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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.

by: Theresa Flaherty - Wednesday, August 26, 2015

Yesterday, the UPI team (parent of HME News) coaxed me into our conference room overlooking the Royal River (as well as the woodpile for the restaurant) to “surprise” me on my tenth anniversary with the company.

(Note: Editor Liz and I have an unspoken agreement that we will give each other a heads up in these situations).

It’s easy to remember my anniversary, especially as it coincides with the anniversary of Hurricane Katrina. One of my very first stories, my first or second week on the job, was about the impact of that storm on HME providers in the region. Imagine if you will, trolling through a giant database, southeast maps in hand, trying to pinpoint areas that might have been hit and, if you can even get a dial tone, asking providers if their inventory is at the bottom of Lake Pontchartrain or if their documentation is a soggy, audit-ready mess.

Yep. But, what I’ve learned is that people find it helpful to talk to get the word out.

Of course, I tried to assign a far-less tragic disaster beat story to a new-ish editor after Hurricane Sandy, only to be kiboshed by the bosh. Boss.

“You can’t expect a new (ish) person to do a story like that!” said Liz.

Uh, OK. To be fair, it was probably Jim Sullivan or Mike Moran who saddled me with the Katrina piece. Liz wasn’t in the power seat at the time, instead operating out of a storage area waiting for an office to open up.

And no, I didn’t think I’d stick around for 10 years but the job must agree with me.

As to whether I’ll be here in 2025 (that sounds like I’m living in a science fiction film), who knows? But it will be interesting to see what HME News looks like in 10 years.

Theresa Flaherty

by: Theresa Flaherty - Monday, August 17, 2015

Last week, while vacationing at the Cape, I helped mom clean out and organize her storage shed.

This is not as altruistic as it might sound. The more Stuff (and it is Stuff) I can encourage mom to get rid of now, the less I have to deal with when she shuffles off her mortal coil.

I’m practical that way.

I’m also happy to report improvements in, uh, aging-in-place for dear old dad.

You may recall, in January, I posited here that my parents had yet to install grab bars, and that dad was resisting the cane.

There are now three grab bars in the bathroom (1 pretty and shiny which they hang washcloths from, 2 your basic ugly white). There is also a very pretty new railing on the back deck.

I believe all of this work was done by the mysterious Junior (Jr.?). Junior is like the Cape Cod version of Sasquatch. He’s rumored to exist, but I’ve never actually laid eyes on him. He’s an all around handyman for my parents. This winter, to their delight, he added snowplowing to his menu. They wouldn’t divulge his information to the handful of other year rounders in the ‘hood hinting at wanting to hire him.

Fun fact: snowplow companies in the area were charging $200 a pop to plow.

Dad has also acquired a quad cane, which he doesn’t use around the house, but will take elsewhere. At home, he likes to leave it in the middle of the floor. Oh, the irony if one of them trips over it.

All in all, it was a great week. Beaches, margaritas, a hot tub and even a movie (Rikki and the Flash.)

I did have one senior moment myself. I had in one hand my vitamin D and Synthroid; in the other, I had the cap to a syringe. Guess which one I accidentally threw out? Yup. The meds, and I didn’t have extra in my handy 7-day pill thingy. Which is probably just as well. I came home on schedule (if you know the Cape, you’ll know I left at 7 am), when I might otherwise have been tempted to tell editor Liz I was staying longer.

by: Theresa Flaherty - Tuesday, August 4, 2015

Don’t do it, they said. It’s too risky, they said.

And yet, Florida Medicaid officials went ahead and gave their business to Univita Health. All of it.

Less than a year later, Univita has collapsed and patients, providers and the medical community are left scrambling.

This is what happens when you put all of your eggs in one basket, only to have the bottom of said basket fall out. That leaves Medicaid officials with egg on their faces.

Bureaucratic heads should roll on this one, people.

I don’t know what’s behind the collapse of Univita, a company that, despite its reputation as an evil behemoth, seemed to be doing innovative things.

I also find it fascinating that, right up until they pulled the plug, the company was launching businesses, joining associations and sponsoring stuff.

I mean, did the corner office guys not know this was coming? I guess I can never make the big bucks because I could never imagine being in a position to keep smiling all the while knowing this was coming.

But, I digress. One Florida provider I spoke with about this debacle said it was likely that Medicaid’s low reimbursement was a factor.

We’ve already seen this with the dreaded Medicare bid program, in which providers accepted contracts at draconian price cuts and eventually folded because they couldn’t sustain their businesses at those rates.

I’ve never understood the equation where an increase in volume, multiplied by what is essentially a negative, is supposed to add up to a viable business model.

If there’s a blessing in disguise here, it’s that the Univita story will serve as a warning against similar arrangements.

Because, while big banks and big car companies are considered “too big to fail,” I don’t think healthcare providers will be afforded the same protections.

by: Theresa Flaherty - Tuesday, July 21, 2015

Well here’s an app we could have used in the offices of HME News world HQ this winter.

The ResApp lets you cough into your phone to try and diagnose why you are hacking and coughing all over innocent coworkers (here’s looking at you, Liz, cough, cough). Illness this winter took us all down, often on more than one occasion.

The ResApp has reportedly achieved 96% accuracy in diagnosing pneumonia and 100% in diagnosing asthma.

