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by: Mike Moran - Tuesday, June 8, 2010

We are co-sponsoring a Webinar with Emerge Sales next Week (June 16 and 18) that I'm looking forward to.

The Webinar's called "The Pulmonologist Speaks," and that pretty much says it all. I talked to about a dozen respiratory providers, who gave me a bunch of questions they wanted pulmonologists to answer. Once we finalized the list of questions, I handed it over to Emerge Sales, which specializes in gathering market intelligence. Emerge acquired contact information for hundreds of pulmonologists all over the country and began calling them (or the appropriate office staff).

We'll present the data during next week's Webinar, which we'll run four times (we're trying to accommodate everyone's busy schedule). I can't wait to find out what percentage of pulmonologists understand the impact of Medicare's 36-month cap on oxygen patients; how many track hospital readmissions; and what motivates them to switch to a new HME provider.

If you want more insight into how to work better with this key referral source, this Webinar will be a big help.

If you'd like to register for "The Pulmonologist Speak," click here.

Here's the list of questions Emerge has been asking pulmonologists.

Mike Moran

Clinical questions
1.    What are your top three diagnoses for patients? (Rank in order of most common)

2.    What are your primary goals for patients you refer to home medical equipment providers?
a.    Keep them at home for as long as possible with a treatment of respiratory medications and supplemental oxygen
b.    Provide supplemental oxygen, pulmonary rehab and other therapies/services that allow the patient to be as active as possible
c.    See patient as needed and treat exacerbations as they occur
d.    Other (specify)

3.    Is there an oxygen delivery modality you insist upon for your patients, or are there multiple modalities that are effective in your experience?

4.    Do you feel that liquid and gaseous oxygen systems are equally effective in treating COPD?
a.    Yes
b.    No. Liquid oxygen is more effective
c.    No. Gaseous oxygen is more effective

5.    When you prescribe oxygen for a chronic condition, do you monitor the patients ongoing need for oxygen?
a.    Yes
b.    No

6.     Do you keep track of hospital readmissions for your home oxygen patients?
a.    Yes
b.    No

7.    Do you refer sleep patients to HME providers or do you let sleep labs make the referral?
a.    I make the referral
b.    I let the sleep make the referral

Patient care questions - Updates on patient progress
8.    Do you like to receive updates from HME providers on how your patients are doing?
a.    Yes
b.    No

9.    If yes, do you want updates on all of your patients or just those that are high-risk or having problems?
a.    All
b.    Just high-risk

10.    How often would you like to receive updates on high risk patients?
a.    Monthly?
b.    Quarterly?
c.    Every six months?
d.    Other (specify)

11.    How often would you like to receive updates on stable patients?
a.    Monthly
b.    Quarterly
c.    Every six months
d.    Other (specify)

12.    What areas of HME would you like more education on?
a.    Reimbursement
b.    New respiratory products
c.    Medical policy changes
d.    Other

Patient Insurance-related questions
13.    Is it okay for your patients to accept some financial responsibility for products or services not covered by their insurance?
a.    Yes
b.    No

14.    Do you understand the impact on a beneficiary once Medicares 36-month cap on oxygen reimbursement ends?
a.    Yes
b.    No

15.    What do you consider a fair price for an HME provider to charge an uninsured patient for supplemental oxygen?
a.    $0 month
b.    $25 month
c.    $50 month
d.    100 month
e.    $150 or more
f.    Other

HME Provider-related questions
16.    What would motivate you to switch to a different HME provider?
a.    Lengthy referral process
b.    Not responsive to patient complaints/needs/concerns
c.    Inability to provide certain modalities or brands
d.    Request too much documentation after referral is given
e.    Other (specify)

17.    Rank the following in order of importance when it comes to HMEs:
a.    Technology that enhances patient ambulation
b.    Disease state management programs designed to reduce hospital readmissions
c.    Responds quickly when a patient calls
d.    Brand of equipment
e.    Other (specify)

