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by: Mike Moran - Saturday, January 24, 2009

This week, I would like to metaphorically toss two shoes at Alice Rivlin, former head of the Congressional Budget Office and the White House Office of Management and Budget, for her foot-in-mouth comment on national competitive bidding.

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During a Senate Budget Committee hearing on Wednesday, Rivlin championed competitively bidding HME as a means to save Medicare money. Rivlin said that, with all due respect, the decision to delay the program was "ridiculous," reported the Congressional Quarterly.

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In its weekly update, AAHomecare president Tyler Wilson retorted: "With all due respect to Ms. Rivlin, it would have been ridiculous to continue that bidding program, which was a disaster for patients and providers alike, which is why Congress wisely reformed and delayed the program."

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by: Mike Moran - Thursday, January 22, 2009

The Obama administration, on its first day in office, issued instructions to federal agencies to review all pending and recently issued regulation (Past presidents have done the same thing). The VGM Group and AAHomecare believe the review should include the interim final rule on national competitive bidding, which was published in the Federal Register Jan. 16. Industry stakeholders ask providers to call on their members of Congress to urge the Obama administration to review the competitive bidding rule. In an update to members, AAHomcare highlighted this paragraph from the instructions:

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"...extending for 60 days the effective date of regulations that have been published in the Federal Register but not yet taken effect…for the purpose of reviewing questions of law and policy raised by those regulations. Where such an extension is made for this purpose, you should immediately reopen the notice-and-comment period for 30 days to allow interested parties to provide comments about issues of law and policy raised by those rules.” The memo states that for those rules that raise “substantial questions of law or policy, agencies should notify the [Office of Management and Budget] Director and take appropriate further action.

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by: Mike Moran - Thursday, January 15, 2009

An in-depth story published by The Associated Press calls attention to the vulnerability of people who rely on medical equipment like oxygen concentrators during power outages. The story points out that few states are equipped to identify people at risk. As a result, emergency planners are often unable to provide these people with the help they need to survive an outage due to a hurricane, ice storm, etc. In some cases, that has meant death.

In a nice piece of positive PR, the story does recognize the important role homecare providers play during power outages:

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When it comes to oxygen, many home health care companies "bend over backward" to race tanks to customers during power outages, noted Washington's Rubinson. In fact, after Hurricane Katrina, the American Association for Home Care asked the government to designate oxygen providers as "first responders" for easier movement in disaster zones. 100 million BC download

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But the story points out more needs to be done. For example: Registries of power-dependent people need to be set up in each state.

How can providers work with state authorities to better coordinate care for power-dependent people? It seems like they would be natural resources for states looking to formalize assistance to these people.

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by: Mike Moran - Thursday, January 8, 2009

AAHomecare sent out a media update this morning (Jan. 8th) that provides a few more details on its plan to reform the home oxygen therapy benefit. After months of working on the plan, the association shared it yesterday (Jan. 7th) with various industry stakeholders: state associations, The VGM Group, The MED Group. Some interesting tidbits:

*The "budget-neutral" plan would carve out oxygen from national competitive bidding and eliminate the 36-month cap. How is it budget neutral? Does the plan set up a different pay scale for patients with different needs, i.e. lower reimbursement for nocturnal patients?

*The plan was presented by Leslie Norwalk. Yup, the former CMS Administrator.

*The plan would change the legal status of oxygen companies from "suppliers" to "providers" to recognize the services they provide.

*AAHomecare has scheduled a Feb. 11 fly-in to shop the plan around Capitol Hill. Does that give the association enough time to tweak the plan based on feedback from state associations and others?

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We'll have a story in our NewsWire on Monday.

Stay tuned.

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by: Mike Moran - Wednesday, December 31, 2008

Drumline divx Only a few dozen comments were submitted on the recent guidance for the 36-month oxygen cap by the Dec. 29 deadline, industry stakeholders reported this week. That's despite numerous pleas from AAHomecare, The VGM Group, NAIMES and other industry stakeholders. What gives? If providers are "freaking out," as one industry stakeholder put it, why didn't more of them submit comments? What better way for providers to send a message to CMS that they think this policy stinks? What better way to have some of their concerns addressed in future guidance?

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Are providers making their concerns heard in other ways? If so, I want to hear about them.

Did providers think their comments wouldn't make a difference? If so, that's not the right attitude.

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Did providers think it was futile to submit comments by Dec. 29 for a rule that goes into effect Jan. 1? If so, you have a point, but still.

Really, this shocked the whole HME News team. This is no way to end 2008 and kick off 2009.