It’s just the latest we’ve heard of in healthcare apps that purport to track everyone from fitness to sleep to disease state management. I’ve written before about how I use the Glucose Buddy app—when I think of it.

Provider Eric Cohen recently took a couple of sleep apps for a test drive. While Cohen said they both seemed to do as advertised, his personal take way was along the lines of, OK, now what?

Now what, indeed? We’ve been talking a lot about healthcare technology here lately in the office, but it mostly seems like we’re talking about what it all means for the future. A future with a big question mark.

Obviously, most HME providers aren’t app whiz kids, but what sorts of technology can HME providers tap into to help serve patients and grow their business?

by: Theresa Flaherty - Monday, July 6, 2015

You may recall that two months back, I bought an old school pedometer rather than the sexier Fitbit. This was primarily because I already track blood sugar, carbs and insulin with the aid of a glucometer and a phone app. And then only when I actually feel like inputting said data into the phone app.

Any more data, using yet another device, would have made my head explode.

Fast forward to a recent conversation I had with Andy Flanagan, CEO of Telcare, which has created a blood glucose meter that allows you to enter all of the above, in real-time, and can also take input from other sources (re: Fitbit), all with little effort on the part of the user.

Editor Liz handed back my story with the comment: What do YOU think of all this capability?

Well, Liz, I think it’s amazing, and I think it’s long overdue. In fact, I blogged about the company nearly three years ago when they first appeared on the horizon.

The company’s mission, as Flanagan told me, is to simplify life for somebody living with diabetes with as few touches as possible.

What’s not to love?

Also, I won’t lie. Looks matter. I used to wonder why Steve Jobs couldn’t throw his genius into medical devices so that users could gain sophisticated technology in a pretty package.

Maybe I shouldn’t complain. I’ve read descriptions of the first glucometers marked for home use (circa 1981) as a brick. Which would be real heavy to carry in my purse.

If the Telcare adds Pandora or another music service, I’m all in!

by: Theresa Flaherty - Tuesday, June 16, 2015

My last blog covered the Xtreme Eating Awards and the ridiculous entrees dreamed up by chain restaurants. Many of these entrees supplied a full day’s worth of calories and up to several days worth of things like fat and sodium.

While she’s dropped like a stone from the headlines, you probably recall reading about the school cafeteria worker who was fired for feeding a hungry kid, something she’s done before, she said.

“I had a first grader in front of me, crying, because she doesn’t have enough money for lunch,” Curry, a mother of two, told a CBS Denver station. “Yes, I gave her lunch.”

I realize that schools gotta take a stand somewhere, but in a country where a member of the middle class will order a 1.5 pound entrée, graze at an all-you-can-eat buffet for some ridiculously low price, or eat an 8-pound burrito to get the free t-shirt, I don’t think kids should be going hungry.

Our collective gluttony aside, did you know that 40% of food in the U.S. goes uneaten? That’s equal to more than 20 pounds of food per person per month.

Fortunately, all is not lost (tossed), per this Time Inc. article. Food rescue groups are redistributing perfectly fine food to soup kitchens and shelters. A former Trader Joe’s exec is piloting a nonprofit grocery concept in which nutritious food from grocery stores, food supplies, restaurants will be made available at very low cost in urban areas.

While the school’s defense is that it is not required to feed kids (and to be fair, they do give them three hot meals, and then, a cheese sandwich and milk thereafter), it’s a shame that our educational system is so rigid and inside the box.

by: Theresa Flaherty - Thursday, June 4, 2015

It’s that time again. The Center for Science in the Public Interest has announced the latest winners of its Xtreme Eating Awards.

I always love this feature because it fascinates me that people would actually order this stuff off the menu. Or that people sit around and think this stuff up. I mean we are talking about entrees that tip the nutritional scale at 2,000 calories.

I haven’t heard of half of these restaurants (hopefully they’ll never come to Maine), but I have heard of The Cheesecake Factory, which never fails to appear on the list.

This year’s entree? Louisiana Chicken Pasta, which has 2,370 calories, 80 grams of fat (four days worth) and 2,370 milligrams of sodium (1.5 day’s worth). By comparison, that’s equivalent to two orders of fettuccine Alfredo plus breadsticks at Olive Garden, according to the article.

The meal itself actually weighs 1.5 pounds! If you eat 1.5 pounds of food, do you step (waddle? roll?) away from the table 1.5 pounds heavier? (no, you don’t).

I won’t lie: it looks tasty in a horrifying, I can’t look away kinda way.

What doesn’t look good? The 7X7 Steakburger ‘n Fries at Steak ‘n Shake. Punctuation problems aside, this dish features 7 burger patties with cheese on a bun. I can’t even wrap my mind around this concept, and certainly no one could wrap her mouth around it. The burger clocks in at 1,330 calories and 4,750 grams of sodium.

Fun fact: the burger is only available from midnight to 6 a.m.—for the stoned, the drunk and the damned, presumably.

It doesn’t matter that obesity is (still!) exploding in this country or that Type 2 diabetes threatens to bankrupt the medical system.

Despite all the healthy school lunch initiatives implemented by Michelle Obama or community gardens and farm-to-table dining that has become popular around the country, chain restaurants seem determined to march in the opposite direction.

I don’t want plates piled with so much it overwhelms me. Give me small (and less pricey) plate choices, I beg you!

Check back next week for the flip side of our overabundant plates.

Gotta run! I need to renew my membership to CSPI.