18.    What would make the referral process for home medical equipment easier and faster?
a.    Ability to have a "form" or have them accept our community discharge forms
b.    Electronic referral info (encrypted ) so we don't have staff spending a lot of time on phone or at a fax machine
c.    Providers (and prescriptions) would require the same information every time
d.    Other (specify)

19.    In order of priority, what are the three most important criteria you evaluate to select a new HME provider?
a.    Reliability/response time (reputation)
b.    Ability to provide a range of products and services
c.    Ability to bill insurances used by our patients
d.    Location
e.    Other (specify)

20.    How many HME providers do you currently refer patients to?
a.    1-2
b.    3-5
c.    More than 5

21.    How important is the sales representative in selecting an HME provider?
a.    Not important
b.    Important
c.    Very important

22.    How often would you like to see a sales rep?
a.    Weekly
b.    1-3 times a week
c.    Twice a month
d.    Monthly
e.    Quarterly

by: Mike Moran - Friday, June 4, 2010

Over the past week, we've written two stories on PECOS and a blog, and while I hate to beat a dead horse, this PECOS stuff is important. I also believe there is some misinformation circulating around out there as to whether or not HME providers should begin filing PECOS compliant claims by July 6, 2010. On Wednesday, HME News Managing Editor Theresa Flaherty emailed the following questions to Pete Ashkenaz, CMS's deputy director of media affairs.

Hi Pete: Sorry to keep bothering you, but we are are hearing now from other industry sources that CMS does not plan to reject claims until Jan. 2011 and that (PECOS) won't take effect until the final rule is published. Is there a way to get answers to any of these questions in layman's terms?

HME News: Does CMS expect DME providers to submit PECOS compliant claims on and after July 6?
CMS: Yes

HME News: What if providers submit non-compliant claims on or after July 6?
CMS: They will be in violation of the rules.

HME New: When does CMS expect to have the edit in place that will detect non-compliant PECOS claims?
CMS: That has not been finalized, (and will be) based on comments we receive on the (interim final rule).

HME News: Once this edit is in place, will CMS review claims retroactively?
CMS: That has not been finalized, (and will be) based on comments we receive on the (interim final rule).

HME News: Is it true that the interim final rule carries no weight? That is, until the final rule is in place, providers don't have to worry about submitting PECOS compliant claims?
CMS: An interim final rule is a final rule that is being enforced. The fact that the regulation is still open for comment means that we are encouraging comment on the rule that is already being enforced and may be tweaked based on public input.

You may not like it, but there it is, straight from the horse's mouth: CMS expects HME providers to begin submitting PECOS compliant claims by July 6.

Here are the links to the other articles we've written over the past week on PECOS:

PECOS update

CMS to Providers: No PECOS grace period

CMS's behavior on PECOS has been disgraceful

Mike Moran

by: Mike Moran - Thursday, June 3, 2010

When it comes to PECOS, the bureaucrats at CMS ought to be ashamed of themselves, especially Jim Bossenmeyer.

At last week's open door forum, two different listeners asked Bossenmeyer if home medical equipment providers had until Jan. 3, 2011 to begin submitting PECOS compliant claims. Most providers believed that to be the case, but on May 5, CMS published an interim final rule requiring physicians to become compliant with PECOS by almost six months to July 6, 2010. The rule created confusion.

Here's how Bossenmeyer answered the first question on this issue: The ordering referring report that we have on the Web site contains information, and we'll update it again probably in the middle of June. As physicians are enrolled, that information is updated in our system and shared nightly with our claims processing systems. So initially while the compliance date is July 6, you are correct that is the date that the DMEPOS suppler or home health agency is required to put the name and NPI of their individual who has ordered or referred the service. When we establish and implement the editing of process those claims will be rejected on the front end of the process. They will not be denied.

Huh? It sounded like Bossenmeyer had answered a different question. I was confused. So was the person who asked the question, which is why he asked the same question again to which Bossenmeyer issued a bureaucratic response as twisted and confusing as his first. Later on, a second listener asked for more clarification on the PECOS implementation date. Bossenmeyer again responded in regulatory gibberish.

He recited the same gooblygook when HME News called him this week, looking to clarity. Fortunately, we were able to whittle that interview down into a coherent article.