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by: Mike Moran - Wednesday, December 17, 2008

The industry was able to convince Congress to delay national competitive bidding on July 15, two weeks after the program was implemented. The oxygen cap goes into effect Jan. 1. Does that mean the industry will be able to convince Congress of another delay, this time for the cap, on Jan. 15? The timing may be just about right.

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The debate over the cap has reached a crescendo. This week, a "dear colleague" letter written by Reps. Tom Price, R-Ga., (he wrote an unsuccessful bill to repeal the cap) and Heath Shuler, D-N.C., had 88 co-signers. The letter asks CMS to delay the cap, giving Congress time to reform payment and policy.

Also this week, the industry and CMS began duking it out in the press. Read this Pray 2: The Woods move for a provider-friendly story from ScrippsNews and this for a CMS-friendly story from The Associated Press. (In the latter, CMS doesn't mince words. Laurence Wilson says concerns are unfounded and stem in many cases from misleading representations from unhappy medical equipment companies. Ouch.)

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We haven't seen this much activity, again, since competitive bidding left town. I'm sure the industry's hoping luck comes in twos.

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by: Mike Moran - Friday, December 5, 2008

Wayne Stanfield has been getting daily calls from providers confused and worried about the ramifications of the oxygen cap. The executive director of the National Association of Medical Equipment Suppliers said the horror stories are trickling in. Here's one example that just about sums it up. A Tennessee-based provider has tried to line up a provider in Wisconsin to care for an elderly woman—capping in January—who moved to be be near her grandson. Out of seven providers, only one was willing to take on the patient—at a price. The Wisconsin provider would charge the guy in Tennessee $225 a month, plus $50 a tank. That works out to between $300 and $400 a month out of the provider's pocket. He can't afford it. The beneficiary complained to CMS that her original provider was leaving her high and dry. The grandson is livid. The original provider is stuck in limbo. CMS had no answers for any of them.

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by: Mike Moran - Wednesday, December 3, 2008

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Apria Healthcare, now a portfolio company of The Blackstone Group, named Dr. Norman Payson CEO on Dec. 2. Payson, who has been a member of Apria's board of directors for the past two years, has quite a resume. In addition to an Ivy League education (MIT and Dartmouth), he has served as CEO of two multi-million member publicly traded health plans: Healthsource, a physician sponsored health plan now part of Cigna; and Oxford Health Plans, New York City's largest health plan. Apria lauds Payson's "expertise in the transition of complex healthcare businesses." I wonder what "transition" he and The Blackstone Group have in mind for Apria?

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by: Mike Moran - Wednesday, November 26, 2008

Provision gives hope to some
Recently released guidance on the 36-month oxygen cap may contain a silver lining for providers, at least those with long-term patients. On pages 846 and 847 of the guidance, Medicare states that, after five years from the day of set up, providers can supply oxygen patients with new equipment and bill Medicare for another three years. That’s music to the ears of Lee Guay, a coordinator for Apex of St. Peters in Helena, Mont. Thanks to the provision, 40 oxygen patients who he thought were capping out Jan. 1 are eligible for new equipment. The patients have been on oxygen for at least six years. “This is pulling some providers out of the fire,” Guay said.

AAH details oxygen reform

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AAHomecare sent an update to members this week outlining the type of oxygen reform it will propose to members of Congress early next year. The reform includes eliminating the 36-month oxygen cap and paying for therapy during the entire period of medial need; basing payments on a patient-focused not equipment-focused model; and removing oxygen from national competitive bidding.

CMS answers questions
CMS has posted answers to frequently asked questions about the 36-month oxygen cap. Find the FAQ article.

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by: Mike Moran - Tuesday, November 18, 2008

This is a bit off the beaten path for an industry which cares more for people during their golden years, but interesting nonetheless. California's Superior Court last Friday struck down a 2007 agreement between the American Diabetes Association and the California Department of Education that allowed trained school personnel to give insulin injections to school children, something many medical professionals, parents and diabetics support.

Rise the movie The American Nurses Association and several California nursing groups then filed suit, arguing that only medical professionals should be allowed to administer injections. Judge Lloyd Connelly agreed, saying that state law backs them up.

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What all this means is that children who cannot give themselves injections (maybe they are simply too young or scared of needles) must either stay home from school; their parents must go to the schools to give the shots; or everybody needs to keep their fingers crossed that a nurse will be available at the right time. That last part seems unlikely in a state where the ratio of students to nurses is 2,150 to 1, according the Disability Rights and Education Defense Fund.