am?! (Actually she's quiet as a mouse, I think every thing just sounds louder at that hour.)

Lately, I've gotten worse at sleeping.

But, I’ve also been slacking off on things like exercise and even just fresh air (since we are in Maine, I have an excuse for this; that fresh air is still pretty cold), both of which I firmly believe help with sleep. So, in an effort to sleep better, I am taking off extra early today to force myself to the gym and start building the habit again.

(Yawn). Wish me luck.



by: Theresa Flaherty - Friday, April 8, 2016

I’ve written in the past about my obsession with Dear Prudence, an advice column on

I’ve discovered an advice blog that I now read regularly: AskAManager, and it’s all about work, from the benign (“How long can your resume be?”) to the bizarre (“Low performers in my office are paraded around and forced to wear dunce caps”).

This week, a reader wondered how best to navigate job interviews in a wheelchair.

In order to be out and about for eight to ten hours a day for a commute and job, I’m going to have to use my wheelchair. The thing is, I’m terrible at it. I bump into doorways. I have trouble getting lined up with desks properly. I’ve run into people accidentally — a lot. Plus, I sweat quite a bit while using it, probably a combination of muscles unused to the work of pushing it and nervous perspiration. I think time and practice will help me get better at it, but what do I do for job interviews now? 

Now, first of all, we all know job interviews are painful in any circumstance, but this is one of those things those of us who don’t use wheelchairs would never think of. While we talk a lot about wheelchair users (for example) leading as normal a life as possible, this points to how much effort "normal" can take.

I should mention this blog has has a passionate community of commentators and many of them not only had helpful suggestions, from making sure your interview suit allows you to maneuver, to practice, practice, practice, to wondering whether a rollator might be a more workable option.

Other commenters discussed things like insurance coverage (She doesn’t qualify for an electric power chair), Medicare issues, etc.

And, as most providers will appreciate: the wheelchair user had to travel an hour to buy her chair because she lives in—a rural area!

And now, just for fun, a few more headlines:

I punched a coworker at the office Christmas party

A vegan coworker is being aggressive toward me about food

My office wants us to chip in to send our CEO's family on a ski trip

I just hope I don’t come across this question on the blog:

"I recently asked if anyone needed anything from the grocery store and one of my direct reports had the nerve to ask me to pick her up a half gallon of milk. She even specified “skim.” Should I write her up?


by: Theresa Flaherty - Friday, April 1, 2016

There's been a lot of chatter over the past two weeks about the new Round 2 re-compete payment amounts. With seemingly a gazillion different HCPCS codes with their corresponding prices (per region), folks have been burning up their calculators to crunch the numbers, I'm sure.

Except for one product category: mail-order diabetes, which was delightfully simple to parse, what with it being one national price for each of eight codes. 

So, my scientific analysis (which consisted of printing off a hard copy of the new rates and comparing them to the hard copy of the previous mail-order rates tucked in a red file folder conveniently labeled "mail-order") tells me that the price for test strips has inexplicably gone down! 

The old rate: a draconian $10.41 per box. The new rate: a sub-draconian $8.32 per box—a difference of $2.09, which I believe calculates to a nearly 21% decrease. (Does it? I'm a wordsmith, not a math genius. Not even a math moderate.)

Can mail-order providers even ship for $8.32? And who's going to want to? CMS also announced that it was extending contract offers to nine providers, compared to the 18 or so last time. What will this do for access? What happens when we have a mail order or two fail because they can't make the numbers work? The numbers of people with diabetes ain't falling, folks.

And, will retail pharmacies want to offer the "big four" brands at these rates?

There's been a study, just published, making the rounds recently about the disruption in access for beneficiaries as a result of the bid program. People keep mentioning it to me, but frankly, I covered the study as story in June after it was presented at the American Diabetes Associations 75th Scientific Sessions.

I mentioned the radio silence on this lower pricing to Jonathan Sadock in passing. His guess was as good as any: "Perhaps it's just been so decimated that it doesn't even make the news any more."