Maybe I'm just too literal. When someone asks a yes-or-no question, I expect a yes-or-no answer. By getting all technical, CMS is just adding confusion to an already confusing topic. When providers ask CMS for help, I expect CMS to help. To do otherwise is unacceptable and dereliction of duty.

Of course, after all the back and forth with CMS, we do have them on the record saying: "The interim final rule is effective until we publish a final version of the rule." I read that to mean (and I'm not the only one) that providers better make sure their claims are PECOS compliant on and after July 6—or until CMS tells you otherwise.

Mike Moran

by: Mike Moran - Friday, May 28, 2010

I've traveled more miles and talked face-to-face to more HME providers over the past three weeks than the previous four months of 2010 combined. First at Medtrade spring; then at the annual meeting of the Pennsylvania Association of Medical Equipment Suppliers (PAMS); and last week at the annual meeting of the New England Medical Equipment Dealers Association (NEMED), right here in my hometown of Portland, Maine.

It was a great few weeks. With the Memorial Day weekend staring us in the face, I'm not going to go on too long, but there is one thing I want to run past you.

I think pound-for-pound, when it comes to combining business smarts with clinical expertise, no healthcare provider does it better than a good HME. With all the reimbursement cuts the industry has endured over the years, what choice have providers had but to up their game?

Of course, I may be a tad naive on this point. When I brought this up during a dinner at Medtrade Spring, one of my dinner guests said that as an editor at HME News, I live in a kind of ivory tower. In reporting the news, he said, HME News editors talk to the best of the best. He estimated that there are far more poorly run HME companies than stellar performers.

That got me thinking. Maybe it's the 80-20 rule. Maybe 20% of HME providers are really good, and 80% are fair or worse.

My dinner companion was right on one point. When it comes to providers, HME News does talk to the best of the best, and we've developed these contacts by trial and error over the years. There's really no point in us talking to lousy providers. They generally don't have much to add when we're working on a story. If they have anything worth listening to, it's how not to run a business.

Whatever. All I know is that when it comes to HME providers, the best of the best are very good. On that point, I'm sticking to my guns.

Have a great Memorial Day weekend.

Mike Moran

by: Mike Moran - Monday, May 24, 2010

I saw something last week that I'd never seen in all my 13 years at HME News: a highway billboard advertising AdvaCare Home Services, an HME company in Bridgeville, Pa.

I spied the sign while driving from the Pittsburgh airport (I flew in from HME News' international headquarters in Yarmouth, Maine) to the annual meeting of the Pennsylvania Association of Medical Equipment Suppliers (PAMS). I can't remember exactly what the billboard said, but it was something like "Respiratory Therapists on duty 24/7." As I passed the billboard, I got a little bit excited (yes, I'm a nerd) and said out loud to my self, "Hey, that's cool. This must be HME Land."

In some ways, that little encounter sums up the challenges HME providers face during these days of increased regulatory oversight and decreased reimbursement: Adapt or watch your business dwindle away. That sounds a little bit simplistic, I know, but it's the truth and it was the overriding message that emerged from PAMS' annual meeting.

Providers need to strengthen their core competencies, diversify their payer and product mix, use technology to become more efficient, boost cash sales, reach customers through billboards and other marketing strategies.

MED Group CEO Bill Elliott said he expects the next five years to separate HME providers into two groups: winners and losers. The winners will adapt. The losers won't.

Here are a few more tidbits from the PAMS meeting:

* President Obama has given CMS marching orders to reduce improper claims so expect a major increase in Medicare audits. "As someone who has spent a large portion of his professional career in Washington, I have never seen a top-down message this strong," said attorney Mike Bell. "We are going to see more bounty hunters in the future."

* HME sales people must be persistent, said Susan McGinnis, corporate sales trainer for Philips Respironics, and here's why: Eighty percent of the all sales occur after the fifth closing attempt; 50% of sales people make only one call on a client; only 10% of sales people make more than five calls.

* Definition of a sale: A transfer of enthusiasm from the sales person to the customer.

* PAMS Executive Director John Shirvinsky on competitive bidding: "I have never seen a more anti-business program: a program designed to put the majority of an industry of out business."

* How can American HomePatient and Rotech be in such precarious financial health and still continue to operate? You got me, and PAMS speaker Don Davis, too. "Neither looks like it should make it to the next quarter," said Davis, who has a long background in corporate finance, "but they do."

Mike Moran

by: Mike Moran - Friday, May 21, 2010

I'm on the road again. Last week it was Medtrade Spring in Las Vegas; this week it's the Pennsylvania Association of Medical Equipment Suppliers (PAMS) at Seven Springs Mountain Resort in Seven Springs, Pa., about 90 minutes outside Pittsburgh. It's been a great meeting (in a beautiful setting), but more on that in the next day or two.

Right now I want to pass on some data we received this week from CMS. About a month ago, HME News used the Freedom of Information Act (FOIA) to request the "number of DMEPOS suppliers that were active as of January, February, March and April 2010."

This data supports industry reports that more and more providers who voluntarily gave up their supplier numbers last fall to get accredited have become accredited and are returning to the Medicare program. We suspected that was going to happen, but as you know, CMS dragged its feet reinstating providers. This data seems to support industry reports that the foot-dragging has ended. Why it ever occurred in the first place is beyond me, but that's CMS for you.

Without further ado, here's the data.

The number of active DMEPOS suppliers as of January 1, 2010:

Jurisdiction A: 20,368

Jurisdiction B: 19,907

Jurisdiction C: 35,754

Jurisdiction D: 21,135

Total: 97,164

The number of active DMEPOS suppliers as of as of April 1, 2010

Jurisdiction A: 20,596

Jurisdiction B: 20,313

Jurisdiction C: 36,139

Jurisdiction D: 21,654

Total: 98,675

Mike Moran

by: Mike Moran - Tuesday, May 18, 2010

I can't prove this beyond a doubt, but I believed the HME News crew traveled farther to Medtrade Spring in Las Vegas last week than anyone else—at least anyone in the continental United States.

If you look at a map, that appears to be the case, and according to Google (isn't everything according to Google these days?), the driving distance to Las Vegas from Portland, Maine is 2,860 miles. Fortunately, we did not have to drive, but the 6.5 hour flight, not including a painful three-hour layover, seemed to go on forever.

I've made this trip from Portland to Medtrade Spring each year for the past 13 years. Once we get to Vegas, the time difference is three hours. It takes me 2-3 days to adjust my internal clock  to Vegas time and then I leave and have to readjust all over again once I get home.

Anyways, after spending the weekend catching up on my sleep, I returned to the office Monday and reviewed some notes I jotted down at the show. Here are some things that struck me as being interesting for one reason or another.

1. Probably I don't have to tell you this, but it is worth repeating: The most important challenge facing the HME industry is competitive bidding. On the legislative front, nothing else really matters. For example, say the industry delays the first-month purchase option elimination, repeals the oxygen cap but does not eliminate competitive bidding. What has it really achieved? If you're a provider, this perspective should help prioritize your to-do list.

2. When it comes to success for HME providers, there's no golden goose, and if you spend too much time looking for one, you may find that your goose is cooked. "It's the little things that create efficiencies for providers," one exhibitor told me." That could be a new wheelchair design that cuts down the amount of time it takes a provider to fit a client. Or maybe it is a simplified form of some kind. Lots of little incremental improvements across all phases of a company's business add up to big savings. Reminds me of the old adage: Take care of your nickels and dimes, and the dollars will take care of themselves.

3. If the first-month purchase option for power wheelchairs is eliminated at the end of this year as scheduled, products must have bullet-proof reliability. CMS won't reimburse providers for repairs made during the rental period. So the more repairs you make, the less you make.

4.  Here are some fun facts, courtesy of Cy Corgan, Pride Mobility's national sale director for retail mobility: 1. One square foot of HME retail space generates $1,200 a year in sales; 2. Baby boomers have $1.1 trillion in buying power; 3. Cash sales in the HME industry are increasing 8% to 10% a year. If you're a provider and those numbers don't convince you to seriously consider retail sales, what do you know that the rest of us don't?

Mike Moran

by: Mike Moran - Monday, May 17, 2010

I spent four days in Las Vegas last week attending Medtrade Spring. The show was great, lots of energy, one of the best in years--the town, not so much. Poor Las Vegas. Something is broken. People are dancing but there's no music. The city has lost its mojo.

Here's some stuff about Vegas' current depression that I picked up from various sources, including the 10 or so cab drivers who shuttled me around

- The unemployment rate is about 13%--second only to Michigan.

- A house that sold for $400,000 four years ago is today lucky to fetch $130,000.

- Despite the drop in home values, there's a home building frenzy going on in Vegas. Most people willing pay $130,000 for a home, it seems, prefer new to used. Something weird and wasteful about that.

- The flagging economy and tumbling home values has created a whole new class of adult escort: desperate housewives trying to pick up some extra cash to pay the mortages on those $400,000 homes that today are worth only $130,000. So said the cabbie who drove me to the airport at 4:45 a.m. Friday morning.

- For $37.50, a person could could eat at seven buffets in a single day. What kind of person would want to do that?

- Restaurants are still expensive, but hotel rooms are dirt cheep. My bill for three nights at the Flamingo: $282. An industry acquaintance told me he stayed at a more upscale establishment for $69 a night. Hotels are dropping their prices dramatically/desperately to entice people to visit Vegas.

Tomorrow, I'll talk more specifically about Medtade Spring, where the mood inside the show was much different from that outside on the street. Even with the ax of national competitive bidding poised over the industry's outstretched neck, the show offered plenty of reasons to feel, if not completely optimistic, at least hopeful.

Mike Moran

by: Mike Moran - Wednesday, May 5, 2010

I had an interesting talk recently with Lou Kaufman, vice president of patient/clinical services for Roberts Home Medical, a two-time HME Excellence Award winner in the home respiratory category. We were talking about the importance of titrating home oxygen patients to make sure their conserving devices deliver the appropriate amount of oxygen.

Amazingly, I'm told, even in this day and age, some providers still believe that a two, or three or whatever setting on one conserver equals the same setting on a different brand conserver. Some even think that's the case with concentrators and conservers.

Not so, and providers who don't titrate their oxygen patients risk having them desaturate and end up back in the hospital. Given that, I asked Kaufman how Roberts sets up a patient on oxygen. Here's what he said:

"We follow clinical practice guidelines. We get an order for a specific continuous flow--sometimes it is different with exertion--and we get an order from the physician to titrate the conserving device. The therapist meets with the patient and evaluates their oxygen saturation at rest and with exertion on the prescribed continuous flow. He then puts them on a conserver at rest and exertion. He looks at the oxygen saturation, not the setting on the device, and comes up with the necessary setting.

"Two years ago, we looked at 100 different patients and about 75% ended up with the same setting on the conserver as they had with continuous flow; 25% had a different setting, either higher or lower at rest and exertion. That's why we titrate."

For more on this issue, check out this story that ran in the May issue of HME News.

Mike Moran

by: Mike Moran - Friday, April 30, 2010

We  received two big pieces of news this morning: Invacare CEO Mal Mixon has suffered a mild stroke; and American HomePatient plans to restructure its debt and go private.

In a press release issued this morning, Mal stated the following: "I have suffered a mild stroke, but fortunately, my condition is stable and my doctors have told me the prognosis for a full recovery is favorable. I look forward to returning to Invacare soon to full duty."

Mal is an icon and has worked tirelessly on behalf of the industry. We send our best wishes to him for a speedy recovery.

American HomePatient

The AHP news while big, really comes as no surprise. We've followed AHP's trials and tribulations for ages. In fact, for about as long as I can remember, the national provider has labored under tremendous debt and tottered on the brink of bankruptcy. In fact, AHP stated that if this latest effort to reorganize its finances fails, it may have to file for Chapter 11.

For the company's explanation on this new development, click here.

Mike Moran